BBB评分评估脊髓损伤大鼠后肢运动功能的探讨

目的：探讨大鼠脊髓损伤后和修复中如何评估人鼠后肢运动的BBB评分。方法：对4组大鼠分别行T10脊髓背侧半切断(A组)、T10脊髓全切断(B组)、T10脊髓节段全切除(C组)、T10以下脊髓全切除(D组)，制成不同损伤程度的大鼠脊髓损伤模型，对所有动物的后肢运动功能进行BBB评分和脊髓组织学观察。结果：A组大鼠BBB评分存损伤后5崩达到20分或21分，B组和C组大鼠存术后2周以后BBB评分维持在8分．D组大鼠BBB评分维持在0。B组和C组大鼠脊髓顺行追踪显示脊髓损伤区和尾侧无追踪剂分布．连续矢状冰冻切片抗神经丝(NF)染色未见连续NF通过损伤区，结论：大鼠脊髓损伤模型的后肢运动功能BBB评分如果在8分以下，就需要慎重评价，这种运动有可能完全是或包括有自发的后肢运动。     

全反式维甲酸干预鼠胚神经干细胞联合胶质细胞源性神经营养因子及硫酸软骨素酶ABC移植修复大鼠脊髓损伤的研究

目的探讨全反式维甲酸(all-trans-retinoic acid,ATRA)干预培养的鼠胚神经干细胞(neural stem cells,NSCs)联合胶质细胞源性神经营养因子(glial cell line derived neur otrophic factor,GDNF)、硫酸软骨素酶ABC(chondroitinase ABC,Ch ABC)移植治疗大鼠脊髓损伤的效果。方法取健康成年雌性SD大鼠60只,体重200~250 g,随机分为5组(n=12),分别为假手术组(A组)、损伤对照组(B组)、NSCs+GDNF移植组(C组)、NSCs+Ch ABC移植组(D组)、NSCs+GDNF+Ch ABC移植组(E组)。B~E组于T10平面横断脊髓建立脊髓全横断损伤模型,A组仅显露硬脊膜但不损伤脊髓。于术后第8天将Brd U标记的ATRA干预培养的鼠胚NSCs移植至C、D、E组大鼠,第8~14天C~E组每天对应给予10μL GDNF、10μL Ch A BC,A、B组给予等量生理盐水。术后观察大鼠一般情况;于术前1 d、术后7 d及移植后1、2、5、8周采用BBB评分评估大鼠双后肢运动功能,采用体感诱发电位(somatosensory evoked potentials,SEP)评估神经传导功能。移植8周处死各组大鼠,取移植节段脊髓行HE染色和免疫荧光染色观察。结果造模术后共5只大鼠死亡,均补充。造模术后各时间点,B~E组大鼠BBB评分均较A组降低,SEP潜伏期均较A组延长,差异有统计学意义(P0.05);造模术后7 d、移植后1周时,B~E组组间BBB评分、SEP潜伏期比较,差异无统计学意义(P0.05);移植2、5、8周,C~E组大鼠双后肢功能逐步恢复,各时间点BBB评分均高于B组,SEP潜伏期均短于B组,差异有统计学意义(P0.05);移植5、8周,E组BBB评分高于C、D组,SEP潜伏期短于C、D组,差异有统计学意义(P0.05)。HE染色示,A组灰、白质分界清楚,细胞排列规则;B组损伤区血管形态欠完整,细胞排列紊乱,可见囊腔及胶质瘢痕形成;C~E组细胞增生明显,坏死囊腔较B组小。免疫组织荧光染色示,A、B组未见明显Brd U标记阳性细胞;C、D、E组Brd U阳性细胞胞体呈橘红色,E组阳性细胞多于C、D组(P0.05)。C~E组神经胶质纤维酸性蛋白阳性细胞少于A、B组,E组少于C、D组,差异均有统计学意义(P0.05)。C~E组抗微管相关蛋白2阳性细胞多于A、B组,E组多于C、D组,差异均有统计学意义(P0.05)。结论经ATRA干预培养的NSCs联合GDNF及Ch ABC移植对大鼠脊髓损伤再修复的促进作用优于NSCs分別联合GDNF、Ch ABC,提示GDNF、Ch ABC在治疗脊髓损伤修复过程中具有协同作用。     

