PDF(Pubmed)
Abstract：
Early surgical decompression within 24 hours for traumatic spinal cord injury (SCI) is associated with improved neurological recovery. However, the ideal timing of decompression is still up for debate. The objective of this study was to utilize our retrospective single-institution series of ultra-early (<5 hours) decompression to determine if ultra-early decompression led to improved neurological outcomes and was a feasible target over previously defined early decompression targets. Retrospective data on patients with SCI who underwent ultra-early (<5 hours) decompression at a level one metropolitan trauma center were extracted and collected from 2015-2018. American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement was the primary outcome, with ASIA Motor score improvement and complication rate as secondary outcomes. Four individuals met the criteria for inclusion in this case series. All four suffered thoracolumbar SCI. All patients improved neurologically by AIS grade, and there were no complications directly related to ultra-early surgery. Given the small sample size, there was no statistically significant difference in outcomes compared to a control group who underwent early (5-24 hour) decompression in the same period. Ultra-early decompression is a feasible and safe target for thoracolumbar SCI and may lead to improved neurological outcomes without increased risk of complications. This case series can help create the foundation for future, larger studies that may definitively show the benefit of ultra-early decompression.
摘要：
创伤性脊髓损伤（SCI）24小时内早期手术减压与改善神经系统恢复有关。然而,减压的理想时机仍有待讨论。这项研究的目的是利用我们的回顾性单机构系列超早期（<5小时）减压来确定超早期减压是否导致改善的神经系统结果，并且是先前定义的早期减压目标的可行目标。从2015-2018年提取并收集了在大都会创伤中心一级接受超早期（<5小时）减压的SCI患者的回顾性数据。美国脊髓损伤协会（ASIA）损伤量表（AIS）等级提高是主要结果，以ASIA运动评分改善和并发症发生率为次要结局。四个人符合纳入本案例系列的标准。所有四个人都患有胸腰椎SCI。所有患者通过AIS等级改善了神经系统，并且没有与超早期手术直接相关的并发症。鉴于样本量小，与同期接受早期(5~24小时)减压的对照组相比,结果无统计学显著差异.超早期减压是治疗胸腰椎SCI的可行且安全的目标，并且可以改善神经系统预后，而不会增加并发症的风险。这个案例系列可以帮助为未来奠定基础，更大的研究可能明确显示超早期减压的好处。
