目的 优化纸质版脊髓损伤神经功能评估系统, 探讨其在脊柱脊髓损伤患者临床管理中的实际应用效果。方法 广泛检索国内外关于脊柱脊髓损伤患者神经运动功能评估的文献, 结合课题组成员的临床经验, 初步筛选出神经运动功能评估的关键项目。通过两轮德尔菲专家函询, 确定评估项目内容, 对纸质版脊髓损伤神经功能评估系统进行优化, 并进行临床应用验证。选取2021年8月1日—2023年5月31日在广州市第一人民医院脊柱外科住院的120例脊柱脊髓疾病患者作为研究对象, 随机分为观察组和对照组。对比两组在应用优化前后评估系统的神经功能评估准确性、评估所需时间以及临床应用便捷性等方面的差异。结果 观察组的评估准确性显著高于对照组,错评率由20.3%降至4.7%,漏评率由32.0%降至5.0%; 此外,优化后的评估系统显著缩短了评估时间,平均减少6.0 min, 有效提升了评估效率。结论 优化后的脊髓损伤神经功能评估系统显著提高了评估的准确性和效率, 有效减少了主观误差。

Objective To refine and optimize the paper-based assessment tool for evaluating neurological function in spinal cord injury patients, and to explore its impact on clinical practice．Methods A comprehensive review of existing literature on neuromotor function assessment in spinal cord injury patients was conducted, complemented by discussions among members of this study．This led to the integration of a preliminary evaluation framework．Subsequently, a two-round Delphi consensus process involving experts was undertaken to finalize the content of the assessment project．Based on this, a paper-based evaluation system was developed and converted into an electronic format by computer professionals．This system was then tested in a clinical setting, where it was administered to 120 spinal cord injury patients at the Spine Surgery Department of Guangzhou First People’s Hospital between 1 August 2021 and 31 May 2023．Patients were randomly assigned to either an experimental group or a control group, allowing for a comparison of accuracy, efficiency, and convenience in clinical application．Results The experimental group demonstrated a notable improvement in assessment accuracy over the control group, with a significant reduction in error rate from 20.3% to 4.7% and a decrease in omission rate from 32.0% to 5.0%．Furthermore, the average assessment time was shortened by 6.0 minutes, markedly enhancing the efficiency of the evaluation process．Conclusions The optimized neurological function assessment system for spinal cord injury patients has proven effective in enhancing both the accuracy and efficiency of assessments, while significantly minimizing subjective errors．This system holds considerable potential for widespread clinical adoption and application．

目的 探讨规范化康复护理在脊髓型颈椎病前路手术术后功能恢复的影响。方法 将60例行颈椎前路椎间隙减压植骨融合内固定术的患者分为观察组和对照组各30例。对照组实施常规护理,观察组实施规范化康复护理措施。分别在出院时、出院后1、3、6个月进行日本骨科协会脊髓功能JOA评分、颈椎功能残障指数NDI评分、疼痛视觉模拟VAS评分、生活自理能力评分以及记录两组住院时间、术后并发症发生率。结果 手术后观察组与对照组的平均住院时间、术后并发症、术后脊髓功能恢复情况、颈椎功能恢复、生活自理能力的差异有统计学意义(P<0.05);观察组的平均住院时间均低于对照组(P<0.05);术后脊髓功能功能评分、生活自理能力评分均高于对照组(P<0.05);颈椎功能残障指数评分、术后并发症发生率均低于对照组(P<0.05)。结论 规范化康复护理可以促进脊髓型颈椎病行前路手术术后脊髓、颈椎功能的恢复,减少住院时间,减少术后并发症的发生,提高患者生活自理能力,提高生活质量。

Objective To investigate the effect of standardized rehabilitation nursing on functional recovery of cervical spondylotic myelopathy (CSM) after anterior operation. Methods Sixty patients were divided into two groups: observation group (n = 30) and control group (n = 30). Routine nursing was carried out in the control group and standardized rehabilitation nursing measures were carried out in the observation group. At the time of discharge, 1,3,6 months after discharge, the JOA score of spinal cord function of the Japanese Orthopaedics Association, the NDI score of cervical spine disability index, the VAS score of visual analogue of pain, the score of self-care ability of life were taken. The length of hospitalization of the two groups and incidence of postoperative complications were recorded. Results There were significant differences in average hospitalization time, postoperative complications, recovery of spinal cord function, recovery of cervical spine function and ability of living self-care between the observation group and the control group after operation (P<0.05). The average hospitalization time in the observation group was lower than that in the control group (P<0.05), and the scores of spinal cord function and self-care ability after operation were higher than those in the control group (P<0.05). The score of cervical disability index and the incidence of postoperative complications were lower than those of the control group (P<0.05). Conclusion Standardized rehabilitation nursing may promote the recovery of spinal cord and cervical spine function, reduce hospital stay, reduce postoperative complications, improve the self-care ability of patients and improve the quality of life.

目的 系统评价手术与保守治疗无骨折脱位型颈脊髓损伤的疗效。方法 应用计算机检索 PubMed、Cochrane Library、EMbase、OVID、CNKI、维普及万方数据库,纳入关于手术及保守治疗无骨折脱位型颈脊髓损伤疗效比较的随机或非随机对照试验。由2名研究人员独立对文献进行筛选、提取和纳入文献评价,采用 Rev-Man 5.3软件对两种治疗的JOA评分、ASIA运动评分、神经功能恢复率、ASIA分级改善进行Meta分析。结果 ①共纳入13 篇研究,共598例患者,手术和保守治疗组分别371例和227例;②Meta分析显示,与保守治疗相比,手术治疗后的JOA评分更高[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01];神经功能恢复率更高[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01];ASIA分级改善更明显[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006];在ASIA运动评分方面,两者无差异[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]。结论 对于无骨折脱位型颈脊髓损伤的患者,手术治疗更有利于患者神经功能的改善。

Objective To systematically assess the clinical efficacy of surgical treatment versus conservative treatment for CSCIWFD from previously clinical investigations. Methods A systematic search of all the studies published was conducted on the PubMed, Cochrane Library, EMbase, OVID, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that compared between surgical treatment and conservative treatment for CSCIWFD were identified. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the quality of included studies. Meta-analyses were performed to assess variables including Japanese Orthopaedic Association scores(JOA), Neurological function recovery rate, ASIA impairment scale grade, ASIA motor scores. Results ①A total of 13 articles were included, involving 598 patients, of which 371 and 227 patients received sugical or conservative treatment. ②The results of the meta-analysis indicated that, compared with conservative group, surgical group has higher JOA scores[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01], better Neurological function recovery rate[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01], better ASIA impairment scale grade improvement[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006], and there were no significant differences in the ASIA motor scores[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]. Conclusion These result suggests that surgical treatment can improve the neurological function more effectively for patients with cervical spinal cord injury without fracture and dislocation.