The Importance of Early Surgical Decompression for Acute Traumatic Spinal Cord Injury.
The Importance of Early Surgical Decompression for Acute Traumatic Spinal Cord Injury.
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DOI：
10.4055/cios.2018.10.4.448
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发表时间：
2018-12
影响因子：
2.5
通讯作者：
Kim DH
中科院分区：
文献类型：
--
作者：
Lee DY;Park YJ;Song SY;Hwang SC;Kim KT;Kim DH
创伤性脊髓损伤(SCI)是一起对个人和社会以及医疗保健系统产生重大影响的悲惨事件。这项研究的目的是调查手术治疗时机和神经功能改善之间的关联强度。本研究纳入56例创伤性脊髓损伤致神经功能损害的患者。从2013年1月到2017年6月，对他们的所有医疗记录进行了审查。最初，为了确定影响急性脊髓损伤后神经功能恢复的因素，我们对各种变量进行了单变量Logistic回归分析。然后，我们对单变量分析中p值为0.2的变量进行了多变量Logistic回归分析。采用Hosmer-Lemesow检验确定多元Logistic回归模型的拟合优度。在不同因素与神经功能改善之间关联强度的单变量分析中，以下因素的p值为0.2：手术时机(早期8小时；晚期8-24小时；p=0.033)，脊髓损伤的完整性(完全/不完全；p=0.033)，以及吸烟(p=0.095)。在多变量分析中，只有两个变量有意义：手术时机(优势比[OR]，0.128；p=0.004)和脊髓损伤的完整性(OR，9.611；p=0.009)。创伤性脊髓损伤后8小时内早期手术减压可促进神经功能恢复。此外，不完全性脊髓损伤与神经功能改善的关系比完全性脊髓损伤更密切。因此，我们建议早期减压是治疗创伤性脊髓损伤的有效方法。
Traumatic spinal cord injury (SCI) is a tragic event that has a major impact on individuals and society as well as the healthcare system. The purpose of this study was to investigate the strength of association between surgical treatment timing and neurological improvement. Fifty-six patients with neurological impairment due to traumatic SCI were included in this study. From January 2013 to June 2017, all their medical records were reviewed. Initially, to identify the factors affecting the recovery of neurological deficit after an acute SCI, we performed univariate logistic regression analyses for various variables. Then, we performed a multivariate logistic regression analysis for variables that showed a p-value of < 0.2 in the univariate analyses. The Hosmer-Lemeshow test was used to determine the goodness of fit for the multivariate logistic regression model. In the univariate analysis on the strength of associations between various factors and neurological improvement, the following factors had a p-value of < 0.2: surgical timing (early, < 8 hours; late, 8–24 hours; p = 0.033), completeness of SCI (complete/incomplete; p = 0.033), and smoking (p = 0.095). In the multivariate analysis, only two variables were significant: surgical timing (odds ratio [OR], 0.128; p = 0.004) and completeness of SCI (OR, 9.611; p = 0.009). Early surgical decompression within 8 hours after traumatic SCI appeared to improve neurological recovery. Furthermore, incomplete SCI was more closely related to favorable neurological improvement than complete SCI. Therefore, we recommend early decompression as an effective treatment for traumatic SCI.