胶原支架结合脑源性神经营养因子移植促进全横断脊髓损伤大鼠轴突再生及运动功能恢复的研究

目的评价胶原支架结合脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)移植修复大鼠全横断脊髓损伤的效果。方法将32只成年雌性SD大鼠随机分成4组(n=8):A组为假手术组,只暴露T_9、T_(10)段脊髓;B、C、D组切除长4 mm的T_9、T_(10)段脊髓后,C、D组分别于损伤处植入相应长度的线性有序胶原支架(linear ordered collagen scaffolds,LOCS)和结合了胶原结合结构域(collagen binding domain,CBD)-BDNF的LOCS。术前及术后3个月内每周对大鼠进行BBB运动功能评分。术后3个月,实施神经电生理检测各组大鼠运动诱发电位(motor evoked potential,MEP);然后于L_2段脊髓组织注射荧光金(fluorogold,FG)实施逆行示踪,1周后取大鼠大脑及胸、腰段脊髓组织,脱水后观察脊髓组织形态;取包含损伤区的胸、腰段脊髓组织作切片。其中,脊髓冠状切片于激光共聚焦显微镜下进行观察,计算FG阳性细胞积分吸光度(IA)值;胸段脊髓组织水平切片采用免疫荧光染色,观察全横断脊髓损伤造模情况、脊髓损伤区轴突再生情况、D组再生轴突的突触形成情况。结果术后各时间点B、C、D组BBB评分均显著低于A组(P0.05);术后2～12周D组BBB评分均明显高于B、C组(P0.05)。电生理检测示,B组未观测到MEP;C、D组MEP潜伏期显著长于A组,C组显著长于D组,差异均有统计学意义(P0.05)。脊髓组织形态观察示,B组脊髓损伤区域向两端延伸,损伤部位组织破坏严重;C、D组脊髓形态恢复较好,D组更接近正常组织形态。逆行示踪结果显示,各组大鼠损伤区以下的腰段脊髓灰质中均充满了FG阳性细胞;在损伤区以上的胸段脊髓中,A组FG阳性区域IA值显著大于B、C、D组(P0.05),C、D组大于B组(P0.05),C、D组间差异无统计学意义(P0.05)。免疫荧光染色示,自同一脊髓背侧至腹侧选出的组织切片显示了明显异于正常组织的全横断脊髓损伤区域。A组NF阳性轴突数明显多于B、C、D组,C、D组多于B组,D组多于C组,差异均有统计学意义(P0.05)。结论 LOCS结合CBD-BDNF移植可以促进大鼠全横断脊髓损伤后轴突再生以及后肢运动功能恢复。     

辛伐他汀促进脊髓损伤后神经功能修复的实验研究

目的:探讨脊髓损伤后急性期应用辛伐他汀对大鼠脊髓神经功能修复的影响。方法:成年雌性SD大鼠32只,假手术组(A组)8只,只做椎板切除,不损伤脊髓,不给药,重物坠落法制作脊髓损伤模型24只,损伤大鼠随机分为三组:羧甲基纤维素钠溶液组(B组)、5mg/kg辛伐他汀治疗组(C组)和10mg/kg辛伐他汀治疗组(D组)(n=8)。术后1d开始灌胃给予辛伐他汀每天一次,连续治疗5周。术后1d、3d以及1～8周,进行BBB评分、斜板试验评价大鼠脊髓神经功能,在第8周时电生理检测大鼠运动及感觉功能的恢复情况,随后处死取材,病理学检查(Luxol fast blue染色)观察残余髓鞘情况。结果:术后2周时,BBB评分D组高于B组(P<0.05);建模3周～8周,BBB评分D组及C组均高于B组(P<0.05),且D组最高(P<0.05)。建模3周时,斜板试验D组及C组均大于B组(P<0.05),且4周～8周,D组角度均大于C组(P<0.05)。感觉诱发电位检查发现,D组,C组的潜伏期小于B组(P<0.05),且D组波幅高于B组(P<0.05)。病理学检查,D组,C组比B组有更多的髓鞘残余(P<0.05)。结论:辛伐他汀急性期治疗脊髓损伤可以促进大鼠损伤脊髓神经功能修复。     

