急性外伤性脊髓损伤中脊髓肿胀的演变。

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2025-02-12 eCollection Date: 2025-01-01 DOI:10.1089/neur.2025.0005
Hasan Asif, Ravindran Visagan, Ellaine Boseta, Argyro Zoumprouli, Marios C Papadopoulos, Samira Saadoun
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引用次数: 0

摘要

我们假设Monro-Kellie原则作为创伤性脑损伤(TBI)的关键原则也适用于创伤性脊髓损伤(TSCI)。通过分析79例TSCI患者9986 h的椎内压(ISP)监测数据,我们发现量化TBI代偿储备的概念可以在TSCI中类似地定义,称为ISP脉冲幅度(sAMP),脊髓代偿储备指数(sRAP)和ISP波形形状。当ISP升高超过15 mmHg时,代偿储备受损(sAMP升高,sRAP变为正值)。当ISP增加到20 mmHg以上时,ISP波形的形态从以P1为主的三个峰(P1、P2、P3)变为以P2为主的三个峰,最后变为一个圆角信号。与TBI相比,TSCI的关键差异是没有平台ISP波,也没有sAMP下降和sRAP为负的临界ISP。四个因素与脊髓肿胀增加或脊髓顺应性降低相关:胸部损伤程度、未切除椎板、延迟手术和更严重的损伤。我们还假设,在创伤性脑损伤中,脊髓在受伤后几天最大程度地肿胀。9例患者损伤脊髓的连续超声扫描和79例患者的ISP、sAMP和sRAP随时间的基线变化图显示,手术5天内最大脊髓肿胀延迟。我们得出结论,脊髓Monro-Kellie概念允许脊髓代偿储备被量化。我们的数据显示,当ISP升高到15-20 mmHg以上时,脊髓代偿储备就会耗尽,并且损伤后存在延迟性脊髓肿胀,这意味着手术中超声证实的充分脊髓减压可能不会在术后持续。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evolution of Spinal Cord Swelling in Acute Traumatic Spinal Cord Injury.

We hypothesized that the Monro-Kellie doctrine, a key principle in traumatic brain injury (TBI), also applies in traumatic spinal cord injury (TSCI). By analyzing 9986 h of intraspinal pressure (ISP) monitoring data from 79 TSCI patients, we show that concepts developed to quantify compensatory reserve in TBI may be analogously defined in TSCI, termed ISP pulse amplitude (sAMP), spinal compensatory reserve index (sRAP), and ISP waveform shape. As ISP increases beyond 15 mmHg, compensatory reserve becomes impaired (sAMP rises and sRAP becomes positive). As ISP increases beyond 20 mmHg, the morphology of the ISP waveform changes from three peaks (P1, P2, P3) with P1 dominant, to three peaks with P2 dominant, to a rounded signal. Key differences in TSCI, compared with TBI, are no plateau ISP waves, and no critical ISP beyond which sAMP decreases and sRAP becomes negative. Four factors were associated with increased spinal cord swelling or reduced spinal cord compliance: thoracic level of injury, no laminectomy, delayed surgery, and more severe injury. We also hypothesized that, as in TBI, the spinal cord maximally swells a few days after injury. Serial ultrasound scans of the injured spinal cords in 9 patients and plots of change from baseline in ISP, sAMP, and sRAP versus time in 79 patients revealed delayed maximal cord swelling within 5 days of surgery. We conclude that the spinal Monro-Kellie concept allows the spinal compensatory reserve to be quantified. Our data show that spinal compensatory reserve becomes exhausted as ISP increases above 15-20 mmHg and that there is delayed cord swelling after injury, which implies that adequate cord decompression confirmed during surgery by ultrasound may not persist postoperatively.

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来源期刊
CiteScore
2.40
自引率
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