轻型创伤性中央脊髓综合征27例分析

创伤性中央脊髓综合征（Traumatic Central Cord Syndrome简称TCCS）又称急性中央颈脊髓损伤综合征,是一种急性的中央颈脊髓损伤,最为常见的急性颈脊髓不完全性损伤,其主要特点为上肢运动功能受累明显而下肢受累较轻或不受累、直肠膀胱功能障碍以及损伤平面以下感觉不同程度的损害,     

脊髓损伤患者的步行功能评定

步行功能的改善或恢复是脊髓损伤康复的主要目的之一。步行功能评定是脊髓损伤患者功能能力评定的重要内容。目前临床上常用的许多评定方法如：功能独立性评定（functional independence measure,FIM）、巴氏指数（barthel index,BI）、改良巴氏指数（modified barthel in- dex,MBI）、脊髓损伤独立性评定（spinal cord independencemeasure，SCIM）均涉及到步行功能评定。     

颈椎病脊髓功能的神经学评价

对颈椎病脊髓功能的客观评定，有助于病因探讨、疗效评估和预后判断，便于交流和研究。国内外用于颈椎病脊髓功能评定的方法很多，本文就其神经学方面的评价进行综述。     

脊髓损伤残疾的运动功能评价

脊髓损伤残疾的运动功能评价丁伯坦体育运动是促使脊髓损伤患者全面康复的一种重要方法。自从英国著名脊髓损伤治疗和康复专家Ｌ．Ｇｕｔｔｍａｎ于本世纪４０年代开创应用体育运动方法促进脊髓损伤患者康夏以来，脊髓损伤患者死亡率显著降低，生存期明显延长。各种并发症...     

慢性压迫性颈脊髓病患者的肺功能变化

目的：探讨慢性压迫性颈脊髓病对患者肺功能的影响。方法：８３例脊髓型颈椎病患 获得平均１７．９个月随访,分别对患者术前、术后的脊髓评定分值和肺功能检查结果进行统计、分析。结果：⑴慢性压迫性颈脊髓病患者通气功能障碍程度与其脊髓功能损害程度呈极显著的正性相关,Ｐ〈０．００１。⑵术后、术前通气功能（ＶＣ％）有显著性差异,Ｐ〈０．００１;通气功能（ＶＣ％）改善程度与脊髓功能的改善呈正相关,Ｐ〈０．０５。结论     

颈髓兴奋性神经元在维持脊髓损伤小鼠呼吸功能中的作用

正呼吸功能障碍是创伤性颈脊髓损伤的常见并发症,也是导致死亡的主要因素。各种脊柱退变、感染、肿瘤或血管疾病均可引起非创伤性颈脊髓损伤,进而导致严重的颈髓损伤、运动神经元损害和神经功能缺损,但呼吸功能障碍并不显著。本研究的目的在于观察非创伤性颈脊髓损伤赖以维持呼吸功能的颈脊髓微循环的变化,旨在寻找创伤性脊髓损伤后恢复呼吸功能的潜在方法。     

经口咽前、后路一期手术治疗难复性寰枢椎脱位伴脊髓压迫症

目的：总结经口咽前路同时后路减压枕颈内固定治疗难复性寰枢椎脱位的临床效果。方法：C地10例难复性寰枢椎脱位,根据术前临床分型安排前后路手术顺序。同时期进行经口咽前路减压松解复位和后路减压,枕颈CD或Cervifix枕颈内固定。按JOA17分法颈脊髓损害功能评定标准进行手术前后颈髓功能评定,并测量比较脊髓矢径的变化。结果：平均随访8个月。仍髓功能改善率达58．3％,颈髓减压改善率平均达69％。结论：经口咽前路减压同时行后路减压枕颈内固定手术的临床疗效佳,适用于难复性寰枢椎脱位或不可复性寰枢椎脱位伴颈髓压迫症。     

脊髓损伤残疾预防与早期康复

脊髓损伤残疾预防与早期康复关骅１脊髓损伤是因各种不同原因引起的脊髓结构、功能的损害，造成损伤不平以下脊髓功能（运动、感觉、括约骨及反射功能）的障碍。脊髓损伤可分为外伤性和非外伤性脊髓损伤。非外伤性脊髓损伤主要因脊柱、脊髓的病变（肿瘤、炎症、结核等）所...     

