脊髓损伤的解剖层次对脊髓创伤神经损伤严重程度的影响

O. Nekhlopochyn, A. N. Nikiforova, V. Verbov, T. A. Yovenko, I. Cheshuk
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摘要

背景。创伤性脊髓损伤是一个重大的医学和社会问题。尽管进行了大量研究,但在减少此类患者神经系统后果方面仍未取得实质性成功,有几个方面仍未得到充分研究,特别是脊髓对不同解剖层次损伤的反应。本研究旨在利用最大的公开脊髓外伤患者数据库,分析损伤的解剖层次、患者性别和损伤机制对脊髓外伤急性期功能障碍模式的影响。材料和方法对国家脊髓损伤模型系统数据库(2021 ARPublic 版)的数据进行了统计分析。该数据库包括 21,343 个病例,其中包含性别、受伤时的年龄、受伤情况、住院时的神经紊乱程度以及外伤的解剖层次(精确到脊髓节段)等信息。结果数据分析显示,根据美国脊髓损伤协会的量表,脊髓损伤的解剖层次不同,功能等级的分布模式也存在明显差异。在颈椎区域,A、B、C 和 D 级的频率分布如下:胸椎区--70.97%(95% CI:69.94-71.97%)、10.27%(95% CI:9.60-10.97%)、9.92%(95% CI:9.26-10.61%)和 8.85%(95% CI:8.23-9.51%),腰椎区为 21.29%(95% CI:19.57-23.12%)、15.87%(95% CI:14.35-17.52%)、24.43%(95% CI:22.62-26.34%)和 38.40%(95% CI:36.32-40.52%)。结论神经功能损伤的功能等级分布模式在很大程度上取决于脊髓损伤的解剖层次。胸段损伤的临床症状最为严重,而腰段损伤的症状最轻。患者的性别在统计学上没有显著影响,而受伤情况与颈椎段神经损伤的频率相关,对腰椎段的这一指标没有影响。
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Influence of the anatomical level of spinal cord injury on the severity of neurological impairments in spinal cord trauma
Background. Traumatic spinal cord injury is a significant medical and social issue. Despite numerous studies, substantial success in reducing neurological consequences in such patients has not yet been achieved, and several aspects remain understudied, particularly the response of the spinal cord to injury at different anatomical levels. The purpose is to analyze the influence of the anatomical level of injury, the patient’s gender, and the mechanism of injury on the pattern of functional disorders in the acute period of spinal cord trauma using the largest publicly available database of patients with traumatic spinal cord injuries. Materials and methods. A statistical analysis of data from the National Spinal Cord Injury Model Systems Database (version 2021 ARPublic) was conducted. It included 21,343 cases containing information on gender, age at the time of injury, circumstances of injury, the degree of neurological disorders at hospitalization, and the anatomical level of traumatic injury (with precision down to the spinal cord segment). Results. The data analysis revealed significant differences in the pattern of distribution of functional classes according to the American Spinal Injury Association scale depending on the anatomical level of spinal cord injury. For the cervical region, the distribution of frequencies for A, B, C, and D classes was as follows: 43.06 % (95% confidence interval (CI): 42.15–43.97 %), 14.99 % (95% CI: 14.35–15.66 %), 16.17 % (95% CI: 15.50–16.86 %) and 25.78 % (95% CI: 24.98–26.59 %), respectively, for the thoracic region — 70.97 % (95% CI: 69.94–71.97 %), 10.27 % (95% CI: 9.60–10.97 %), 9.92 % (95% CI: 9.26–10.61 %) and 8.85 % (95% CI: 8.23–9.51 %), for the lumbar region — 21.29 % (95% CI: 19.57–23.12 %), 15.87 % (95% CI: 14.35–17.52 %), 24.43 % (95% CI: 22.62–26.34 %) and 38.40 % (95% CI: 36.32–40.52 %). Conclusions. The pattern of distribution of functional classes of neurological impairments significantly depends on the anatomical level of spinal cord injury. Thoracic segment injuries are characterized by the most clinically severe symptoms, whereas lumbar segment injuries are the least severe. The patient’s gender does not have a statistically significant influence, while the circumstances of the injury correlate with the frequency of neurological impairments in cervical segments and do not affect this indicator in the lumbar region.
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