伴并发症脊髓损伤的神经学分类研究进展

doi:10.3969/j.issn.1006-9771.2022.08.009

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (8): 934-938.doi: 10.3969/j.issn.1006-9771.2022.08.009

伴并发症脊髓损伤的神经学分类研究进展

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

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:2022-03-28 修回日期:2022-05-18 出版日期:2022-08-25 发布日期:2022-08-30
通讯作者: 周红俊 E-mail:zh87569303@qq.com
作者简介:刘根林(1965-),男,汉族,浙江义乌市人,博士,主任医师,主要研究方向：脊髓损伤康复。

Advance in neurological classification of spinal cord injury with complications

LIU Genlin^1,²,ZHOU Hongjun^1,²(),LI Jianjun^3,^4,⁵,WEI Bo^1,²,ZHENG Ying^1,²,HAO Chunxia^1,²,ZHANG Ying^1,²,WANG Yiji^1,²,KANG Haiqiong^1,²,LU Xiaolei^1,²,YUAN Yuan^1,²,MENG Qianru^1,²

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation 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. Neural Injury and Repair Center, Beijing Institute for Brain Disorders, Beijing 100068, China

Received:2022-03-28 Revised:2022-05-18 Published:2022-08-25 Online:2022-08-30
Contact: ZHOU Hongjun E-mail:zh87569303@qq.com

摘要/Abstract

摘要：

目的介绍伴并发症脊髓损伤的神经学分类新进展。

方法检索近10年国内外相关文献,总结相关内容。

结果 2022年1月美国脊柱损伤协会(ASIA)国际标准委员会的专题小组发表的脊髓损伤神经学分类国际标准(ISNCSCI)提出伴并发症脊髓损伤的神经学分类新方法,应用扩展的“*”标记概念,可统一记录、评分和分类,对高于、位于或低于神经损伤平面受脊髓损伤并发症影响的感觉和运动检查结果。

结论伴并发症脊髓损伤的神经学分类新方法克服了既往ISNCSCI版本的不足,有助于提高ISNCSCI分类精确性,可供临床试用。

关键词: 脊髓损伤, 并发症, 脊髓损伤神经学分类国际标准, 分类

Abstract:

Objectives To introduce the progress in neurological classification of spinal cord injury (SCI) with complications.

Methods The literatures in recent ten years were reviewed and summarized.

Results In January, 2022, a new neurological classification of SCI with complications in the International Standards for Neurological Classification of SCI (ISNCSCI) was published by the focus group of the American Spinal Injury Association (ASIA) International Standards Committee, with the extended "*"-tag concept, sensory and motor examination results impacted by SCI complication above, at, or below the neurological level of injury (NLI) could be consistently documented, scored, and classified.

Conclusion This new taxonomy in neurological classification of SCI with complications has overcome the shortcomings of the previous ISNCSCI versions and benefits the accuracy of ISNCSCI classifications, it could be tried in the clinical application.

Key words: spinal cord injury, complication, International Standards for Neurological Classification of Spinal Cord Injury, classification

中图分类号:

R651.2

刘根林,周红俊,李建军,卫波,郑樱,郝春霞,张缨,王一吉,康海琼,逯晓蕾,袁媛,蒙倩茹. 伴并发症脊髓损伤的神经学分类研究进展[J]. 《中国康复理论与实践》, 2022, 28(8): 934-938.

LIU Genlin,ZHOU Hongjun,LI Jianjun,WEI Bo,ZHENG Ying,HAO Chunxia,ZHANG Ying,WANG Yiji,KANG Haiqiong,LU Xiaolei,YUAN Yuan,MENG Qianru. Advance in neurological classification of spinal cord injury with complications[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(8): 934-938.

