不同预防硬膜外粘连的方法对神经电生理功能的影响

目的探索预防硬膜外粘连的几种方法对脊髓、神经根传导功能的影响。方法40只新西兰白兔随机分为4组。切除L5椎板造成12mm×6mm硬脊膜裸露区,探查神经根。A组注入生理盐水1ml,B组充填高分子量透明质酸钠凝胶1ml,C组用自体L6棘突重建L5椎板,D组用透明质酸钠凝胶充填后再进行L5椎板重建。分别检查术前、术后即刻、术后1、3、6周腓肠肌诱发肌电图,记录M波、H波。结果术后H波潜伏期显著延长,B、D组1周恢复正常,C组3周恢复正常,A组6周恢复正常。M波手术前后潜伏期无明显差异。M波、H波波幅个体差异大,手术前后无明显差异。结论通过测定肌肉动作电位H波潜伏期可灵敏反映神经根、脊髓传导功能;透明质酸钠凝胶能促进脊髓、神经根传导功能的恢复。     

医用自交联透明质酸钠凝胶预防兔硬膜外粘连的安全性研究

目的利用体感诱发电位及运动功能评分,评价医用自交联透明质酸钠凝胶预防椎板切除术后硬膜外粘连的安全性。方法将L5全椎板切除的新西兰兔24只随机分为4组,A组为对照组:术区生理盐水冲洗后关闭切口;B组、C组、D组均为实验组:均在术区硬脊膜暴露区覆盖医用自交联透明质酸钠凝胶,而覆盖剂量各不相同,分别为0.5、0.75和1.0ml。分别于麻醉后,椎板切除术后,闭合手术切口之后,术后8周这4个时间点进行体感诱发电位监测并记录潜伏期值。并分别于术前,术后1d,术后8周对各组动物进行后肢运动功能评分。结果麻醉后和椎板切除术后各组潜伏期值无统计学差异(P0.05)。在关闭切口后测定各组的潜伏期值显示:A组和B组潜伏期值均无延迟(P0.05),C组和D组潜伏期值出现明显延迟(P0.05)。在术后8周复测各组潜伏期值,均处于正常范围(P0.05)。运动功能评分结果:术前所有动物评分均正常。在术后1d,A组和B组动物的评分仍然正常,C组和D组的动物评分下降。在术后8周,各组动物的运动功能评分均再次正常。结论体感诱发电位是测定脊髓损伤的敏感指标;椎板切除术后局部覆盖预防粘连剂有剂量的要求,0.5ml的医用自交联透明质酸钠凝胶不会对该动物模型的脊髓的电生理功能及后肢运动功能产生影响。     

应用丝裂霉素C预防椎板切除术后硬膜外粘连的安全性研究

目的探讨局部应用丝裂霉素C预防大鼠椎板切除术后硬膜外粘连的安全性。方法 48只SD大鼠行L1节段椎板切除术,暴露硬脊膜,术中各组分别以棉片浸透生理盐水(C组)或0.7mg/ml(H组)、0.5mg/ml(M组)、0.3mg/ml(L组)的MMC,置于裸露的硬脊膜后方5分钟。分别测定实验动物手术前、后的热板痛阈、BBB评分、斜板试验、体感诱发电位潜伏期,进行安全性评价。结果各组动物行椎板切除手术前、后的痛阈、后肢功能、体感诱发电位潜伏期差异无统计学意义﹙0.05﹚。结论在椎板切除术中局部应用0.7mg/ml或较低浓度的MMC,对大鼠的痛觉、运动、神经传导功能的无明显影响,该方法具有良好的安全性。     