脊髓损伤的功能独立性评定的应用

脊髓损伤的功能独立性评定的应用王彤，周士枋，励建安为进一步反映脊髓损伤对病人功能及生活能力的影响，指导医务人员制定有效的康复治疗计划及监测治疗效果，必须有一个标准的日常生活能力测定方法。以往国际上通用的功能评定方法很多，象Ｂａｒｔｈｅｌ指数和ＰＵＬＳ...     

颈椎脊髓损伤的治疗现状和进展

颈脊髓损伤多源于交通伤、坠落伤、运动伤或暴力，患者多为青壮年，损伤后可出现截瘫、呼吸障碍甚至死亡。除损伤引起的颈椎管连续性破坏，骨折或脱位压边颈脊髓，后期的继发性损伤也是造成脊髓功能障碍的主要原因、近年来，我国对颈脊髓损伤的治疗取得了很大进步，包括现场急救水平的提高、外科干预和内固定技术的改进、保护神经细胞和促神经生长药物的临床应用、减少继发性损伤、理想的康复等措施，使对颈脊髓损伤患者的救治获得了满意的结果。文章评述了颈脊髓损伤的治疗现状及未来研究的设想。     

体感诱导电位在可逆性脊髓损伤和根性病损中的应用

为了弄清脊髓损伤的发展规律，我们对动物模型从Ａｌｌｅｎ的背侧撞击改用腹侧撞击，使其更接近于脊髓损伤的模式。在一定功率下可使动物模型产生可逆性单侧损伤，从而观察脊髓损伤后的病理变化。用０．０１５８Ｊ／ｃｍ的力，制成不全截瘫的动物模型，并用ＳＥＰ波型及其潜伏值来进行定量分析，了解伤后的发展进程，同时通过病理观察；与ＳＥＰ检查匹配，对脊髓损伤的程度和变化有一个比较清楚的概念。对脊髓损伤，完全性操作不会出现ＳＥＰ波，一旦ＳＥＰ波出现，说明脊髓功能已存在，单从波形角度考虑，不能说明可以恢复，应看其发展过程中潜伏值的变化，比较上、下肢的潜伏值系数，才具有显著的评估意义。可以看出潜伏值的变化与临床表现有密切关联。ＳＥＰ只能代表脊髓的感觉功能，而不能代表运动功能。     

A new scale for the clinical assessment of spinal cord function.

The systems currently used for grading the severity of neurologic injuries have serious limitations. The authors have developed a neurologic grading system to assess spinal cord function. This is a new, functionally oriented scale which can be used at the bedside and requires no special tests other than those done in a routine clinical neurological examination. This scale includes assessment of motor and sensory function, rectal tone, and bladder control. A major advantage of this scale is that motor function is assessed on a functional rating system. To evaluate the usefulness of this scheme, patients who have been previously entered into a prospective study on the surgical treatment of burst fractures were re-evaluated. A significant number of patients under our new reclassification system were noted to have had significant improvement which had been overlooked using the Frankel Grade system. The authors conclude that their new spinal cord assessment technique has many advantages and suggest that it be used by spinal cord injury centers.     

急性中央型颈髓损伤综合征的临床治疗

目的探讨急性中央型颈髓损伤综合征的临床治疗.方法对30例急性中央型颈髓损伤综合征患者,根据病情分别采取保守治疗、颈椎前路、后路脊髓减压手术.结果平均随访4年8个月,根据ASIA分级标准,在21例非手术治疗组中,治疗前B级1例,C级5例,D级15例,治疗后恢复至D级者4例,恢复至E级者15例,无明显恢复者2例;在9例手术治疗组中,治疗前B级2例,C级4例,D级3例,治疗后恢复至C级者1例,恢复至D级者3例,恢复至E级者4例,无明显恢复者1例.结论对于MRI显示脊髓无明显受压的患者,经保守治疗多可取得满意疗效.对于MRI显示脊髓明显受压的患者,行颈椎前、后路脊髓减压手术,有利于脊髓功能的恢复.     

