摘要
目的研究分析无骨折脱位型颈脊髓损伤(cervical spinal cord injury without fracture and dislocation)病例资料,建立其临床治疗预后模型以评价其临床预后。方法回顾性分析2012-09～2018-03我院收治无骨折脱位型颈脊髓损伤的患者62例,均行颈后路单开门椎管扩大成形术,分别于术前、术后6个月进行日本骨科学会(JOA)评分,以术后6个月的日本骨科学会(JOA)评分术后改善率≥60%为阈值。收集年龄、性别、致伤外力大小、病程、颈椎管狭窄程度、术前JOA评分、颈椎生理曲度7个可能影响手术预后的因素数据并行二分类Logistic回归分析建模。采用内部验证(internal validation)方法分析,包括自助法抽样、绘制吻合线以及计算受试者曲线下面积(AUC)分别评价预后模型的吻合力以及分辨力。结果本预后模型为logit(P)=-26. 352 3+20. 526 5VALUE+1. 315 8SCORE-4. 322 3TIME,其中VALUE表示颈椎管狭窄所对应的Pavlov比值(取实际数值); SCORE表示术前JOA评分分值(0-17分); TIME表示病程(受伤至手术的时间)。受试者曲线下面积(AUC)=0. 882 3(95%CI 0. 753 0-0. 983 2)。结论本预后模型的吻合力和分辨力较好,颈椎管狭窄以及病程是影响无骨折脱位型颈脊髓损伤临床预后的危险性因素;术前JOA评分是无骨折脱位型颈脊髓损伤的临床预后的保护性因素。当logit(P)≥-2. 620 3时可认为预后良好,模型在一定程度上尚待完善改进,但已具有一定的临床应用价值。
Objective To establish a clinical prognostic model for evaluating the clinical prognosis of cervical spinal cord injury without fracture and dislocation.Methods From September 2012 to March 2018,62 patients suffering from cervical spinal cord injury without fracture and dislocation were enrolled and received posterior cervical expansive open-door laminoplasty.The Japan Orthopaedic Association(JOA)score was recorded respectively before operation and 6 months after operation,with the improvement rates≥60%at 6 month after operation as a threshold value.Data on seven potential factors influencing the prognosis after operation were collected to set up a dichotomous logistic regression analysis model,including age,gender,degree of outside force causing injury,course of di-sease,size of cervical spinal stenosis,JOA score and cervical physiological curve.Additionally,the model was analyzed and evaluated through employing internal validation including bootstrap method,drawing concordant profile and figuring out the area under curve(AUC)among patients.Results The prognostic model was listed as follow:logit(P)=-26.352 3+20.526 5VALUE+1.315 8 SCORE-4.322 3TIME,of which VALUE referred to Pavlov ratio(actual value)of cervical spinal stenosis,SCORE referred to the number(0-17)given by the JOA scoring system after operation,and TIME referred to the course of disease(from injury to operation).The AUC score among subjects was 0.882 3(95%CI=0.753 0-0.983 2).Conclusion The prognostic model is well consistent with the disease and easy to distinguish the diagnosis.The cervical spinal stenosis and its disease course are the risk factors for the prognosis of cervical spinal cord injury without fracture and dislocation after operation,whereas JOA scoring system before operation is a protective factor.Moreover,the prognosis of disease is considered to be good when logit(P)≥-2.620 3,and the model has a certain clinical application value though it is yet to be improved to some extent.
作者
王杰
郭帅
蔡璇
徐嘉伟
李浩鹏
WANG Jie;GUO Shuai;CAI Xuan;XU Jiawei;LI Haopeng(Department of Orthopaedic Surgery,Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)
出处
《山西医科大学学报》
CAS
2019年第1期106-111,共6页
Journal of Shanxi Medical University
基金
国家自然科学基金资助项目(30672136)
关键词
无骨折脱位型颈脊髓损伤
颈椎管狭窄
预后模型
cervical spinal cord injury without fracture and dislocation
cervical spinal stenosis
prognostic model
