《中国康复理论与实践》

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (6): 706-711.doi: 10.3969/j.issn.1006-9771.2021.06.012

• 临床研究 • 上一篇    下一篇

脊髓损伤儿童神经功能预后和并发症的调查

张缨1,2(),周红俊1,2,刘根林1,2,郑樱1,2,逯晓蕾1,2,康海琼1,2,郝春霞1,2,卫波1,2,王一吉1,2,袁媛1,2,蒙倩茹1,2,李建军3,4,5   

  1. 1.首都医科大学康复医学院，北京市 100068
    2.中国康复研究中心北京博爱医院，北京市 100068
    3.中国康复科学所，北京市 100068
    4.神经损伤与康复北京市重点实验室，北京市 100068
    5.北京脑重大疾病研究院神经损伤与修复研究所，北京市 100068
  • 收稿日期:2020-10-19 修回日期:2020-12-28 出版日期:2021-06-25 发布日期:2021-06-21
  • 通讯作者: 张缨 E-mail:iamzhangying@tom.com
  • 作者简介:张缨(1974-)，女，汉族，江苏无锡市人，博士，副主任医师，主要研究方向：脊髓损伤康复。
  • 基金资助:
    中央级公益性科研院所基本科研业务费专项资金项目(2015CZ-25)

Survey of Neurological Function and Complications of Pediatric Spinal Cord Injury

Ying ZHANG1,2(),Hong-jun ZHOU1,2,Gen-lin LIU1,2,Ying ZHENG1,2,Xiao-lei LU1,2,Hai-qiong KANG1,2,Chun-xia HAO1,2,Bo WEI1,2,Yi-ji WANG1,2,Yuan YUAN1,2,Qian-ru MENG1,2,Jian-jun LI3,4,5   

  1. 1.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
    2.Beijing Bo'ai Hospital, China Research Centre, Beijing 100068, China
    3.China Rehabilitation Science Institute, Beijing 100068, China
    4.Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing 100068, China
    5.Center of Neural Injury and Repair, Beijing 100068, China
  • Received:2020-10-19 Revised:2020-12-28 Published:2021-06-25 Online:2021-06-21
  • Contact: Ying ZHANG E-mail:iamzhangying@tom.com
  • Supported by:
    Fundamental Research Funds for Central Public Welfare Research Institutes(2015CZ-25)

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摘要： 目的

调查脊髓损伤儿童神经功能预后及并发症的发生特点。

方法

选取2011年至2019年收治的15岁以下脊髓损伤儿童，记录损伤后1个月、3个月和1年的脊髓损伤神经学平面、美国脊柱损伤协会残损分级(AIS)，并对压疮/烫伤、泌尿系感染、肾积水/膀胱输尿管返流、便秘、骨质疏松/骨折、深静脉血栓、神经痛、异位骨化、脊柱侧弯和髋关节发育不良等儿童脊髓损伤常见并发症的发生情况进行全面调查。

结果

159例脊髓损伤儿童中，男性41例，女性118例；受伤年龄2~14岁，平均(6.08±2.57)岁；主要致伤原因为运动损伤(47.8%)；主要损伤部位为胸段脊髓损伤(81.1%)。脊髓损伤儿童的致伤原因与损伤年龄(r = -0.160, P = 0.044)、性别(r = -0.458, P < 0.001)和脊髓损伤部位(r = -0.249, P = 0.002)相关。71.7%为完全性脊髓损伤，损伤1个月与损伤12个月的AIS显著相关(r = 0.984, P < 0.001)。主要并发症为泌尿系感染(69.2%)、便秘(67.9%)、肾积水/膀胱输尿管返流(37.7%)、脊柱侧弯(25.8%)、髋关节发育不良(25.2%)。压疮/烫伤与脊髓损伤部位相关(r = 0.179, P = 0.024)。损伤3个月脊髓损伤儿童的AIS与泌尿系感染、便秘、脊柱侧弯、髋关节发育不良明显相关(|r| > 0.227, P < 0.01)。压疮/烫伤与骨质疏松/骨折的发生明显相关(r = 0.208, P < 0.01)。泌尿系感染的发生与肾积水/膀胱输尿管返流、便秘、脊柱侧弯、髋关节发育不良显著相关(r > 0.261, P < 0.001)，与骨质疏松/骨折的发生相关(r = 0.195, P < 0.05)。肾积水/膀胱输尿管返流的发生与便秘、骨质疏松/骨折、脊柱侧弯和髋关节发育不良明显相关(r > 0.146, P < 0.01)。便秘的发生与脊柱侧弯、髋关节发育不良显著相关(r > 0.313, P < 0.01)，与骨质疏松/骨折的发生相关(r = 0.160, P < 0.05)。骨质疏松/骨折的发生与脊柱侧弯、髋关节发育不良显著相关(r > 0.342, P < 0.01)。脊柱侧弯与髋关节发育不良明显相关(r = 0.818, P < 0.001)。