三七透明质酸钠凝胶干预硬膜外瘢痕中α-平滑肌肌动蛋白的表达

背景:脊柱椎板减压后硬膜外瘢痕是导致继发性椎管狭窄的重要原因之一。研究证实局部应用三七凝胶能有效预防术后硬膜外瘢痕粘连的形成。目的:进一步验证三七透明质酸钠凝胶在家兔硬膜外瘢痕组织中α-平滑肌肌动蛋白表达的影响。方法:大耳白品系家兔96只,随机方法分为4组,制作家兔椎板切除模型,分别在兔硬膜囊周围涂抹生理盐水、三七浓缩液、透明质酸钠、三七透明质酸钠凝胶各0.5 mL,用药后1,2,4,8周取材,采用免疫组织化学方法分析α-平滑肌肌动蛋白抗体的表达。结果与结论:用药1,2周时,与生理盐水组比较,其他3组α-平滑肌肌动蛋白抗体表达明显降低(P0.01或P0.05),三七透明质酸钠凝胶组与三七组、透明质酸钠组差异不显著(P0.05);用药4,8周时,三七透明质酸钠凝胶组α-平滑肌肌动蛋白抗体表达明显低于其他3组(P0.01或P0.05),三七组、透明质酸钠组与生理盐水组差异不显著(P0.05)。结果证实三七透明质酸钠凝胶抑制α-平滑肌肌动蛋白的表达,减轻瘢痕挛缩。     

Micro-CT联合硬膜外造影在医用自交联透明质酸钠凝胶预防椎板切除后硬膜外粘连中的应用

背景：二维平面角度已证实医用自交联透明质酸钠凝胶能够在术后8周有效预防兔椎板切除后硬膜外粘连的发生。 目的：应用Micro-CT联合硬膜外造影技术观察和评估自交联透明质酸钠凝胶预防椎板切除后硬膜外粘连的可行性。 方法：将18只L₅椎板全切除的新西兰大白兔随机分组：对照组用生理盐水冲洗术区后关闭切口;HyaRegen/SPⅠ组用医用自交联透明质酸钠凝胶HyaRegen/SPⅠ 0.5 mL覆盖暴露硬脊膜后关闭切口;HyaRegen/SPⅡ组用医用自交联透明质酸钠凝胶HyaRegen/SPⅡ 0.5 mL覆盖暴露硬脊膜后关闭切口。 结果与结论：各组体感诱发电位潜伏期均无明显延长,3组间差异无显著性意义(P > 0.05)。Micro-CT联合硬膜外造影扫描并三维重建后显示,HyaRegen/SPⅠ组及HyaRegen/SPⅡ组对比剂能够顺利充盈硬膜外间隙,对照组对比剂充盈不顺畅,在术区局部形成多处充盈缺损。HyaRegen/SPⅠ组及HyaRegen/SPⅡ组术区硬脊膜外单位体积内对比剂充盈体积均高于对照组(P < 0.05),前2组间差异无显著性意义(P > 0.05)。对照组硬膜外粘连程度要远高于HyaRegen/SPⅠ组及HyaRegen/SPⅡ组(P < 0.05)。证实医用自交联透明质酸钠凝胶可有效预防兔椎板切除后硬膜外粘连的发生,应用Micro-CT联合硬膜外造影技术能有效观察和评估硬膜外粘连。     

神经根刺激H反射的指标分析

目的：探讨神经根刺激H反射(NRSH)各指标的意义及其H—M起始与峰间期的关系。方法：选择无腰骶神经根病及周围神经病的正常人15例(30侧)，行常规H反射及NRSH检查并作碰撞实验。结果：NRSH H—M起始间期较峰间期显著延长；各指标聚类得出3个独立因子，因子1和主要常规H反射H—M间期显著相关，因子2和NRSH H—M间期显著相关，因子3和常规H反射M波起始潜伏期显著相关。结论：H波由传导速度相对较慢的α运动神经传导是引起H—M起始间期较峰间期延长的原因，H—M峰间期更合理地反映了S１神经根的传导功能；NRSH的H—M间期主要反映神经根的传导功能，而常规H反射H—M间期则反映了坐骨神经近髓段的传导功能。     

