Neurological and functional recovery after thoracic spinal cord injury
Neurological and functional recovery after thoracic spinal cord injury
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DOI：
10.1179/2045772314y.0000000280
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发表时间：
2016-01-01
影响因子：
1.7
通讯作者：
Marino, Ralph J.
中科院分区：
文献类型：
--
作者：
Lee, Brian A.;Leiby, Benjamin E.;Marino, Ralph J.
目的：描述创伤性截瘫后的神经和功能结果。设计：纵向数据库的回顾性分析。设置：脊髓损伤模型系统。参与者：脊髓损伤模型系统数据库中登记的 661 名受试者，在 2000 年至 2011 年间受伤，初始神经损伤水平为 T2-12。 265 名受试者进行了第二次神经系统检查，400 名受试者在受伤后 6 个月以上具有功能独立测量 (FIM) 评分。结果测量：美国脊柱损伤协会损伤量表 (AIS) 等级、感觉水平 (SL)、下肢运动评分 (LEMS) 和 FIM。结果：基线时，73% 的受试者为 AIS A，其中 15.5% 转为 AIS A电机不完整。 AIS A 等级受试者的平均 SL 增加为 0.33 +/- 0.21； 86% 保持在两个基线水平之内。低位胸椎截瘫 (T10-12) 受试者比高位截瘫 (T2-9) 表现出更大的 LEMS 增益，并且还具有更高的 1 年 FIM 评分，这一点在早期报告中并未提及。更好的 FIM 分数也与更好的 AIS 等级、更年轻的年龄和 AIS 等级的提高相关。 1 岁时行走能力与胸部损伤较低、初始 LEMS 较高、不完全损伤和 AIS 等级升高相关。结论：完全性胸部 SCI 患者的神经功能恢复很少，尤其是 T10 以上水平的患者。受伤时年龄较大的人比年轻人的功能恢复较差。转为更好的 AIS 等级与一年后自我护理和行动能力的改善相关。
Objective: To describe neurological and functional outcomes after traumatic paraplegia.Design: Retrospective analysis of longitudinal database.Setting: Spinal Cord Injury Model Systems.Participants: Six hundred sixty-one subjects enrolled in the Spinal Cord Injury Model Systems database, injured between 2000 and 2011, with initial neurological level of injury from T2-12. Two hundred sixty-five subjects had second neurological exams and 400 subjects had Functional Independence Measure (FIM) scores >= 6 months after injury.Outcome Measures: American Spinal Injury Association Impairment Scale (AIS) grade, sensory level (SL), lower extremity motor scores (LEMS), and FIM.Results: At baseline, 73% of subjects were AIS A, and among them, 15.5% converted to motor incomplete. The mean SL increase for subjects with an AIS A grade was 0.33 +/- 0.21; 86% remained within two levels of baseline. Subjects with low thoracic paraplegia (T10-12) demonstrated greater LEMS gain than high paraplegia (T2-9), and also had higher 1-year FIM scores, which had not been noted in earlier reports. Better FIM scores were also correlated with better AIS grades, younger age and increase in AIS grade. Ability to walk at 1 year was associated with low thoracic injury, higher initial LEMS, incomplete injury and increase in AIS grade.Conclusion: Little neurological recovery is seen in persons with complete thoracic SCI, especially with levels above T10. Persons who are older at the time of injury have poorer functional recovery than younger persons. Conversion to a better AIS grade is associated with improvement in self-care and mobility at 1 year.