胚胎脊髓组织移植联合应用神经生长因子对损伤脊髓再生修…

选择胎龄为１４－１５天的大鼠胚胎脊髓植入成年大鼠半横断的脊髓损伤腔，同时局部应用神经生长因子。术后２－８个月，用组织学、免疫细胞化学、辣根过氧化酶示踪及超微结构的检查方法证实，移植组织在宿主脊髓内的存活率为９０％，并且分化成熟，具有正常的神经组织结构特征，大多数移植物充满损伤腔，与宿主脊髓形成良好的融合，移植组织与宿主组织出现新的纤维联系，使脊髓损伤的两端恢复了解剖的连续性。     

同种胚胎脊髓移植对成年大鼠损伤脊髓组织形态与功能的修复作用

探讨大鼠胎脊髓组织移植对成年大鼠损伤脊髓组织形太民与功能的修复作用。在半切洞损伤的成年大鼠脊髓内，植入大鼠胚胎脊髓组织，术后行联合行为记分、诱发电位及组织学检查。结果“移植物能在宿主脊髓损伤部位存活，并能生长、分化、修复宿主脊髓的组织损伤，诱导宿主神经纤维系的建建，改善宿主损伤脊髓的神经传导，促进功能恢复。     

胚胎脊髓组织移植促进成年宿主损伤脊髓功能恢复的研究

目的 探讨胚胎脊髓组织移植促进成年宿主损伤脊髓功能恢复的作用。方法 采用成年大鼠脊髓半切洞损伤模型，移植胚胎大鼠脊髓组织，术后进行联合行为计分（CBS)、体感诱发电位(SEP）、运动诱发电位(MEP）和性行为及生育机能检查。结果 移植组CBS与对照组比较相差显著（P＜0.05)，移植术后4周以内两者相差非常显著(P＜0.01）；移植组SEP、MEP早期反应的峰潜伏时恢复优于对照组(P＜0.05)；术后4～12周75%的雌鼠阴道涂片检出精子并能正常生育。结论 胚胎脊髓移植能促进成年宿主损伤脊髓的功能恢复。     

胚胎脊髓移植对成鼠损伤脊髓血流量恢复的影响

以往有过不少脊髓损伤移植修复的研究报道，但有关移植后宿主脊髓血流量变化的研究却未见报道。为此，作者将胎鼠脊髓植入成鼠损伤脊髓后，用氢清除法测量了宿主脊髓血流量（Spinalcordbloodflow，SCBF），旨在探讨胚胎脊髓移植对宿主脊髓血流量恢复的影响。材料与方法以成年Wistar大鼠脊髓为移植受体。乌拉坦1．259从g腹腔麻醉后，暴露脊髓腰膨大。半切左侧脊髓，并搅毁局部脊髓组织，尔后用吸引器吸除损毁的脊髓组织。如此在半切脊髓的基础上制造了一个直径约Zmm、深达脊髓腹侧硬脊膜的盲洞、取妊娠14d服鼠颈胸段脊髓，剔除与之相连的…     

移植胚胎脊髓促进宿主损伤脊髓的组织形态重建

近年来胚胎脊髓移植研究取得了不少进展.然而移植后宿主损伤脊髓的形态结构得到明显改善的报道并不多.我们采用大鼠脊髓半切洞损伤模型,借助显微外科技术.严格控制移植的技术环节.进行大鼠同种胚胎脊髓移植研究,结果表明胚胎脊髓组织移植物较理想地促进了成年大鼠损伤脊髓的组织形态重建.     

同种胚胎脊髓移植物对成年大鼠损伤脊髓组织形态与功能的修复作用

探讨大鼠胚胎脊髓组织移植物对成年大鼠损伤脊髓组织形态与功能的修复作用。在半切洞损伤的成年大鼠脊髓内，植入大鼠胚胎脊髓组织，术后行联合行为记分、诱发电位及组织学检查。结果：移植物能在宿主脊髓损伤部位存活，并能生长、分化、修复宿主脊髓的组织损伤，诱导宿生神经纤维联系的重建，改善宿主损伤脊髓的神经传导，促进功能恢复。以上结果提示：胚胎脊髓移植物对成年大鼠损伤脊髓组织形态与功能均具有修复作用。     