骨髓基质干细胞移植联合应用G-CSF对大鼠脊髓损伤修复的影响

[目的]探讨骨髓基质干细胞(bone marrow stromal stem cells,BMSCs)移植联合应用粒细胞集落刺激因子(granulocyt colony stimulating factor,G-CSF)对大鼠脊髓损伤的治疗修复作用。[方法]48只Wistar大鼠采用改良的Allen’s装置在T11水平制成大鼠脊髓损伤模型,随机分成4组(n=12):A组为BMSCs移植联用G-CSF组,B、C组为单纯BMSCs移植组和G-CSF治疗组,D组为损伤对照组。术后1、2、3、4周采用Basso-Beattie-Bresnahan(BBB)评分评价大鼠后肢神经功能恢复情况,术后4周取材HE染色观察,免疫荧光染色检测神经元特异性烯醇化酶(neuron-specific enolase,NSE)、神经胶质纤维酸性蛋白质(glial fibrillary acidic protein,GFAP)和神经丝蛋白200(neurofilament 200,NF-200)的表达变化。[结果]术后1~4周,A组评分均明显高于其他3组,D组最低,差异均有统计学意义(P0.01);B组术后3、4周高于C组(P0.01)。HE与免疫荧光染色显示,BMSCs联合应用G-CSF对脊髓损伤的修复作用最好,D组恢复最差,B、C组介于A、D组之间。A组在脊髓损伤区及周缘NSE、NF 200阳性细胞均较B组多,C组未见明显的NSE、NF 200阳性细胞,但在损伤周缘有大量的GFAP阳性细胞,并向脊髓损伤空腔内延伸;D组损伤区看见大量结构杂乱的GFAP阳性细胞,瘢痕组织形成明显,损伤区未见明显的脊髓再生现象及NSE、NF-200阳性细胞。[结论]BMSCs移植能在脊髓损伤周围存活并分化;移植联用G-CSF更能促进神经修复及功能的恢复;二者联用具有协同作用。     

通用型脊髓打击器的研制与脊髓损伤动物模型的建立

目的:研制一种通用型脊髓打击器;并评估其制作脊髓分级挫伤动物模型的稳定性.方法:依据重物坠落致伤原理;设计一种通用型脊髓打击器;将50只SD大鼠;分为3个实验组和1个对照组;实验组应用该打击器以质量为20g的打击棒在不同高度实施打击:12.5mm组(A组;n=12);25mm组(B组;n=12);50mm组(C组;n=14);对照组仅行椎板切除;不打击(n=12);分别于术前、术后第2天、1周至6周进行大鼠BBB运动评分.方差分析比较各组各时间点的BBB评分;术后1周和6周取材行组织学观察;用Photoshop CS软件直方图命令处理连续切片中最大受损面积的图像;计算大鼠脊髓最大受损面积比;对BBB评分与大鼠脊髓最大受损面积比进行相关分析.取4只国产家猪;应用该打击器以50g×150mm打击能量打击后制备胸髓半侧挫伤模型;于术前、术后第2天和第7天行改良Tarlov分级法评价猪后肢功能;并进行组织学观察.结果:通用型脊髓打击器能够准确定点、定高打击制作动物脊髓损伤模型.大鼠分级脊髓挫伤模型在各个时间点上BBB评分差异有统计学意义(P＜0.05);A组和B组在术后1周后肢功能有不同程度恢复;而C组至术后6周均无明显恢复;对照组无功能障碍.大鼠和猪脊髓组织学表现均为以打击震中为中心的离心纵向损伤.大鼠脊髓最大受损面积比在各损伤组组内齐同、组间差异有统计学意义(P＜0.05);脊髓最大受损面积比与BBB评分呈密切负相关关系(r=0.89807;P＜0.001).猪脊髓半侧挫伤后Tarlov分级法评价显示为中重度损伤.结论:研制的通用型脊髓打击器可成功建立不同损伤程度、稳定性高的大鼠急性脊髓挫伤模型;并可用于建立猪脊髓挫伤模型.     

