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目的：探讨创伤性脊髓中央损伤综合征（TCCS）患者伤情和预后的影响因素。方法：纳入2013—2022年中国康复研究中心北京博爱医院收治的颈脊髓损伤（CSCI）患者中符合TCCS诊断标准者191例。收集患者的年龄、性别、受伤时间、住院康复时间、致伤原因、颈椎退行性变类型、髓内高信号（IMHS）特征、手术方式、神经损伤平面（NLI）、运动评分（MS）、感觉评分（SS）、美国脊髓损伤协会残损分级（AIS）和改良日本骨科协会（mJOA）颈椎病评分。采用多因素回归分析，研究各变量对TCCS患者伤情和预后的影响。结果：TCCS的主要致伤原因是跌倒，主要病理基础是多节段颈椎间盘突出。C3～5节段损伤和AIS D级患者占比较高。多因素logistic回归分析显示：TCCS患者伤情的危险因素包括高NLI(OR=2.75)、IMHS长度（5～<10 mm,OR=2.50；≥10 mm,OR=8.83）和IMHS宽度（OR=1.76）。TCCS患者预后的保护因素为住院康复时间（60～<90 d,OR=0.53；≥90 d,OR=0.31）；危险因素为高NLI(OR=3.17)、IMHS长度（5～<10 mm,OR=2.62；≥10 mm,OR=3.21）、后纵韧带骨化（OR=3.85）、多节段颈椎间盘突出（OR=3.14）和颈椎管狭窄（OR=2.92）。结论：TCCS患者中NLI越高，IMHS长度越长、宽度越大提示病情越重；NLI越高、IMHS长度越长、后纵韧带骨化、多节段颈椎间盘突出和颈椎管狭窄提示预后不良，较长的康复时间能给患者带来更佳的功能改善。
Abstract：Objective: To investigate the influencing factors of injury severity and prognosis in patients with traumatic central cord syndrome(TCCS). Methods: A total of 191 patients diagnosed as TCCS among those with cervical spinal cord injury(CSCI) admitted to Beijing Boai Hospital, China Rehabilitation Research Center from 2013 to 2022 were included. Clinical materials were collected,including age, gender, time from injury to admission, duration of rehabilitation hospitalization, cause of injury, type of underlying cervical spine pathology, intramedullary high signal(IMHS) characteristics, type of surgical treatment, neurological level of injury(NLI), motor score, sensory score, American Spinal Injury Association Impairment Scale(AIS), and modified Japanese Orthopaedic Association score. Multivariate regression analysis and correlation analysis were performed to identify factors affecting injury severity and prognosis in TCCS patients. Results: Falling injury were the leading cause of TCCS, and the most common underlying pathology was multi-segmental disc herniation. Injuries to C3-5 segments and AIS grade D patients accounted for a higher percentage.Multivariate regression analysis revealed that risk factors for injury severity in TCCS patients included higher NLI(OR=2.75), IMHS length(5-<10 mm, OR=2.50; ≥10 mm, OR=8.83), and IMHS width(OR=1.76). Protective factors for the prognosis of patients with TCCS included duration of rehabilitation hospitalization(60-<90 d, OR=0.53; ≥90 d, OR=0.31). Risk factors for prognosis included NLI(OR=3.17), IMHS length(5-<10 mm, OR=2.62; ≥10 mm, OR=3.21), ossification of the posterior longitudinal ligament(OR=3.85),multi-segmental disc herniation(OR=3.14) and cervical stenosis(OR=2.92). Conclusions: In TCCS patients, the higher NLI, longer IMHS length, and greater IMHS width indicate more severe injury. Poor prognosis is associated with Higher NLI, longer IMHS length,ossification of the posterior longitudinal ligament, multi-segmental disc herniation, and cervical stenosis. Conversely, prolonged rehabilitation hospitalization is beneficial for functional recovery.
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基本信息:
DOI：
中图分类号:R651.2
引用信息:
[1]谢玉磊,吕振,金晓庆等.创伤性脊髓中央损伤综合征伤情及预后的相关因素分析[J].中华骨与关节外科杂志,2025,18(04):289-297.
基金信息:
国家重点研发计划（2019YFB1312505）