结论

儿童脊髓损伤后神经功能恢复与AIS密切相关，完全性脊髓损伤患者预后不良。儿童脊髓损伤后常见并发症具有特定的年龄特征，泌尿系感染、便秘、肾积水/膀胱输尿管返流、脊柱侧弯、髋关节发育不良为常见并发症，需要高度重视。

关键词: 脊髓损伤, 儿童, 功能, 并发症, 预后

Abstract: Objective

To investigate the outcome of neurological function and the clinical characteristics of complications in children with spinal cord injury.

Methods

From 2011 to 2019, children under 15 years old with spinal cord injury were selected in our hospital. Their level of injury and American Spinal Injury Association Impairment Scale (AIS) at one month, three months and one year were recorded. And the complications such as pressure ulcers/scald, urinary tract infection, hydronephrosis/vesicoureteral reflux, constipation, osteoporosis/fracture, deep vein thrombosis, neurodynia, heterotopic ossification, scoliosis and hip dysplasia were analyzed.

Results

Of 159 individuals, 41 were boys and 118 were girls, the average age at injury was (6.08±2.57) years. The main cause of spinal cord injury was sports accidents (47.8%), and the main injury sites were thoracic spinal cord injury (89.3%). The cause of spinal cord injury was correlated with age at injury (r = -0.160, P = 0.044), gender (r = -0.458, P < 0.001) and injury sites (r = -0.249, P = 0.002). Complete spinal cord injury counted for 71.7%, and the AIS grade at one month was correlated with that at twelve months (r = 0.984, P < 0.001). The main complications were urinary tract infection (69.2%), constipation (67.9%), hydronephrosis/vesicoureteral reflux (37.7%), scoliosis (25.8%) and hip dysplasia (25.2%). The incidence of ulcers/scald was correlated with injury site (r = 0.179, P = 0.024). The AIS grade three months after injury was significantly correlated with urinary tract infection, constipation, scoliosis and hip dysplasia (|r| > 0.227, P < 0.01). The incidence of ulcers/scald was correlated with osteoporosis/fracture (r = 0.208, P < 0.01). The incidence of urinary tract infection was significantly correlated with hydronephrosis/vesicoureteral reflux, constipation, scoliosis and hip dysplasia (r > 0.261, P < 0.001), as well as osteoporosis/fracture (r = 0.195, P < 0.05). The incidence of hydronephrosis/vesicoureteral reflux was significantly correlated with constipation, osteoporosis/fracture, scoliosis and hip dysplasia (r > 0.146, P < 0.01). The incidence of constipation was significantly correlated with scoliosis and hip dysplasia (r > 0.313, P < 0.01), as well as osteoporosis/fracture (r = 0.160, P < 0.05). The incidence of osteoporosis/fracture was significantly correlated with scoliosis and hip dysplasia (r > 0.342, P < 0.01). The incidence of scoliosis was significantly correlated with hip dysplasia (r = 0.818, P < 0.001).

Conclusion

The recovery of neurological function after spinal cord injury in children is closely correlated to AIS. The outcome of complete spinal cord injury is poor. The common complications after spinal cord injury in children demonstrate specific age characteristics, and the incidence of urinary tract infection, constipation, hydronephrosis/vesicoureteral reflux, scoliosis and hip dysplasia are common complications, which need more attention.

Key words: spinal cord injury, children, function, complication, prognosis

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