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

Abstract

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

CLC Number:

R651.2

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.

Figures/Tables 2

References 21

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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

Advance in neurological classification of spinal cord injury with complications

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