Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prog...Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) =-25.4545 + 21.2576 VALUE + 1.2160SCORE-3.4224 TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score(0–17) after the operation, and TIME refers to the disease duration(from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941(95% confidence interval, 0.7930–0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥-2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University, China(approval number: 2018063) on May 8, 2018.展开更多
目的比较3种固定方式在颈后路单开门椎管扩大术治疗多节段颈椎管狭窄症中的应用特点及临床疗效。方法将44例手术患者按固定方式分为三组:A组微型钢板固定11例,B组带线锚钉固定15例,C组普通螺钉固定18例,记录三组患者手术时间、术中出血...目的比较3种固定方式在颈后路单开门椎管扩大术治疗多节段颈椎管狭窄症中的应用特点及临床疗效。方法将44例手术患者按固定方式分为三组:A组微型钢板固定11例,B组带线锚钉固定15例,C组普通螺钉固定18例,记录三组患者手术时间、术中出血量、住院时间、治疗费用、JOA评分、颈椎管横截面积、颈椎活动度(range of motion,ROM)、颈椎曲率指数(cervical curvature index,CCI)及手术并发症情况。并评价术后3年时神经功能改善率。结果A组手术时间、术中出血量及治疗费用均显著多于B、C组,住院时间显著短于B、C组(P<0.001);B组的治疗费用显著多于C组(P<0.001)。术后3年,A组JOA评分、颈椎管横截面积均显著大于B、C组(P<0.05),B组和C组之间差异无统计学意义(P>0.05)。术后3年,A组颈椎ROM和CCI均显著大于B、C组(P<0.001),B组和C组之间差异无统计学意义(P>0.05)。并发症方面,A组术后发热1例,B组术后脑脊液漏2例,C组术中硬脊膜撕裂1例,术后C5神经根麻痹1例。结论3种固定方式治疗多节段颈椎管狭窄症均可取得满意疗效,其中普通螺钉手术操作简单、治疗费用低,微型钢板固定更牢固、疗效更佳,但操作费时、创伤大、费用高。展开更多
基金supported by the National Natural Science Foundation of China,No.30672136(to HPL)
文摘Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) =-25.4545 + 21.2576 VALUE + 1.2160SCORE-3.4224 TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score(0–17) after the operation, and TIME refers to the disease duration(from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941(95% confidence interval, 0.7930–0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥-2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi'an Jiaotong University, China(approval number: 2018063) on May 8, 2018.
文摘目的比较3种固定方式在颈后路单开门椎管扩大术治疗多节段颈椎管狭窄症中的应用特点及临床疗效。方法将44例手术患者按固定方式分为三组:A组微型钢板固定11例,B组带线锚钉固定15例,C组普通螺钉固定18例,记录三组患者手术时间、术中出血量、住院时间、治疗费用、JOA评分、颈椎管横截面积、颈椎活动度(range of motion,ROM)、颈椎曲率指数(cervical curvature index,CCI)及手术并发症情况。并评价术后3年时神经功能改善率。结果A组手术时间、术中出血量及治疗费用均显著多于B、C组,住院时间显著短于B、C组(P<0.001);B组的治疗费用显著多于C组(P<0.001)。术后3年,A组JOA评分、颈椎管横截面积均显著大于B、C组(P<0.05),B组和C组之间差异无统计学意义(P>0.05)。术后3年,A组颈椎ROM和CCI均显著大于B、C组(P<0.001),B组和C组之间差异无统计学意义(P>0.05)。并发症方面,A组术后发热1例,B组术后脑脊液漏2例,C组术中硬脊膜撕裂1例,术后C5神经根麻痹1例。结论3种固定方式治疗多节段颈椎管狭窄症均可取得满意疗效,其中普通螺钉手术操作简单、治疗费用低,微型钢板固定更牢固、疗效更佳,但操作费时、创伤大、费用高。