医用自交联透明质酸钠凝胶预防兔腰椎板切除术后硬膜外粘连的实验研究

目的:通过大体观察、组织学观察及羟脯氨酸浓度分析,评估两种医用自交联透明质酸钠凝胶——HyaRegen/SPI和HyaRegen/SPII预防椎板切除术后硬膜外粘连的效果.方法:将Ls全椎板切除的新西兰兔36只随机分为3组(n=12).A组为对照组,术区生理盐水冲洗后关闭切口;B组和C组为实验组,分别在暴露出的硬膜外覆盖HyaRegen/SPI 0.5 ml和HyaRegen/SPII 0.5 ml后关闭切口.所有动物术后8周予以安乐死,完整切下脊柱节段(L4～6)进行如下评估.①对硬膜外粘连程度进行大体观察,并根据Rydell标准进行分级;②对标本进行组织学观察和评估;③取术区硬膜外背侧少量瘢痕组织行羟脯氨酸浓度分析.结果:大体观察发现,A组硬膜外粘连严重、无法完整分离,而B组及C组未见明显粘连,A组的粘连程度Rydell分级要远高于B组和C组(P＜0.05);组织学观察发现3组均在原椎扳切除术区形成大量新生骨,不同的是A组新生骨下可见广泛而致密的硬膜外粘连,脊髓向背侧牵拉,硬膜外间隙消失,而B组和C组新生骨下可见极少量瘢痕组织,硬脊膜表面光滑,未与周围组织形成粘连,硬膜外间隙存在,进行组织学评级后发现B组和C组之间差异无统计学意义(P＞0.05),分别与A组比较,差异均有统计学意义(P＜0.05);羟脯氨酸浓度分析结果显示B组、C组瘢痕组织中羟脯氨酸浓度要明显低于A组(P＜0.05).结论:两种医用自交联透明质酸钠凝胶(HyaRegen/SPI和HyaRegen/SPII)均能够在术后8周有效预防新西兰兔椎板切除术后硬膜外粘连的发生.     

颈椎椎板切除术后神经根病的解剖学研究

目的 :探讨多节段颈椎椎板切除术后神经根病的解剖学基础及其发病机理。方法 :对 2 0具 (4 0侧 )成人固定标本的颈段脊髓、椎管及颈段神经根进行观察 ;其中 5具标本模拟颈椎椎板切除术 ,观察脊髓的反弹情况。结果 :颈神经脊髓附着端至椎间孔内侧缘距离平均为 8.5± 0 .3(3.5～ 11.0 )mm ,以C5、C6 最长 ;脊髓反弹紧贴椎管后壁时颈神经根移动平均为 1.2± 0 .5 (0～ 2 .0 )mm ,以C5、C6 神经根移位最大 ,而硬脊膜囊在椎间孔处对移动的脊神经根形成栓系。结论 :颈椎后路减压术后神经根病的发生最可能的原因是脊髓反弹引起神经根栓系卡压 ,神经根病的发病与脊髓反弹时神经根的移动度有关     

兔腰骶神经根牵拉的微循环和体感诱发电位变化的研究

目的建立一种不同程度的腰骶神经根牵拉损伤动物模型,探讨脊髓神经根牵拉损伤后微循环和电生理改变。方法将40只中国大白兔随机分为对照组、轻度牵拉组、中度牵拉组和重度牵拉组。全椎板切除显露双侧荐1神经根,用测力神经根拉钩分别以不同的拉力造成神经根的牵拉性损伤。行体感诱发电位监测神经根和骶髓微循环研究。结果轻度牵拉组SEP潜伏期比对照组相稍延长(P>0.05),神经根和骶髓微血管密度轻度增加;中度牵拉组SEP潜伏期明显延长(P<0.05),去除牵拉后潜伏期接近正常(P>0.05),神经根和骶髓微血管密度明显增加;重度牵拉组SEP潜伏期明显延长(P<0.01),去除牵拉后潜伏期稍缩短,和对照组仍存在显著性差异(P<0.05),神经根和骶髓微血管密度轻度增加。结论以拉力为参数可以稳定的建立不同程度的腰骶神经根牵拉性损伤动物模型,微血管密度和SEP可以较好的衡量神经根和脊髓的损伤程度。     

脊髓圆锥部SPR和SAR手术脊神经根辨认的应用解剖学

目的 :为脊髓圆锥部进行SPR和SAR手术提供定位、入路和辨认神经根的解剖学依据。方法 :选 14具儿童脊柱标本 ,显露脊髓圆锥及其马尾神经。观测该区域神经根位置、形态及其与周围组织的关系。结果 :脊髓圆锥末端大多数平对L1椎板。L1神经根硬膜出口亦位于L1椎板范围内 ,神经根在该区域按顺序排列。S1后根最粗 ,S2 明显变细 ,S3～ 5最细。神经后根进入脊髓角度以L5最大 ,S1其次 ,S2 角度骤然变小 ,与脊髓接近平行。结论 :仅处理L1椎板即可满意显露所需处理的神经根。 6cm皮肤切口即可达显露要求。根据终丝 ,L1神经根硬膜出口 ,S1和S2 的形态特征以及节段血管等四个方面综合鉴别能准确辨认神经根。     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.