Clinical Study Of Hyperbaric Oxygen Therapy On Postoperative Neurological Function Recovery Of Spinal Fracture Complicated With Spinal Cord Injury

Abstract:Objective:To observe the efficacy of hyperbaric oxygen(HBO)in the treatment of spinal fracture complicated with spinal cord injury and its effects on the recovery of neurological function,and to analyze the related factors affecting the recovery of neurological function after HBO therapy,and to find out the positive factors affecting neurological function recovery after HBO therapy,so as to provide theoretical reference for the clinical use of HBO in the treatment of spinal fracture complicated with spinal cord injury.Methods:A total of 120 patients with spinal fracture complicated with spinal cord injury who were treated at Nanchong Central Hospital from March 2017 to June 2018were selected for the study.All patients were given conventional spinal decompression and internal fixation,and 65 patients who were treated by hyperbaric oxygen therapy at different time periods after operation were set as HBO group,and 55 patients who were not treated by hyperbaric oxygen after operation were set as non-HBO group.The general data of all patients were collected and sorted out.The spinal cord function and activities of daily living were evaluated by American Spinal Injury Association(ASIA)grading standard,Barthel index scoring method and Franke spinal cord scoring standard before treatment and at 3 months after treatment.Serum interleukin-6(IL-6),interleukin-8(IL-8)and tumor necrosis factor-?(TNF-?)levels were measured before and after treatment by ELISA.The follow-up methods of outpatient,telephone and postal letter were used to count the occurrence of adverse reactions during treatment and at 3 months after treatment.Univariate analysis was performed on the observation data(age,time from injury to operation,injury site,causes of injury,injury degree,treatment time of postoperative hyperbaric oxygen and frequency of postoperative hyperbaric oxygen)in HBO group.Logistic multivariate regression was used to analyze the factors that might affect the efficacy of HBO,and then multivariate analysis was made.Results:From March 2017 to June 2018,a total of 130 patients with spinal fracture complicated with spinal cord injury were treated at Nanchong Central Hospital,and a total of 125 patients were eligible for inclusion and exclusion in this study,and there were 120 cases with effective follow-up,including 55cases in HBO group and 65 cases in non-HBO group.There were no significant differences in the gender,age,time from injury to operation,causes of injury,injury degree and preoperative ASIA grading between the two groups(P>0.05).After treatment,the total effective rate in HBO group was significantly higher than that in non-HBO group(87.69%vs 69.09%)(P<0.05).The scores of exercise and sensory function in HBO group were higher than those in non-HBO group(18.82±2.68 vs 14.13±2.36;20.13±2.51 vs 15.82±2.42)(all P<0.05).The excellent and good rate of Barthel score and effective rate of Franke neurological function score after treatment in HBO group were significantly better than those in non-HBO group(92.31%vs 76.36%;72.31%vs 36.36%)(?~2=5.94,15.61,all P<0.05).After treatment,serum IL-6,IL-8and TNF-?levels decreased in both groups,and HBO group was lower than non-HBO group(P<0.05).There were no significant adverse reactions in the two groups during treatment and at 3 months after treatment.Univariate analysis showed that age,time from injury to operation,injury site and causes of injury had no significant impacts on treatment effects(all P>0.05).HBO treatment efficacy was related to the injury degree and the time and frequency of postoperative hyperbaric oxygen therapy(all P<0.05).And the severer the injury degree,the longer the time of postoperative hyperbaric oxygen and the fewer the frequency of postoperative hyperbaric oxygen,the poorer the efficacy.The injury degree,time of postoperative hyperbaric oxygen and frequency of postoperative hyperbaric oxygen were included in Logistic multivariate regression analysis,and it was found that the time of postoperative hyperbaric oxygen was an independent risk factor for the efficacy of HBO(P<0.05).Conclusions:(1)For patients with spinal fracture complicated with spinal cord injury,compared with decompression alone,combined HBO after decompression can effectively improve the exercise and sensory function,and significantly improve the activities of daily living and quality of life,and it has better efficacy and higher safety.(2)Combined with HBO after decompression can effectively alleviate the inflammatory reaction in patients with spinal fracture and spinal cord injury,and promote their neurological recovery.(3)The injury degree,frequency of postoperative HBO therapy and treatment time of postoperative HBO therapy are the main factors affecting the recovery of neurological function after HBO.The treatment time of postoperative HBO therapy is an independent risk factor for the recovery of neurological function in patients after HBO therapy.HBO therapy is suitable for incomplete injury,and it is recommended to perform HBO therapy within 8 h after operation,and it is best to continue treatment for more than 3 courses,which is more conducive to the recovery of neurological function and better efficacy.