Late neurologic recovery after traumatic spinal cord injury
Late neurologic recovery after traumatic spinal cord injury
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DOI：
10.1016/j.apmr.2004.03.015
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发表时间：
2004-11-01
影响因子：
4.3
通讯作者：
Tulsky, D
中科院分区：
文献类型：
--
作者：
Kirshblum, S;Millis, S;Tulsky, D
目的：介绍模型脊髓损伤系统（MSCIS）在脊髓损伤（SCI） 1年后晚期神经功能恢复的数据。设计：通过损伤后1年和5年的年度评估确定神经系统状态的纵向研究。背景：MSCIS中心向国家脊髓损伤统计中心数据库提供创伤性脊髓损伤患者的数据。参与者：1988年至1997年间在MSCIS接受1年和5年随访检查的创伤性脊髓损伤患者（N=987）。干预措施：不适用。主要结果测量：美国脊髓损伤协会（ASIA）损伤量表（AIS）分类、运动指数评分（MIS）、运动水平和神经损伤水平（NLI），测量并比较随时间的变化。结果：大多数（94.4%）在1年时神经功能完全损伤的受试者在伤后5年仍保持完整，其中3.5%改善到AIS B级，分别高达1.05%改善到AIS C级和d级。MIS的变化具有统计学意义。运动水平和NLI在4年内无明显变化；然而，大约20%的受试者的运动水平和NLI得到改善，完全损伤和不完全损伤的人在运动水平上有相似的改善，但不完全损伤的受试者在NLI和MIS方面有更大的改善机会。结论：外伤性脊髓损伤后神经系统有一定程度的恢复（损伤后1 ~ 5y）。5.6%的病例发生了1 - 5年从神经完全性损伤到不完全性损伤的晚期转化，但这一比例仅为2%。有1%是从电机完成到电机不完全状态的转换。本研究的局限性包括研究期间亚洲分类的变化，以及亚洲标准纵向研究中典型的内部和内部可靠性的变化。未研究功能变化。对后期恢复程度的了解可能有助于分析新的干预措施以提高恢复。
Objective: To present Model Spinal Cord Injury System (MSCIS) data on late neurologic recovery after 1 year after spinal cord injury (SCI). Design: Longitudinal study of neurologic status as determined by annual evaluations at 1 and 5 years postinjury.Setting: MSCIS centers contributing data on people with traumatic SCI to the National Spinal Cord Injury Statistical Center database.Participants: People with traumatic SCI (N=987) admitted to an MSCIS between 1988 and 1997 with 1- and 5-year follow-up examinations.Interventions: Not applicable.Main Outcome Measures: American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, motor index scores (MIS), motor level, and neurologic level of injury (NLI), measured and compared for changes over time.Results: The majority of subjects (94.4%) who had a neurologically complete injury at 1 year remained complete at 5 years postinjury, with 3.5% improving to AIS grade B, and up to 1.05% each improving to AIS grades C and D. There was a statistically significant change noted for MIS. There were no significant changes for the motor level and NLI over 4 years; however, approximately 20% of subjects improved their motor level and NLI People with complete and incomplete injuries had similar improvements in motor level, but subjects with an incomplete injury had a greater chance of improvement in NLI and MIS.Conclusions: There was a small degree of neurologic recovery (between 1 and 5y postinjury) after a traumatic SCI. Late conversion, between 1 and 5 years, from a neurologically complete to an incomplete injury occurred in 5.6% of cases, but in only up to 2. 1 % was there a conversion from motor complete to motor incomplete status. Limitations of this study included changes in the ASIA classification during the study and in the intra- and interrater reliability typically seen in longitudinal studies of the ASIA standards. Functional changes were not studied. Knowledge of the degree of late recovery may help in analyzing newer interventions to enhance recovery.