中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2011年
8期
673-678
,共6页
张宏其%盛斌%黄术%邓盎%王昱翔%吴建煌%刘金洋%葛磊%陈静%王锡阳
張宏其%盛斌%黃術%鄧盎%王昱翔%吳建煌%劉金洋%葛磊%陳靜%王錫暘
장굉기%성빈%황술%산앙%왕욱상%오건황%류금양%갈뢰%진정%왕석양
脊髓损伤%危险因素%外科手术
脊髓損傷%危險因素%外科手術
척수손상%위험인소%외과수술
Spinal cord injury%Risk factor%Surgical procedures,operative
目的 分析颈、胸椎手术中可能导致医源性脊髓损伤(iatrogenic spinal cord injury，ISCI)的危险因素，为减少手术中脊髓损伤提供理论依据。方法 回顾性调查2002年1月-2009年1月行颈、胸椎(C1～ T12)手术患者120例，按随机数字表法分为损伤组（34例）和对照组（86例），对两组临床因素、影像学因素、手术和病理因素及可能的保护因素等共30个变量进行单因素分析，对差异有统计学意义的指标进行多因素非条件Logistic回归分析。结果 两组单因素比较显示，合并高血压、合并糖尿病、术前美国脊髓协会( ASIA)损伤分级、椎管狭窄率、脊髓／有效椎管面积比值、脊髓MRI T2W1高信号、术中出血量、椎管内突出物与硬膜粘连及术中使用甲基强的松龙( methylprednisolone，MP)等9个变量差异有统计学意义(P＜0.05)。Logistic回归分析显示合并糖尿病、术前ASIA损伤分级、脊髓／有效椎管面积比值、脊髓MRI T2W1高信号、术中出血量与ISCI呈正相关，术中使用MP与ISCI呈负相关。结论 合并糖尿病、ASIA损伤分级、脊髓MRI T2W1高信号、脊髓／有效椎管面积比值、术中出血量为ISCI的危险因素，术中使用MP对ISCI的发生有预防作用。
目的 分析頸、胸椎手術中可能導緻醫源性脊髓損傷(iatrogenic spinal cord injury，ISCI)的危險因素，為減少手術中脊髓損傷提供理論依據。方法 迴顧性調查2002年1月-2009年1月行頸、胸椎(C1～ T12)手術患者120例，按隨機數字錶法分為損傷組（34例）和對照組（86例），對兩組臨床因素、影像學因素、手術和病理因素及可能的保護因素等共30箇變量進行單因素分析，對差異有統計學意義的指標進行多因素非條件Logistic迴歸分析。結果 兩組單因素比較顯示，閤併高血壓、閤併糖尿病、術前美國脊髓協會( ASIA)損傷分級、椎管狹窄率、脊髓／有效椎管麵積比值、脊髓MRI T2W1高信號、術中齣血量、椎管內突齣物與硬膜粘連及術中使用甲基彊的鬆龍( methylprednisolone，MP)等9箇變量差異有統計學意義(P＜0.05)。Logistic迴歸分析顯示閤併糖尿病、術前ASIA損傷分級、脊髓／有效椎管麵積比值、脊髓MRI T2W1高信號、術中齣血量與ISCI呈正相關，術中使用MP與ISCI呈負相關。結論 閤併糖尿病、ASIA損傷分級、脊髓MRI T2W1高信號、脊髓／有效椎管麵積比值、術中齣血量為ISCI的危險因素，術中使用MP對ISCI的髮生有預防作用。
목적 분석경、흉추수술중가능도치의원성척수손상(iatrogenic spinal cord injury，ISCI)적위험인소，위감소수술중척수손상제공이론의거。방법 회고성조사2002년1월-2009년1월행경、흉추(C1～ T12)수술환자120례，안수궤수자표법분위손상조（34례）화대조조（86례），대량조림상인소、영상학인소、수술화병리인소급가능적보호인소등공30개변량진행단인소분석，대차이유통계학의의적지표진행다인소비조건Logistic회귀분석。결과 량조단인소비교현시，합병고혈압、합병당뇨병、술전미국척수협회( ASIA)손상분급、추관협착솔、척수／유효추관면적비치、척수MRI T2W1고신호、술중출혈량、추관내돌출물여경막점련급술중사용갑기강적송룡( methylprednisolone，MP)등9개변량차이유통계학의의(P＜0.05)。Logistic회귀분석현시합병당뇨병、술전ASIA손상분급、척수／유효추관면적비치、척수MRI T2W1고신호、술중출혈량여ISCI정정상관，술중사용MP여ISCI정부상관。결론 합병당뇨병、ASIA손상분급、척수MRI T2W1고신호、척수／유효추관면적비치、술중출혈량위ISCI적위험인소，술중사용MP대ISCI적발생유예방작용。
Objective To find out the risk factors causing iatrogenic spinal cord injury (ISCI) so as to provide theoretical support for reducing the spinal cord injury during spinal operation. Methods A retrospective study was done on 120 patients undergone cervical or thoracic spinal( C1-T12 ) surgery at Xiangya Hospital of Central South University from January 2002 to January 2009. The patients were randomly divided into injury group (n = 34) and control group (n = 86) and the univariate analysis was used to analyze 30 factors including clinical factors, iconography factors, operation and pathology factors as well as possible protective factors. Then, the factors with statistical difference were analyzed by using the multi-factor unconditioned Logistic analysis.Results The univariate comparison between the two groups showed statistical difference ( P ＜ 0. 05 ) in nine factors including combined hypertension, combined diabetes mellitus, preoperative ASIA grade, spinal canal stenosis rate, ratio of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2WI high signal, bleeding amount during operation, intraspinal prominence adhesion to dura mate of spinal cord as well as intraoperative use of methylprednisolone. The multi-factor Logistic regression analysis revealed that ASIA grade, value of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2W1 high signal and bleeding amount in operation had positive correlation with ISCI. Use of methylprednisolone during operation had negative correlation with ISCI. Conclusions Combined diabetes mellitus, ASIA grade, spinal cord MRI T2W1 high signal, ratio of spinal cord/vertebral canal area and bleeding amount in operation are the risk factors for ISCI. Use of large dose methylprednisolone exerts preventive effect on ISCI.
