Page 58 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第45卷第3期
·346 · Journal of Nanjing Medical University（Natural Sciences） 2025年3月

·临床研究·

基于急诊CT的创伤性颈髓损伤危险因素研究

周 正，方 熙，康 健，李 华，陈旭锋，周 浩 ，李 琳 *
*
南京医科大学第一附属医院急诊与危重症医学科，江苏 南京 210029

［摘 要］ 目的：基于急诊CT检查评估多发伤患者中创伤性脑损伤（traumatic brain injury，TBI）合并创伤性颈髓损伤（traumatic
cervical spinal cord injury，TCSCI）的危险因素及其对预后的影响。方法：回顾性分析2020年1月—2022年12月南京医科大学
第一附属医院急诊接诊时不排除 TCSCI 的 218 例多发创伤患者资料，根据入院后颈椎 MRI 结果，确定是否存在 TCSCI，分为
TCSCI和非TCSCI组。通过多因素Logistic回归分析，筛选出独立危险因素构建受试者工作特征（receiver operating characteristic，
ROC）曲线预测模型并进行内部验证。结果：69例（31.7%）患者合并TCSCI，多因素Logistic回归分析结果显示，较高的头部简明损
伤评分（head abbreviated injury scale，hAIS）（OR=1.552，95%CI：1.101~2.188）、下颈椎损伤分类（sub⁃axial injury classification，
SLIC）评分（OR=1.235，95%CI：1.006~1.517）和截瘫症状（OR=3.810，95%CI：1.115~13.020）是 TCSCI 的独立危险因素。预测模
型ROC曲线下面积为 0.900（95%CI：0.859~0.941），通过Hosmer⁃Lemeshow 检验评价模型效果，提示预测模型区分度和校准度
均较好。结论：hAIS、SLIC评分和截瘫症状是多发创伤患者合并TCSCI的独立危险因素，针对不排除TCSCI的多发创伤患者，
进行急诊CT检查并评估hAIS、SLIC评分、截瘫症状可能有效筛选出高危TCSCI患者。
［关键词］ 创伤性颈髓损伤；急诊CT；头部简明损伤评分；下颈椎损伤分类；截瘫症状；危险因素
［中图分类号］ R681.54 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）03⁃346⁃08
doi：10.7655/NYDXBNSN241372

Research on risk factors of traumatic cervical spinal cord injury based on emergency CT
*
ZHOU Zheng，FANG Xi，KANG Jian，LI Hua，CHEN Xufeng，ZHOU Hao ，LI Lin *
Department of Emergency and Critical Care Medicine，the First Affiliated Hospital of Nanjing Medical University，
Nanjing 210029

［Abstract］ Objective：To evaluate the risk factors and prognostic impact of traumatic brain injury（TBI）combined with traumatic
cervical spinal cord injury（TCSCI）in patients with multiple traumas based on emergency CT. Methods：A retrospective analysis was
conducted on the data of 218 patients with multiple traumas who were admitted to the emergency department of the First Affiliated
Hospital of Nanjing Medical University from January 2020 to December 2022，in whom TCSCI was not excluded. Patients were divided
into the TCSCI group and non⁃TCSCI group based on cervical MRI results. Multivariate logistic regression analysis was used to screen
for independent risk factors，construct a receiver operating characteristic（ROC）curve prediction model，and perform internal
validation. Results：TCSCI was identified in 69 patitents（31.7%）. Multivariate logistic regression analysis showed that higher head
abbreviated injury scale（hAIS）scores（OR=1.552，95%CI：1.101-2.188），sub⁃axial injury classification（SLIC）scores（OR=1.235，95%
CI：1.006-1.517），and paraplegia symptoms（OR=3.810，95%CI：1.115-13.020）were independent risk factors for TCSCI. The ROC
curve for the predictive model showed an area under the curve（AUC）of 0.900（95%CI：0.859-0.941）. The Hosmer⁃Lemeshow test
confirmed good discriminative ability and calibration of the model. Conclusion：hAIS，SLIC scores，and paraplegia symptoms are
independent risk factors for TCSCI in patients with multiple traumas. Emergency CT combined with assessment of hAIS，SLIC scores，
and paraplegia may effectively identify high⁃risk TCSCI patients with multiple traumas where TCSCI cannot be excluded.
［Key words］ traumatic cervical spinal cord injury；emergency CT；head abbreviated injury scale score；sub⁃axial injury classifica⁃
tion；paraplegia symptom；risk factors
［J Nanjing Med Univ，2025，45（03）：346⁃352，359］
［基金项目］ 国家自然科学基金（82302794）；江苏省基础研究计划自然科学基金（BK20220734）；江苏省人民医院临床能力提
升工程项目（JSPH⁃MC⁃2022⁃28）
通信作者（Corresponding author），E⁃mail：njmull@163.com（ORCID：0009⁃0001⁃3700⁃107X）；shishangzhouhao@163.com（ORCID：
∗
0000⁃0001⁃8321⁃0561）