舞蹈致儿童无骨折脱位型脊髓损伤神经学预后的影响因素及预测模型

doi:10.3969/j.issn.1006-9771.2023.05.014

Abstract

Abstract:

Objective To investigate the neurological outcome of children with dance-associated spinal cord injury without radiographic abnormality (SCIWORA) and explore its related factors and predictive model.

Methods From July, 2012 to January, 2022, 75 children with dance-associated SCIWORA hospitalized in Beijing Bo'ai Hospital were divided into improved group (n = 14) and non-improved group (n = 61) according to the American Spinal Injury Association Impairment Scale (AIS) grade a year later, and the related factors were analyzed.

Results All patients were girls aged four to ten years. Most of them were complete spinal cord injuries (52/75, 69%). The time of injury to rehabilitation (OR = 0.926, P = 0.046, 95%CI 0.858 to 0.999), the existing tendon reflex (OR = 46.915，P = 0.012, 95%CI 2.333 to 943.616) and muscle tension (OR = 8.932，P= 0.044，95%CI 1.063~75.067) were correlated with the AIS grade improvement. The combination of time of injury to rehabilitation, tendon reflex and muscle tone existing may predict the improvement of AIS (AUC = 0.953, P < 0.001，95%CI 0.878 to 0.989), the sensitivity and specificity were 100% and 83.61%, respectively.

Conclusion The neurological outcome of children with dance-associated SCIWORA is poor. Rehabilitation training as soon as possible is beneficial to the neurological recovery. Tendon reflexe and muscle tone existing at admission are closely related to improvement of neurological outcome, which could be used as potential indicators.

Key words: spinal cord injury without radiographic abnormality, children, prognosis, influencing factor

CLC Number:

R651.2

GUO Shuang, XIE Yongqi, ZHANG Liang, ZHANG Chunjia, PENG Run, YANG Degang, YANG Mingliang. Related factors and prediction model for neurological outcome of dance-associated pediatric spinal cord injury without radiographic abnormality[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 582-589.

Figures/Tables 5

References 36

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项目		入院	伤后1年随访	χ²/Z值	P值
肌张力/n	存在	17	24	38.981	< 0.001
肌张力/n	消失	58	51	38.981	< 0.001
腱反射/n	存在	20	22	-1.414	0.317
腱反射/n	消失	55	53	-1.414	0.317
Babinski征/n	引出	14	13	-0.577	0.157
Babinski征/n	未引出	61	62	-0.577	0.157
神经损伤平面/n	T_1-6	17	14	-0.447	0.655
	T_7-12	51	55
	L₁~S₅	7	6
感觉评分	M(P₂₅，P₇₅)	136(112, 160)	136(116, 168)	-2.173	0.030
感觉评分	范围	68~224	68~224	-2.173	0.030
针刺觉	M(P₂₅，P₇₅)	68(56, 80)	68(58, 86)	-1.697	0.090
针刺觉	范围	34~112	34~112	-1.697	0.090
轻触觉	M(P₂₅，P₇₅)	68(58, 84)	69(61, 84)	-1.894	0.058
轻触觉	范围	34~112	34~112	-1.894	0.058
双下肢运动评分	M(P₂₅，P₇₅)	0(0, 0)	0(0, 3)	-3.756	< 0.001
双下肢运动评分	范围	0~40	0~50	-3.756	< 0.001
AIS分级/n	A	52	52	-3.557	< 0.001
	B	11	3
	C	6	8
	D	6	10
	E	0	2

因素类别	因素赋值	赋值结果
年龄	< 8岁(0)， ≥ 8岁(1)	0 = 58，1 = 17
有无异常(受伤前两周)	无(0)，有(1)	0 = 59，1 = 16
是否摔倒	否(0)，是(1)	0 = 33，1 = 42
潜伏期	< 4 h (0)，≥ 4 h (1)	0 = 66，1 = 9
是否活动(潜伏期)	否(0)，是(1)	0 = 53，1 = 22
8h内是否使用激素	否(0)，是(1)	0 = 51，1 = 24
是否佩戴腰围	否(0)，是(1)	0 = 47，1 = 28
是否佩戴双下肢支具	否(0)，是(1)	0 = 36，1 = 39
脊髓内长T₂信号	否(0)，是(1)	0 = 7，1 = 68
肌张力是否存在	否(0)，是(1)	0 = 58，1 = 17
腱反射是否存在	否(0)，是(1)	0 = 55，1 = 20
Babinski征是否引出	否(0)，是(1)	0 = 61，1 = 14
神经损伤平面	T_1-6(1)，T_7-12(2)，L₁~S₅(3)	1 = 17，2 = 51，3 = 7