图/表 2

表1

表2

参考文献 21

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[2]	FURLAN J C, FEHLINGS M G, TATOR C H, et al. Motor and sensory assessment of patients in clinical trials for pharmacological therapy of acute spinal cord injury: psychometric properties of the ASIA Standards[J]. J Neurotrauma, 2008, 25(11): 1273-1301. doi: 10.1089/neu.2008.0617
[3]	TUSZYNSKI M H, STEEVES J D, FAWCETT J W, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP Panel: clinical trial inclusion/exclusion criteria and ethics[J]. Spinal Cord, 2007, 45(3): 222-231. doi: 10.1038/sj.sc.3102009
[4]	BLIGHT A R, HSIEH J, CURT A, et al. The challenge of recruitment for neurotherapeutic clinical trials in spinal cord injury[J]. Spinal Cord, 2019, 57(5): 348-359. doi: 10.1038/s41393-019-0276-2
[5]	KRAMER J L, LAMMERTSE D P, SCHUBERT M, et al. Relationship between motor recovery and independence after sensorimotor-complete cervical spinal cord injury[J]. Neurorehabil Neural Repair, 2012, 26(9): 1064-1071. doi: 10.1177/1545968312447306
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[10]	康海琼, 周红俊, 刘根林, 等. 脊髓损伤神经学分类国际标准检查表2019版最新修订及解读[J]. 中国康复理论与实践, 2019, 25(8): 983-985.
	KANG H Q, ZHOU H J, LIU G L, et al. Modification and interpretation of the 2019 International Standards for Neurological Classification of Spinal Cord Injury Worksheet[J]. Chin J Rehabil Theory Pract, 2019, 25(8): 983-985.
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时间	主要内容	优点	不足之处	临床应用
2003年版	如果不存在抑制性脊髓损伤并发症,异常的运动评分将按正常运动评分进行处理,用“5*”标记^[9]	首次提出对脊髓损伤并发症用“*”标记	不能反映患者的实际功能状态	有争议
2015年版	对肌力的评定分为0、1、2、3、4、5、5*和NT共8种情况^[10]	细化肌力评定记录	不能反映患者的实际功能状态	有争议
2019年版	去掉5级分级,将所有由脊髓损伤并发症造成的异常运动评分标注为0、1、2、3、4和NT,增加0、1和NT感觉异常和无法检查的标注方式^[11]	能反映患者的实际功能状态	未说明“*”标记如何影响NLI和AIS的确定	有争议

分类变量		病例1	病例2	病例3
轻触觉	左	C_2-6= 2, C₇~T₁= 1*, T_2-6= 2, T₇= 1, T₈及以下= 0	C_2-7=2, C₈= 1, T₁=2, T₂~L₅=1, S₁= 0, S₂及以下= 1	C_2-7=2, C₈=1, T₁=2, T₂及以下=1
轻触觉	右	C₂~T₆= 2, T₇= 1, T₈及以下= 0	C_2-5= 2, C₆= 1, C_7-8= 2, T₁~L₃= 1, L_4-5= 1*, S₁及以下= 1	C_2-6= 2, C₇~T₁= 1, T₂= 0, T₃及以下= 1
针刺觉	左	C_2-6= 2, C₇~T₁= 1*, T_2-6= 2, T₇= 1, T₈及以下= 0	C_2-7= 2, C₈~L₅= 1, S₁= 0, S₂= 1, S₃= 0, S_4-5= 1	C_2-7= 2, C₈~T₃= 1, T₄= 0, T₅= 1, T₆= 0, T₇= 1, T_8-10= 0, T_11-12= 1, L₁~S₃= 0, S_4-5= 1
针刺觉	右	C₂~T₆= 2, T₇= 1, T₈及以下= 0	C_2-5= 2, C_6-7= 1, C₈= 2, T₁~L₃= 1, L_4-5= 1*, S₁及以下= 1	C_2-6= 2, C₇~T₁= 1, T₂= 0, T_3-4 = 1, T_5-6= 0, T₇= 1, T₈= 0, T₉= 1, T₁₀= 0, T₁₁~L₁= 1, L₂及以下= 0
关键肌	左	C_5-6= 5, C₇= 3, C₈= 1, T₁= 1*, 下肢= 0	C₅= 5, C_6-7= 3, C₈= 2, T₁= 1, L₂= 4, L₃= 3, L_4-5= 2, S₁= 3	C₅= 5, C₆= 4, C₇= 3, C₈= 2, T₁= 0, 下肢= 0
关键肌	右	C₅~T₁ = 5, 下肢=0	C₅= 5, C₆= 2, C₇= 1, C₈= 2, T₁= 1, L_2-3= 3, L_4-5= 2*, S₁= 3	C₅= NT, C₆= 4, C₇= NT, C₈= 2, T₁= 1, 下肢=0
感觉平面	左	T₆*	C₇	C₇
感觉平面	右	T₆	C₅	C₆
运动平面	左	T₆*	C₆	C₆
运动平面	右	T₆	C₅	C₆*
DAP		无	存在	存在
VAC		无	存在	无
NLI		T₆*	C₅	C₆*
损伤程度		完全性	不完全性	不完全性
AIS		A	ND*	B*
感觉ZPP	左	T₇	NA	NA
感觉ZPP	右	T₇	NA	NA
运动ZPP	左	T₆*	NA	C₈
运动ZPP	右	T₆	NA	T₁
备注框说明		左臂丛下根部分麻痹(Klumpke麻痹)。 “*”标记的左侧上肢分数按正常分类	既往膝关节手术导致右侧腓神经部分损伤。 “*”标记的分数按非正常分类。分类为AIS C或D	右肘骨折,右肘关节石膏固定。 “*”标记的分数按以下运动评分分类：右C₅= 5,C₇= 2

伴并发症脊髓损伤的神经学分类研究进展

Advance in neurological classification of spinal cord injury with complications

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