X線異常のない脊髄損傷（SCIWORA）の転帰における手術時期の影響

The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA).

抄録

背景:

X線異常のない脊髄損傷（SCIWORA）は、稀な外傷性脊髄症である。手術は最も重要な治療法の一つであるが、SCIWORAに対する手術は賛否両論あり、特に手術の時期が議論の的となっている。ここでは、受傷から手術までの期間の違いがSCIWORAの転帰に与える影響について検討する。

BACKGROUND: Spinal cord injury without radiographic abnormality (SCIWORA) is a rare traumatic myelopathy. Although surgery is one of the most important treatments, the surgery for SCIWORA is controversial, especially the time of surgery is a topic of controversy. Here, we investigate the effects of difference in duration from injury to surgery on the outcome of SCIWORA.

方法:

2013年1月から2017年4月までに河北医科大学第三付属病院に入院した脊髄損傷患者全員を対象に、本レトロスペクティブ研究を実施した。研究要件を満たした57名の患者を、受傷から手術までの期間に応じて3群に分けた。A群（受傷から3日以内に手術）は18人、B群（3～7日以内に手術）は18人、C群（7日以降に手術）は21人であった。すべてのグループはMann-Whitney U testで比較され，脊髄の機能改善はASIAスポーツスコアとASIA Impairment Scale（AIS）を用いて比較・分析された．

METHODS: This retrospective study was performed in all patients with spinal cord injury admitted to the Third Affiliated Hospital of Hebei Medical University from January 2013 to April 2017. Fifty-seven patients who met the study requirements were divided into 3 groups according to the duration from injury to surgery. Group A (surgery within 3 days of injury) had 18 patients, group B (surgery within 3-7 days) had 18 patients, and group C (surgery later than 7 days) had 21 patients. All the groups were compared with Mann-Whitney U test; the functional improvement of spinal cord was compared and analyzed using the ASIA sports score and ASIA Impairment Scale (AIS).

結果:

3群とも術前と比較して長期的なAIS（最終フォローアップ）の有意な改善を認めた。7日以内の手術は7日後の手術より有意に治癒効果が高かった．ASIAスポーツスコアでは，早期回復が早く，後期回復が遅いことが示され，C群の回復率はA群，B群より悪かった．

RESULTS: There was a significant improvement in the long-term AIS (final follow-up) in all the 3 groups compared to before surgery. The final follow-up recovery rate of group C was worse than group A and group B. The curative effect of operation within 7 days was significantly better than the surgery done 7 days later. The recovery rate of group C was worse than group A and B. The ASIA sports score showed that recovery was quicker in the early stage and slow in the later stage.

結論:

手術治療の最適なスケジュールは受傷後3～7日であり，短期および長期の経過観察効果を有意に改善することができる．受傷から手術までの時間が長いほど予後は不良であった．

CONCLUSIONS: The optimal schedule of surgical treatment was 3-7 days after injury, which can significantly improve the short-term and long-term follow-up effects. Longer the time to surgery from the time of injury, the worse was the prognosis.