多次移植骨髓基质干细胞有利于脊髓损伤修复

[目的] 研究多次经蛛网膜下腔移植骨髓基质干细胞对Wistar大鼠脊髓损伤的功能修复作用.[方法] 骨髓基质干细胞经体外分离、培养并用Hoecst33342标记.按照Allen方法把60只在T_(10)-T_(12)平面损伤的Wistar大鼠随机分4组,A、B、C、D组(对照组).在损伤平面蛛网膜下腔中段放置一硅胶管,在7 d后,注入1×10~6个骨髓基质干细胞.在2、3、5、7、12周荧光显微镜、免疫组化检测骨髓基质干细胞在损伤段脊髓的存活、分布、分化情况并作计数观察.使用BBB评分观测后肢功能恢复.[结果] 移植后7～14 d骨髓基质干细胞达到高峰,在7 d后表达巢蛋白及神经丝蛋白阳性.随时间的延长,移植在损伤部位的骨髓基质干细胞数量及神经元样细胞均有减少,但移植3次的细胞数减少速度较其他两组慢.移植3次组大鼠的BBB评分较移植1、2次组有明显的提高,P＜0.01,有统计学意义.[结论] 多次移植骨髓基质干细胞更有利于脊髓损伤的恢复.     

硫酸软骨素酶ABC及Nogo-66受体拮抗剂联合鼠胚神经干细胞移植对大鼠脊髓损伤的影响

目的:研究硫酸软骨素酶ABC(chondroitinase ABC,Ch ABC)、Nogo-66受体拮抗剂[Nogo-66(1-40)antagonist peptide,NEP1-40]及鼠胚神经干细胞(neural stem cells,NSCs)联合移植对大鼠损伤脊髓功能恢复的影响。方法:体外应用全反式维甲酸(all-trans-retinoic acid,ATRA)(浓度1.0μmol/L)诱导NSCs(前期实验分离、培养并冻存的鼠胚NSCs),诱导后鉴定NSCs特异性标志物,移植前通过5-溴脱氧尿嘧啶核苷(5-Bromo-2-deoxy Uridine,Brdu)标记NSCs。将60只SD大鼠随机分为假手术组(A组,n=10)、损伤对照组(B组,n=10)、NSCs治疗组(C组,n=10)、NSCs联合Ch ABC治疗组(D组,n=10)、NSCs联合NEP1-40治疗组(E组,n=10)、NSCs联合Ch ABC和NEP1-40治疗组(F组,n=10)。移植前分别对B、C、D、E及F组的大鼠制作胸段脊髓全横断损伤模型。术后3d,E和F组经留置的导管注入NEP1-40 20μl/d,连续28d;术后8d,C、D、E及F组经留置导管注入经ATRA干预和Brd U标记的NSCs 10μl;术后8d,D组和F组经留置导管注入Ch ABC 10μl/d,连续7d;各时间点通过留置导管注入生理盐水保持各组移植液等量。术前及术后不同时间点,用BBB评分和体感诱发电位(somatosensory evoked potentials,SEP)潜伏期对大鼠后肢神经功能进行评价。移植后8周通过HE染色观察损伤脊髓组织情况,免疫荧光染色观察移植NSCs存活、神经元分化及轴突生长情况。结果:体外应用1.0μmol/L的ATRA诱导NSCs培养,可提高NSCs向神经元分化的比例。移植后2周开始各组大鼠BBB评分、SEP潜伏期开始观察到改善,移植治疗各组均优于损伤对照组,组间BBB评分和SEP潜伏期有差异(P0.05);移植后2周、5周、8周各时间点,B组与C、D、E及F组比较,BBB评分和SEP潜伏期较差(P0.05);在移植治疗各组中,F组神经功能的恢复最明显,F组与C、D及E组比较具有较高的BBB评分和较短SEP潜伏期(P0.05)。移植后8周,HE染色显示:A组细胞结构完整、排列规则;B组组织结构严重破坏,细胞排列紊乱,见大量较大的囊腔及胶质瘢痕形成;C、D、E及F组细胞增生明显,囊腔较少。免疫荧光染色显示:C、D、E及F组内可见橘红色Brdu标记阳性细胞,F组阳性细胞数多于C、D和E组,差异具有统计学意义(P0.05)。C、D、E、F组微管相关蛋白-2(microtubule-associated protein 2,MAP-2)标记阳性细胞数多于B组,F组多于C、D、E组,差异有统计学意义(P0.05);C、D、E、F组MAP-2标记阳性细胞面积大于B组,F组大于C、D、E组,差异有统计学意义(P0.05)。结论:ATRA诱导后NSCs移植可促进大鼠脊髓损伤功能的恢复,且联合Ch ABC和NEP1-40移植对损伤脊髓功能的恢复具有协同促进作用。     

