颈椎创伤合并脊髓损伤手术治疗的预后和影响因素

摘要

Objective Observation and analysis of influencing factors of spinal cord injury, provides references for the clinical treatment. Methods 237 patients of in our hospital in last 10 years of with cervical trauma complicated with spinal cord injury were collected, multiple factor correlation analysis was used to analyze the prognosis through the age, sex, cause of injury, the time of referral, operation start time, the injury site (section), complications, spinal canal encroachment rate, hormone applicationuse of hormones within the 8h, prehospital cervical support, preoperative traction, and the operation mode of this injury prognosis. Results By single factor analysis of 12 factors influenced, the referral time, preoperative history of injury, operation start time, spinal canal encroachment rate and hormone application within 8h, pre hospital neck support, whether preoperative traction (P≤0.1), the other factors had poor correlation with the prognosis of the patients:age (P=0.203), gender (P=0.982), the damage stage (P=0.774), operation mode(P=0. 189). The influencing factors on screening of multiple factor Logistic regression analysis found that referral time, operation start time, spinal canal encroachment rate and hormone use application within 8h were cClosely related to the prognosis (P<0.05). Conclusion The main factors that influence the prognosis of patients with cervical spine trauma complicated with spinal cord injury were: the referral time, operation start time, spinal canal encroachment rate and hormone application within 8h. Fast and effective pre-hospital aid, the appropriate operation time, timely decompression of the spinal cord and the early application of hormone could effectively improve the prognosis of cervical vertebra trauma complicated with spinal cord injury.%目的 观察分析颈椎创伤合并脊髓损伤手术治疗的预后和影响因素,为临床治疗该类疾病提供参考. 方法 收集本院10年来颈椎创伤合并脊髓损伤的患者237例,采用多因素相关分析研究年龄、性别、致伤原因、送诊时间、手术开始时间、损伤部位(节段)、有无合并伤、椎管侵占率、8小时内激素使用与否、院前颈托使用与否、术前牵引与否、以及手术方式此类损伤预后的影响. 结果 对12项影响因素进行单因素分析,可见送诊时间、术前伤史、手术开始时间、椎管侵占率和8小时内激素应用、院前颈托使用、术前是否牵引与否等因素P≤0.1,其余项目与患者预后的相关性较差:年龄(P=0.203),性别(P=0.982),损伤阶段(P=0.774),手术方式(P=0.189).将初筛的影响因素进行多因素Logistic回归分析发现送诊时间、手术开始时间、椎管侵占率和8小时内激素使用与否对患者预后的影响最大,差异显著(P<0.05). 结论 影响颈椎创伤合并脊髓损伤患者预后的主要影响因素包括:送诊时间、手术开始时间、椎管侵占率和8h内激素使用与否.可见快速有效的院前急救、合适的手术时机、及时解除脊髓压迫和早期应用激素可以有效改善颈椎创伤合并脊髓损伤的预后.