不同胎龄脊髓移植物对成年大鼠完全横断脊髓修复的影响

为探讨不同胎龄大鼠胚脊髓移植植物对成年大鼠脊髓完全横断修复作用的影响，在成年大鼠完全横断脊髓内造腔，分别移植胎龄为１２天、１３天和１４天的大鼠胚胎脊髓组织，术后行常规组织学检查。结果表明，共有８２．５％的移植物能够存活、生长、分化，并可不同程度地修复受体脊髓组织的损伤，以妊娠１３在的胚胎脊髓移植物的组织修复最为理想，部分标本显示它几乎完全修复横新的受体脊髓。     

大鼠胚胎脊髓移植物对成体损伤脊髓运动功能修复的影响

为了探讨胚胎脊髓移植物对成体损伤脊髓运动功能修复的效应，取妊娠１４天胚胎大鼠脊髓组织，移植到成年大鼠脊髓半切洞损伤模型，术后进行联合行为记分（ＣＢＳ）和运动诱发电位（ＭＥＰ）检查。结果发现，移植组ＣＢＳ与对照组比较相差显著（Ｐ＜０．０５），移植术后４周以内两者相差非常显著（Ｐ＜０．０１）。移植组ＭＥＰ早期反应（Ｐ１，Ｎ１）的峰潜伏时恢复优于对照组（Ｐ＜０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤脊髓的功能修复具有促进作用。这可能与胚胎脊髓组织能分泌多种神经营养因子、神经生长因子、神经递质，或激素的调节作用有关。     

大鼠胚胎脊髓移植物对成体损伤脊髓运用能修复的影响

为了探讨胚胎脊髓移植物对成体损伤脊髓运动功能修复的效应，取妊娠１４天胚胎大鼠脊髓组织，移植到成年大鼠脊髓半切洞损伤模型，术后进行联合行为记分（ＣＢＳ）和运动诱发电位（ＭＥＰ）检查。结果发现，移植组ＣＢＳ与对照组比较相差显著（Ｐ〈０．０５），移植术后４周以内两者相差非常显著（Ｐ〈０．０１）。移植组ＭＥＰ早期反应（Ｐ１，Ｎ１）的峰潜代恢复优于对照组（Ｐ〈０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤     

实验性大鼠胚胎脊髓移植对损伤脊髓影响的观察

目的 建立了一个胚胎脊髓（ｆｅｔａｌ ｓｐｉｎａｌ ｃｏｒｄ）组织的低温保存方法笔一个损伤移植模式。方法 通过病理学、组织化学和免疫组织化学的研究,选用胎龄１４天的Ｗｉｓｔａｒ大鼠,分离胚胎脊髓,逐步降温,最后置于液氮中保存。１５天后取出,快速复温,并植入损伤大鼠脊椎内。全部动物于伤后８周处死。结果 经过低温保存的移植物能够在异体脊髓内存活并与宿主组织融合,其在损伤移植区的胶质细胞增生少于对照组。     

The prevention of iatrogenic spinal cord injury utilizing the evoked spinal cord potential

Summary The evoked spinal cord potential elicited by direct stimulation of the cord has been used clinically to monitor cord function in the course of operations on the spine. The technique used allows measurement of a relatively large amplitude of potential, which is fairly stable against anaesthetics and related drugs, by means of a simple recording system and is sensitive enough to indicate cord damage. Continuous monitoring can easily be carried out. We have encountered no complications when using this method on 99 patients.

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Résumé Le potentiel évoqué provoqué par la stimulation directe de la moelle épinière a été utilisé en clinique pour contrôler la fonction de la moelle lors des interventions sur le rachis. Cette technique permet de mesurer une assez grande amplitude de potentiel, qui est relativement stable à l'égard des anesthésiques et d'autres drogues de même type, grâce à un système simple d'enregistrement; il est suffisamment sensible pour détecter des altérations de la moelle. Une surveillance continue peut aisément être effectuée. Aucun incident n'a été rencontré chez 99 malades lors de l'utilisation de cette méthode.