周围神经移植联合神经营养因子修复脊髓传导束的实验研究

目的探讨周围神经移植联合神经营养因子修复脊髓传导束的可行性并观察其再生的情况。方法121只Wistar雄性大鼠被随机分成5组,A组(实验组,n=25):在T9水平横行切断脊髓并切除5mm,植入肋间神经和含酸性成纤维因子(acidicfibroblastgrowthfactor,aFGF)纤维蛋白凝胶;B组(水平对照组1,n=25):同法制备脊髓横断模型,断端间由含aFGF的纤维蛋白凝胶填充;C组(水平对照组2,n=25):同法制备脊髓横断模型,断端间植入肋间神经和不含aFGF的纤维蛋白凝胶;D组(水平对照组3,n=25):同法制备脊髓横断模型,断端间旷置;E组(空白对照组,n=21):仅行椎板切除术。通过BDA顺行神经示踪、FG逆行神经示踪、运动诱发电位(MEP)和大鼠BBB后肢运动功能评分,观察脊髓传导束再生的情况。结果A组在损伤区有BDA标记的神经纤维通过,在颈髓背角和腹侧角、脑干中缝核和红核、网状结构、前庭侧核以及在大脑运动皮层的第V层均发现FG标记阳性的神经细胞数。A组大鼠MEP的平均潜伏期和波幅以及BBB功能评分明显提高,与B、C和D组比较差异有统计学意义(P<0.01)。结论周围神经移植联合神经营养因子能部分修复脊髓传导束。     

BMSCs静脉移植对大鼠脊髓损伤后神经功能恢复的影响

[目的]探讨骨髓间充质干细胞(BMSCs)静脉移植对大鼠脊髓损伤后神经功能恢复的影响.[方法]利用多中心急性脊髓损伤打击器(MASCIS Impactor)建立大鼠T11脊髓损伤模型,建模成功后随机分为两组:对照组(A组)、BMSCs移植组(B组).SCI后1周,A组自大鼠尾静脉注射无血清的DMEM/F12培养液0.1ml,B组自大鼠尾静脉注射移植BMSCs悬液0.1ml.两组大鼠于SCI后1、2、4、8周行BBB后肢运动功能评分,SCI后2、4、8周行SEP检测及脊髓组织病理学检查(HE染色与NF200免疫组化染色).[结果]SCI后2、4、8周,与A组比较,B组BBB评分升高,SEP N1潜伏期缩短、P1-N1波幅增高,差异均有统计学意义(P＜0.01);SCI后8周大鼠脊髓组织HE染色显示,两组大鼠脊髓组织损伤区均可见瘢痕组织及空洞形成,但B组脊髓空洞比A组小;SCI后2、4、8周,NF200免疫组化染色显示,两组大鼠脊髓组织均有NF200阳性表达,与A组比较,B组各时间点NF200阳性表达均增强,差异有统计学意义(P＜0.01).[结论]BMSCs静脉移植对大鼠SCI后神经功能的恢复有明显的促进作用.     