Electrophysiological, histological, and behavioral studies in a cat with acute compression of the spinal cord

We made an animal model of cervical spinal cord injury in a cat and performed electrophysiological, histological, and behavioral studies. The cervical spinal cord injury model was made by inserting a screw through the fourth cervical vertebral body of the cat. After the injury, muscle tonus of the limbs and trunk diminished. The cat was able to walk and to perform target reaching after the injury, although the trunk was unstable and the movement of the forelimb was ataxic. Atrophy of the back muscle remained. The cat was unable to stand bipedally. These behavioral disturbances suggested dysfunction of the ventral funiculus. After behavioral analysis for 3 months, an electrophysiological study was performed. Action potentials of the ventral funiculus evoked by stimulation of the lateral vestibular nucleus or the medial longitudinal fasciculus were recorded at several levels of the cervical cord. They were diminished at levels caudal to the compression site. After the recording, the cervical cord was studied histologically. There was demyelination and gliosis in the ventral funiculus and in part of the ventrolateral funiculus at or near the injured site. Electrophysiological and histological findings were in good agreement with the behavioral ones. Behavioral studies seem useful for evaluating the function of the spinal cord, especially for assessing the injured system in the spinal cord. Received: March 28, 2000 / Accepted: September 13, 2000     

Nervous tissue damage markers in cerebrospinal fluid after cervical spine injuries and whiplash trauma

Clinical examination is the only tool available to assess the extent of the nerve tissue damage after a spinal cord injury, and it is well known that the reliability of classification based on clinical examination is not satisfactory, especially in cases with incomplete motor injuries. There is a need to evaluate new methods in order to improve the possibilities of classifying and prognosticating spinal cord injuries. Methods for assessing central nervous system (CNS) damage using markers in cerebrospinal fluid (CSF) have recently been developed. Previous studies have reported glial fibrillary acidic protein (GFAp) and neurofilament protein (NFL) levels in non-traumatic diseases in the central nervous system. The present study is the first report of GFAp and NFL levels in CSF after trauma to the cervical spine. Six cases with cord damage and pronounced neurological deficit showed significantly increased concentrations of both GFAp and NFL in the CSF. Patients with tetrapareses showed higher values than those with incomplete injuries. Three of the 17 whiplash cases had increased levels of NFL, but normal GFAp. Assessment of nervous tissue markers in CSF will probably improve possibilities to classify and prognosticate spinal cord injuries and also to evaluate pharmacological intervention. The increased levels of NFL in three whiplash cases indicate neural damage in a proportion of the cases with neurological deficit. Neurological examinations are presently the only tools for grading and prognostication of spinal cord injuries. Assessment of nervous tissue markers in CSF makes it possible to quantify the degree of nerve cell damage after different types of cervical spine injury ranging from spinal cord lesions to whiplash injuries.     

腰脊髓损伤伴严重多发伤的外科治疗

目的:探讨腰脊髓损伤为主严重多发伤的救治方法。方法:回顾性分析42例以腰脊髓损伤为主严重多发伤患者的临床资料,创伤严重度(ISS评分)为20～57分,平均(34.60±3.57)分。平均受伤部位约3处。脊髓损伤节段L1-L5,其中单节段损伤29例,2节段以上损伤13例。脊髓损伤(按ASIA分级):A级8例,B级7例,C级12例,D级15例。均采用椎管减压、植骨内固定术重建脊柱稳定性。结果:所有患者获得随访,时间6个月～4年,平均1年4个月,腰背痛症状均明显缓解,生活可自理,无内固定断裂及松动,植骨均融合。随访时脊髓损伤(按ASIA分级):A级5例,B级4例,C级6例,E级27例。27例神经症状完全恢复,8例有1级以上恢复,7例无变化。结论:腰脊髓损伤为主严重多发伤急诊应遵循伤害控制原则,尽早采取手术治疗重建脊柱稳定性,恢复神经功能,减少残疾。     

外伤性无骨折脱位型颈髓损伤的诊断与早期处理

目的 探讨成人外伤性无骨折脱位型颈髓损伤的诊断与治疗特点。方法 56例患者平均54岁,损伤平面分布于C_2-C_8脊髓节段,完全性脊髓损伤11例;不完全性脊髓损伤45例。术前行颈椎X线平片、CT、MRI检查。先行颈部制动,酌情行前路或后路手术,并给予脱水剂、激素、神经营养药物等。结果 CT阳性检出率为79.17％;MRI为90.38％,可明确脊髓的病理状况及脊髓以外软组织的病理变化。根据接受治疗的方法和时间分组对比,显示不同的治疗效果。结论 MRI对于外伤性无骨折脱位型颈髓损伤的诊断具有优越性,可以显示脊髓损伤后脊髓及周围软组织的各种改变。应根据脊髓损伤表现及变化和MRI显示脊髓的病理状况选择治疗方法,对于有脊髓压迫的病例最好在1周内手术治疗。     