     

Experimental spinal cord injury: Lumbar vertebra resection to shorten the gap between spinal cord stumps

Summary Experimental spinal cord transection injuries followed by spinal cord destruction and gentle resection of the destructed cord tissue necessarily lead to a gap between both of the cord stumps. For any attempts to reconstruct the cord or to bridge this gap by transplantation it may be useful to narrow or close the gap. This can be done by vertebral resection.The technique of upper lumbar vertebra resection in cats and rabbits with and without spinal cord lesion is presented. The spine is shortened by approximately 20 mm by spondylectomy. This length exceeds the 10–14 mm long gap in the spinal cord which is created by a spinal cord crush injury using haemostatic forceps and the subsequent destruction zone resection which is performed seven days later. The upper lumbar vertebra is resected by the posterior approach and the spinal cord is sufficiently exposed to perform spinal cord reconstruction experiments.     

Oligodendrogliomas of the spinal cord

Summary The clinical, surgical, and pathological data from 35 published cases of oligodendroglioma and of one personal case are analysed and compared with those from other tumours of the cord and from cerebral oligodendrogliomas. Oligodendroglioma of the cord has a slightly lower average age than other gliomas and is closer to that of glioblastoma. In oligodendroglioma of the cord, as of the brain, acute onset or aggravation of the symptoms and an oscillating course are frequent. Two correlated data are particularly worth noting: a) the mean CSF protein content in oligodendroglioma of the cord is higher than in any other glioma; b) intracranial hypertension, in the form of papilloedema or hydrocephalus, or both, was present in 31% of cases. This signifies cerebral oligodendrogliomatosis, which was found in 6 out of 10 necropsied cases. At operation most oligodendrogliomas of the cord appear as infiltrating gelatinous tumours, though a minority have a firm consistency and apparently clearcut contours, which seem to be associated with a better prognosis. Postoperative radiotherapy seems to be useful.     

应用改进封闭脊髓窗技术活体观察脊髓损伤后脊髓微循环变化

目的:探讨应用改进的封闭脊髓窗技术活体观察大鼠脊髓损伤后脊髓微循环变化的可行性及效果.方法:改进传统的脊髓窗,设计带有打击探头的脊髓窗.45只SD大鼠随机分为对照组(n=20)和实验组(n=25).实验组大鼠脊髓窗安装完成后进行窗内打击脊髓,然后即时观察并记录打击后2h内打击点周围微动脉直径的变化.对照组大鼠在脊髓窗安装完成后不进行打击,只对脊髓微动脉直径进行连续2h观察并记录.术后两组大鼠进行BBB运动功能评分,处死动物取脊髓标本切片,HE染色,观察脊髓组织改变情况.结果:实验组大鼠打击点周围2～6mm的微动脉直径在打击后10min、30min、1h、2h各时间点均较打击前明显减小,术后2d及7d时BBB功能评分明显低于术前,病理切片可见脊髓打击区神经组织变性液化.对照组大鼠在观测开始及结束时脊髓微动脉直径无明显变化,术后BBB评分与术前BBB评分均为21分,病理切片未见脊髓损伤表现.结论:改进的封闭脊髓窗技术可以有效地实现窗内打击脊髓,并可以安全地对脊髓表面微血管进行活体观测.脊髓表面打击点周围2～6mm的微动脉在脊髓损伤后10min即发生痉挛.     

大鼠胚胎脊髓移植后增加损伤脊髓生长抑素mRNA的表达

[目的] 研究大鼠胚胎脊髓移植后是否能够影响生长抑素（SOM）mRNA的表达。[方法]将动物分为单纯半切洞损伤组（A组）、胚胎脊髓移植组（B组）。术后1、3、7、14、28d，采用原位杂交方法观察SOM mRNA的表达，采用计算机图像分析技术，进行定量分析。[结果] 胚胎脊髓移植组SOM mRNA蛋白表达明显多于单损伤组。[结论] 作者的研究表明胚胎脊髓移植后可使损伤脊髓SOM mRNA表达增多。     

Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord

Neurological deficit is a serious though not well-known complication associated with spinal deformity. Sharp-angle kyphosis may be congenital, traumatic, degenerative, infectious, or iatrogenic in origin. Many kyphotic deformities are underestimated, thus leading to severe neurological deficit. In order to determine exactly what procedures of angulation the patients should undergo to stabilize the spine, which are major operations, the authors analyzed in an experimental model the effects of progressive sharp angulation on the anatomy of spinal canal and cord. We found that sharp anterior angulation of 50° causes ante rior-posterior stenosis and the dura will touch the spinal cord. At 90° of angulation, the spinal cord will be squeezed and the pressure in the canal will be double what it was initially, probably leading to ischemia. The experimental confirmation (determination) of these angulations allows the physician in charge to define early in the treatment program when a surgical stabilization procedure should be included, before the angulation causes any neurological damage.     