大鼠脊髓损伤后巢蛋白在脊髓组织中的表达

目的探讨大鼠脊髓损伤后巢蛋白(nestin)的表达规律及其意义。方法30只Wister成年大鼠,随机分为正常对照组(A组)、损伤组(B组)。采用Allen打击模型(25g·cm),在T10段造成急性脊髓损伤,于损伤后1d、3d、1周、4周、8周进行取材,对距离损伤中心5mm处脊髓进行nestin免疫组化检测。应用图像分析软件进行nestin阳性区域面积侧算。结果A组脊髓室管膜细胞只可见极少数细胞胞浆内nestin表达,白质中几乎无表达。B组中nestin于损伤后24h表达于室管膜以及软膜,灰质和白质亦有少量表达,1周达到高峰(P<0.05),4周明显下降,8周时很少或几乎无表达。结论脊髓组织的许多部位可能存在具有分化和更新潜能的祖细胞,脊髓损伤后这些细胞被激活,在功能恢复中可能发挥着重要的作用。     

Chronic regenerative changes in the spinal cord after cord compression injury in rats

Long-term regenerative changes and pathological effects after acute compression injury of the spinal cord were studied in rats. Twenty adult female Wistar rats underwent cord injury by the extradural clip compression technique at T6-7. Following injury, extradural electrodes attached to receiver-stimulators that were implanted subcutaneously were placed proximal and distal to the injury site. The animals were maintained in cages with electromagnetic fields created by encircling antennae. The control animals were in a field adjusted to a frequency below the sensitive frequency range of the receiver-stimulators so that they received no spinal cord stimulation. After 15-20 weeks of continuous spinal cord stimulation, histological sections of the cords were assessed and scored blindly for pathological changes including magnitude and extent of cord injury, and cystic cavitation, and for regenerative changes including proliferation of axons, Schwann cells and ependymal cells, and formation of myelin. In all 20 animals, there was a complete absence of normal cord tissue at the injury site, and cystic cavitation was frequently present at the injury site and beyond. Extensive regenerative changes were seen in all animals including regeneration of axons, Schwann cells and ependymal cells, and formation of myelin. Statistical analysis did not show a significant difference between treatment and control groups.     

脐血库建立中脐血筛选标准的制定及意义

目的探讨脐血筛选标准的制定及在脐血库建立中的意义.方法按脐血采集量、总有核细胞数、细胞活率、病原学感染、有无凝块等作标准进行脐血采集筛选,分析筛选后库存脐血的质量.结果1998年6月至1999年12月共采脐血1625例,合格899例,占55.3%.其中879例分离冻存,占54.1%;不合格726例,占44.7%,不合格原因主要为脐血采集量少、有凝块、细胞活率低、超时送检、总有核细胞数低等.879例库存脐血总有核细胞数平均为1.236×109,平均有效移植体重为33.4kg,88.9%的库存脐血能满足体重为20kg以上的患者移植.脐血细菌培养共检出4例阳性,巨细胞病毒抗体3例阳性,人类免疫缺陷病毒抗体(HIV-1/2Ab)、EB病毒抗体(EBV-IgA)、乙型肝炎病毒表面抗原(HBsAg)、丙型肝炎病毒抗体(HCV-Ab)均为阴性.9例脐血移植中6例获得植入.结论脐血筛选标准的制定可节省建库费用,提高库存脐血质量,使库存脐血均符合临床移植要求,在脐血库的建立中起着重要作用.     

Spinal cord evoked injury potentials in patients with acute spinal cord injury

Six patients were examined in the acute stage of spinal cord injury, between 11 h and 12 days posttrauma. Quadripolar epidural electrodes were positioned either percutaneously using a Tuohy needle or directly into the epidural space during surgical intervention. These electrodes were combined with a common reference to obtain monopolar recordings of spinal cord evoked potentials resulting from either median nerve stimulation at the wrist or tibial nerve stimulation at the popliteal fossa. Spinal cord evoked injury potentials (SCEIPs), stationary potentials with positive polarity on the distal aspect of the lesion and negative polarity on the proximal aspect, were recorded in all cases. The average amplitude (n = 3) of the SCEIP resulting from tibial nerve stimulation as measured across the lesion was 13.5 microV with an average duration of 12.7 msec. For median nerve stimulation, the average amplitude (n = 3) of the SCEIP was 16.3 microV with an average duration of 6.7 msec. There was a change in polarity in all cases over a distance of less than 6 mm, the distance between the electrode contacts on the epidural electrode. In one case, recordings were performed initially at 11 h and repeated at 21 days posttrauma. In the latter recording, the SCEIP was still present but was five times smaller in amplitude. Coincidentally, the patient also showed clinical signs of improvement in sensory and motor spinal cord function. This study demonstrates the feasibility of recording the SCEIP in patients with acute spinal cord injury, describes the features of these SCEIPs, discusses their origins, and explores the utility of recording the SCEIP as an aid in determining the severity of the injury as well as a means of monitoring changes in spinal cord function.     