应用大脑皮层诱发电位建立精确分级脊髓损伤模型

目的 建立脊髓损伤精确分级动物模型.方法 自行设计一种犬的运动-静止压迫型脊髓损伤模型,以大脑皮层诱发电位(CSEP)和不同压迫时间为参数,以T13横突连线为中心,安装大小为0.6 cm×1.0 cm的加压阀,以0.2 mm/min速度压迫脊髓,同时持续性CSEP监测,随压迫深度加深,CSEP波幅不断压低,当波幅下降达基础值的50%时停止下压,继续维持压迫,将20只杂种犬随机分为三组:A组(n=8):脊髓继续受压30 min;B组(n=8):脊髓继续受压180 min;C组(n=4):为对照组,脊髓显露后不损伤.观察电生理学、组织病理学、功能恢复及MRI变化.结果 两组脊髓组织学均有损害、MRI显示两组均有脊髓受压性改变,按照Aiith法计算A、B组的脊髓白质残留面积百分比和MRI脊髓变性空洞区最大横面积百分比,差异均有统计学意义(P<0.05);A组CSEP逐渐恢复达基线的76%,B组CSEP无恢复,C组一直无变化;脊髓受压早期两组均有后肢功能障碍,按照改良的Tarlov测定法和运动能力法评估A、B两组,差异有统计学意义(P<0.05).结论 以CSEP和不同压迫时间为参数,能够建立不同损伤程度的可重复性强的分级脊髓损伤模型.     

Marked enhancement of anti-allodynic effect by combined intrathecal administration of the adenosine A1-receptor agonist R-phenylisopropyladenosine and morphine in a rat model of central pain

BACKGROUND: There is often no satisfactory treatment for chronic pain after spinal cord injury. We have previously reported that intrathecal (i.t.) administration of the adenosine A1-receptor agonist R-phenylisopropyl-adenosine (R-PIA) or the opioid morphine has anti-allodynic effects in a model of presumed chronic central pain after photochemically induced spinal cord injury in rats. In the present study, we set out to investigate the possible interaction between i.t. R-PIA and morphine in spinally injured rats. METHODS: Sprague-Dawley rats displaying allodynia-like behaviors to mechanical and cold stimuli after photochemically induced spinal cord injury with minor motor deficits were used. R-PIA and morphine, either alone or in combination, were administered i.t. through an implanted catheter to lumbar spinal cord. RESULTS: Cumulative doses of R-PIA or morphine dose-dependently reduced the mechanical allodynia-like behavior, with a threshold of 1 nmol and 1.5 nmol, respectively. When co-administrated, R-PIA and morphine produced marked suppression of mechanical allodynia at doses of 5 pmol and 7.5 pmol, respectively. The effect of i.t. co-administration of R-PIA and morphine on cold allodynia was comparable to i.t. R-PIA alone. The combination of R-PIA and morphine did not increase adverse effects such as motor deficits in comparison to either drug alone. CONCLUSION: These results demonstrate a supra-additive interaction between the adenosine A1-receptor agonist R-PIA and morphine to reduce mechanical allodynia-like behavior in rats with chronic spinal cord injury. The combination of R-PIA and morphine administered spinally may be superior to R-PIA or morphine alone for treating such pain.     

体感诱发电位评价家兔脊髓冲击伤模型的神经机能变化

目的 探讨脊髓冲击伤前后的体感诱发电位的变化,评价家兔神经机能的改变程度.方法 应用改良霍普金森杠杆设备根据冲击波的压力不同(0.40 MPa,0.60 MPa,0.80 MPa)建立不同损伤程度的胸T9-T10脊髓冲击伤模型,12 h后用体感诱发电位仪分别计测家兔脊髓冲击伤前后的体感诱发电位,利用分析软件对诱发电位P...