TRH对大鼠脊髓损伤后SCBF和SEP的影响

脊髓损伤（ＳＣＩ）后内源性阿片肽释放，并参与脊髓的继发损伤机制。ＴＲＨ可阻断阿片肽的自主神经效应，而不影响痛觉。本实验探讨大剂量ＴＲＨ（２ｍｇ／ｋｇ／ｈ）治疗对大鼠脊髓打击伤（Ａｌｌｅｎｓ法１０ｇｘ５ｃｍ）后脊髓血流量（ＳＣＢＦ）和脊髓诱发电位（ＳＥＰ）的影响。脊髓损伤后１ｈ，ＳＣＢＦ开始显著下降，持续至伤后２４ｈ，ＳＥＰ峰潜时呈进行性延长趋势；伤后即刻静脉注射ＴＲＨ（２ｍｇ／ｋｇ／ｈ，共５次），可使伤后即刻和２４ｈ的ＳＣＢＦ显著升高，并使伤后ＳＣＢＦ下降时间延迟３ｈ，同时ＳＥＰ峰潜时有不同程度改善。结果表明，ＴＲＨ对受伤脊髓早期有一定的防治作用，并具有一定的后发效应；同时也可促进脊髓的神经传导功能。本文亦对ＴＲＨ治疗ＳＣＩ的病理生物学机制进行了讨论。     

颈髓急性损伤后的磁共振波谱评价

目的:探讨颈髓急性损伤后磁共振波谱(1H-MRS)的诊断价值。方法:对19例急性颈髓损伤患者根据神经功能分为完全性损伤及不全性损伤两组,选取创区与创区头侧远端颈髓行1H-MRS,半定量分析氮-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)和乳酸(Lac)含量的比值。结果:颈髓完全性损伤组中NAA/Cho、NAA/Cr显著减低,Lac/Cho显著增高,其创区头侧远端Lac/Cho含量也增高(P<0.05);不完全损伤组中仅Lac/Cho含量增加,头侧远端乳酸含量亦增高(P<0.05)。颈髓损伤不同程度组间NAA/Cho、NAA/Cr有显著性差异(P<0.05)。结论:1H-MRS所测NAA/Cho、NAA/Cr从代谢水平反映颈髓损伤的不同程度,创区头侧远端Lac/Cho比值增高提示颈髓隐匿损伤的存在。     

Experimental bypass surgery between the spinal cord and caudal nerve roots for spinal cord injuries

Spinal cord injuries often cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate in adult mammalians. Re-establishing functional activity especially in the lower limbs by reinnervating the caudal infra-lesional territories could represent an attractive therapeutic strategy. For several years, we have studied and developed surgical bypasses using peripheral nerve grafts bridging the supra-lesional rostral spinal cord to the caudal infra-lesional lumbar roots. Main objectives were: 1- to overcome the spinal cord lesion and the consecutive glial barrier blocking the axonal regeneration; 2- to find and bring an alternative source of regenerating axons; 3- to guide those axons toward precisely definite targets (for example, lower limb muscles). We report here the results of our experimental research, which led us from animal experimental models (rodents, primates) to the first human experimentation. Limitations of the method (especially technical pitfalls) are numerous. However, we have obtained encouraging results in our attempts to "repair" the motor pathway. Functional recovery with strong evidence of centrifugal axonal regeneration from the spinal cord to the periphery has been observed. Regarding the sensory pathway, we have found evidence of centripetal axonal regeneration from the periphery toward the spinal cord. Further studies are obviously advocated, but our experimental model of spinal cord - nerve roots bypasses may be integrated in future "repair" strategies of both motor and sensory pathways following spinal cord injury.