Functional outcome following spinal cord injury: Significance of motor-evoked potentials and ASIA scores
Functional outcome following spinal cord injury: Significance of motor-evoked potentials and ASIA scores
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DOI：
10.1016/s0003-9993(98)90213-1
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发表时间：
1998-01-01
影响因子：
4.3
通讯作者：
Dietz, V
中科院分区：
文献类型：
--
作者：
Curt, A;Keck, ME;Dietz, V
目的：根据美国脊髓损伤协会 (ASIA) 协议和运动诱发电位 (MEP)，使用神经学检查预测脊髓损伤 (SCI) 四肢瘫痪患者的行走能力和手功能结果。设计：前瞻性队列相关研究。地点：SCI 中心、大学医院。患者：36 名急性 SCI 患者和 34 名慢性 SCI 患者。结果测量：(1) ASIA 运动和感觉评分，(2) 上肢和下肢肌肉的 MEP 记录，以及 (3) 走动能力和手功能结果。 结果：在急性和慢性 SCI 中，初始 ASIA 评分和 MEP 记录均与走动能力和手功能结果显着相关 (p < .0001)。在四肢瘫痪患者中，小指展肌的 MEP（Spearman 相关系数，0.75；p < .0001）和上肢 ASIA 运动评分（Spearman 相关系数，0.83；p < .0001）与手功能结果最相关。行走能力可以通过下肢的 ASIA 运动评分（Spearman 相关系数，0.78：p < .0001）和腿部肌肉的 MEP 记录（Spearman 相关系数，0.77；p < .0001）来预测。在急性 SCI 患者中，创伤后 6 个月内，ASIA 运动评分显着增加 (ANOVA, p < .05)，而 ASIA 感觉评分和 MEP 记录则没有变化 (ANOVA, p > 0.1)。结论：ASIA 评分和 MEP 记录与 SCI 患者的行走能力和手功能结果具有相似的相关性。 MEP 记录对于不合作或不理解患者的临床检查具有附加价值。临床检查和 MEP 记录的结合可以区分运动功能（手功能、走动能力）的恢复和下行运动束冲动传递的恢复。 (C) 1998 年由美国康复医学大会和美国物理医学与康复学会颁发。
Objective: Prediction of outcome of ambulatory capacity and hand function in tetraplegic patients with spinal cord injury (SCI) using neurologic examination, according to the protocol of the American Spinal Injury Association (ASIA) and motor-evoked potentials (MEP).Design: Correlation study on a prospective cohort.Setting: SCI center, university hospital.Patients: Thirty-six patients with acute and 34 with chronic SCI.Outcome Measures: (1) ASIA motor and sensory scores, (2) MEP recordings of upper and lower limb muscles, and (3) outcome of ambulatory capacity and hand function.Results: In acute and chronic SCI, both the initial ASIA scores and the MEP recordings were significantly related (p < .0001) to the outcome of ambulatory capacity and hand function. In tetraplegic patients, the MEP of the abductor digiti minimi muscle (Spearman correlation coefficient, .75; p < .0001) and the ASIA motor score for the upper limbs (Spearman correlation coefficient, .83; p < .0001) were most related to the outcome of hand function. Ambulatory capacity could be predicted by the ASIA motor score of the lower limbs (Spearman correlation coefficient, .78: p < .0001) and by MEP recordings of the leg muscles (Spearman correlation coefficient, .77; p < .0001). In patients with acute SCI, for the period 6 months posttrauma, the ASIA motor score increased significantly (ANOVA, p < .05), whereas the ASIA sensory scores and MEP recordings were unchanged (ANOVA, p > 0.1).Conclusion: Both ASIA scores and MEP recordings are similarly related to the outcome of ambulatory capacity and hand function in patients with SCI. MEP recordings are of additional value to the clinical examination in uncooperative or incomprehensive patients, The combination of clinical examination and MEP recordings allows differentiation between the recovery of motor function (hand function, ambulatory capacity) and that of impulse transmission of descending motor tracts. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.