自变量		AIS分级改善		OR值(95%CI)	P值
自变量		改善组(n = 14)	未改善组(n = 61)	OR值(95%CI)	P值
年龄/岁	< 8	12	46	1	0.413
年龄/岁	≥ 8	2	15	0.511(0.103~2.548)	0.413
受伤至康复时间/d		15(13.5, 21)	29(18, 61)	0.950(0.904~0.998)	0.040
病程/d		132.5(66, 278.5)	131(75.5, 228.5)	1.001(0.997~1.005)	0.712
有无异常 (受伤前两周)	有	3	13	1	0.992
有无异常 (受伤前两周)	无	11	48	1.007(0.244~4.150)	0.992
是否摔倒	是	8	34	1	0.924
是否摔倒	否	6	27	1.059(0.328~3.421)	0.924
潜伏期/h	<4	13	53	1	0.542
潜伏期/h	≥4	1	8	0.510(0.058~4.444)	0.542
潜伏期是否活动	是	3	19	1	0.474
潜伏期是否活动	否	11	42	0.603(0.151~2.413)	0.474
8 h内是否使用激素	是	7	17	1	0.117
8 h内是否使用激素	否	7	44	2.588(0.789~0.489)	0.117
是否佩戴腰围	是	5	23	1	0.890
是否佩戴腰围	否	9	38	0.918(0.274~3.077)	0.890
是否佩戴双下肢支具	是	5	34	1	0.183
是否佩戴双下肢支具	否	9	27	0.441(0.132~1.471)	0.183
脊髓内长T₂信号	是	13	55	1	0.756
脊髓内长T₂信号	否	1	6	1.418(0.157~12.820)	0.756
损伤节段长度		7.25±3.44	6.64±3.87	1.044(0.883~1.234)	0.612
肌张力是否存在	是	8	9	1	0.002
肌张力是否存在	否	6	52	7.704(2.156~27.521)	0.002
腱反射是否存在	是	11	9	1	< 0.001
腱反射是否存在	否	3	52	21.185(4.922~91.185)	< 0.001
Babinski征是否引出	是	7	7	1	0.002
Babinski征是否引出	否	7	54	7.714(2.08~28.606)	0.002
神经损伤平面	T_1-6	1	16	1	0.034
	T_7-12	9	42	3.429(0.401~29.279)	0.260
	L₁~S₅	4	3	21.333(1.726~263.673)	0.017

项目	回归系数B	标准误	Wald值	P值	OR值	95%CI
受伤至康复时间	-0.077	0.039	3.979	0.046	0.926	0.858~0.999
肌张力是否存在	2.190	1.086	4.065	0.044	8.932	1.063~75.067
腱反射是否存在	3.848	1.531	6.315	0.012	46.915	2.333~943.616
Babinski征是否引出	-1.676	1.554	1.163	0.281	0.187	0.009~3.934
神经损伤平面
T_1-6	1.708	0.426
T_7-12	1.616	1.447	1.246	0.264	5.032	0.295~85.876
L₁~S₅	2.530	2.012	1.580	0.209	12.551	0.243~648.004

因素类别	AUC	95%CI	敏感性	特异性	P值
受伤至康复时间	0.758	0.645~0.849	85.7%	67.2%	< 0.001
腱反射	0.819	0.713~0.898	78.6%	85.3%	< 0.001
肌张力	0.712	0.596~0.811	57.1%	85.3%	0.003
合并	0.953	0.878~0.989	100%	83.6%	< 0.001

Related factors and prediction model for neurological outcome of dance-associated pediatric spinal cord injury without radiographic abnormality

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