大鼠脊髓损伤后血脊髓屏障通透性变化的观察

目的：探讨脊髓损伤后血脊髓屏障通透性变化的机理。方法：采用美国纽约大学（New York University,NYU)脊髓损伤模型,选用体重300－350克雄性成年Wistar大鼠35只,随机分为对照组5只;脊髓损伤组30只,分为伤后4、6、12、24、48、72h6组,每组5只,应用NYU脊髓损伤模型,采用免疫组织化学方法,观察脊髓损伤后不同时间免疫球蛋白G（immunglobularprotein,G,IgG)、补体3的C片断（c fragment of complement3,C3c)的表达变化。结果：脊髓损伤后C3c、IgG渗入了脊髓损伤区域、损伤区域周边及血管,脊髓损伤不同时间段这些区域的免疫标记不同。结论：脊髓损伤后C3c、IgG参与了血脊髓屏障的破坏,参与了脊髓损伤后神经细胞的继发性损伤。     

Spinal cord compression in pseudohypoparathyroidism

Background contextSpinal cord compression associated with pseudohypoparathyroidism (PHP) is an increasingly reported sequelae of the underlying metabolic syndrome. The association of neurologic dysfunction with PHP is not well appreciated. We believe this to be secondary to a combination of underlying congenital stenosis, manifest by short pedicles secondary to premature physeal closure, and hypertrophic ossification of the vertebral bony and ligamentous complexes.PurposeThe purpose of this case report is to review the case of spinal stenosis in a child with PHP Type Ia. We are aware of only eight published reports of patients with PHP Type Ia and spinal stenosis—there are only two previously known cases of pediatric spinal stenosis secondary to PHP.Study design/settingThis is a case report detailing the symptoms, diagnosis, interventions, complications, and ultimate outcomes of a pediatric patient undergoing spinal decompression and fusion for symptomatic stenosis secondary to PHP Type Ia. Literature search was reviewed regarding the reports of spinal stenosis and PHP, and the results are culminated and discussed.Patient sampleWe report on a 14-year-old obese male with PHP and progressive lower extremity weakness secondary to congenital spinal stenosis. Examination revealed functional upper extremities with spastic paraplegia of bilateral lower extremities. The patient's neurologic function was cautiously monitored, but he deteriorated to a bed-bound state, preoperatively.MethodsThe patient's chart was reviewed, summarized, and presented. Literature was searched using cross-reference of PHP and the terms “spinal stenosis,” “myelopathy”, “myelopathic,” and “spinal cord compression.” All relevant case reports were reviewed, and the results are discussed herein.ResultsThe patient underwent decompression and instrumented fusion of T2–T11. He improved significantly with regard to lower extremity function, achieving unassisted ambulation function after extensive rehabilitation. Results from surgical decompression in previously reported cases are mixed, ranging from full recovery to iatrogenic paraplegia.ConclusionsThe association of neurologic dysfunction with PHP is not well appreciated. It is important to highlight this rare association. Surgical decompression in patients with PHP yields mixed results but may be of greatest efficacy in younger patients who receive early intervention.     

Methylprednisolone in spinal cord compression

In acute nonsurvival studies, eight anesthetized lambs were subjected to cord compression at T13 by means of an epidural balloon distended to a pressure of 200 mm Hg for 40 minutes. Subsequent to withdrawal of the balloon, each animal received 30 mg/kg of methylprednisolone succinate in an intravenous bolus followed by a continuous infusion of 10 mg/kg/hr for the duration of the experiment. Spinal cord blood flow (SCBF) and spinal evoked potential (SEP) determinations were obtained sequentially prior to, during, and at 1/2, 1 1/2, and 2 1/2 hours following compression. In spite of the absence of ischemia following compression, SEPs failed to recover. Methylprednisolone had no apparent effect on blood flow or on the recovery of SEPs when compared with results in ten control animals that received saline alone.