脊髓损伤与脂质过氧化

氧自由基介导的脂质过氧化反应在脊髓损伤后的继发性损伤过程中起重要作用,这主要表现为损伤组织中脂过氧化物的大量产生、抗氧化剂水平的降低和磷脂膜酶系统的抑制。脂质过氧化反应使脊髓血流量减少并引起神经组织的变性坏死,而应用抗氧化剂能够防止或减轻脂质过氧化反应对脊髓的损伤,这对脊髓损伤的临床治疗具有重要意义。     

外源性供氧对脊髓损伤后继发性脊髓水肿的影响

目的　观察外源性供氧对脊髓损伤组织学的影响。方法　采用Allen法于兔L2 椎体水平造成急性脊髓损伤。对照组不予治疗 ,携氧复合液治疗组和复合液治疗组兔分别在伤后 30min开始给药。于伤后 48h、3、7d、4周分别从各组中取 5只兔 ,进行脊髓组织含水量、丙二醛(MDA)及形态学观察。结果　伤后 48h、3、7d携氧复合液组伤段脊髓组织含水量分别为 (69.1 4±0 .92 ) %、(71 .93± 0 .87) %、(71 .63± 1 .0 1 ) % ;脊髓组织MDA含量分别为 (2 8.54± 5 .98) μmol/g、(2 7.81± 3 .64) μmol/g、(2 6.1 4± 4 .2 6) μmol/g,均显著低于对照组 (P <0 .0 1 )。组织形态学检查携氧复合液组的病理改变较对照组轻。结论　脊髓损伤后早期外源性供氧对继发性脊髓损伤有保护作用。     

脊髓干细胞移植对脊髓损伤后神经功能的影响

目的探讨胚胎脊髓神经干细胞移植对大鼠脊髓损伤后神经功能恢复的意义。方法160只SD大鼠随机分为空白组,假手术组,脊髓损伤组,细胞移植组,分别在细胞移植后1、2、4周应用斜板实验和Tarlov评分对脊髓损伤后功能恢复进行评价,应用nestin标记观察移植后干细胞的存活情况。结果移植后1周、2周、4周,移植组和对照组斜板试验结果分别为(38．30±0．84)°、(18．50±0．76)°；jm(39．40±0．78)°、(19．70±0．66)°；(45．00±0．81)°、(22．30±0．69)°；Tarlov评分分别为3．37±0．45、2．32±0．34；3．45±0．38、2．41±0．43；3．63±0．47、2．45±0．48；有统计学意义(P＜0．01),免疫组织化学观察可见在损伤的脊髓组织中有神经干细胞的存活。结论胚胎脊髓干细胞移植对脊髓损伤后神经功能恢复有促进作用。     

早期补镁对脊髓损伤后继发性脊髓水肿的影响

目的：探讨镁对脊髓损伤后继发性水肿的影响。方法：按改良的Ａｌｌｅｎ’ｓ重物打击法制备兔脊髓损伤模型,将动物分为５组,Ａ组为正常对照组;Ｂ、Ｄ组分别为损伤后２４ｈ和４８ｈ不用镁组;Ｃ、Ｅ组分别为损伤后２４ｈ及４８ｈ用镁组,于脊髓损伤后３０ｍｉｎ一次性给予硫酸镁（６００ｍｇ／ｋｇ,皮下注射）。分别取材测定伤段脊髓组织水、钙、镁含量及观察局部的组织病理学改变。结果：各损伤组脊髓组织含水量显著高于正常对照     

蝮蛇抗栓酶对脊髓损伤影响的实验研究

就蝮蛇抗栓酶对大鼠脊髓损伤时脂质过氧化物、超氧化物歧化酶及组织形态学的影响作了研究。结果表明：蝮蛇抗栓酶治疗组脊髓组织和血浆中脂质过氧化物（ＬＰＯ）含量较对照组低，其脊髓组织和红细胞的超氧化物歧化酶（ＳＯＤ）活性较对照组高，光镜和电镜检查均显示治疗组大鼠的脊髓损伤比对照组轻，脊髓神经功能恢复情况亦优于对照组。表明蝮蛇抗栓酶对大鼠脊髓损伤的影响与其抗氧自由基作用有关。     

血小板活化因子及其受体拮抗剂对脊髓损伤后脊髓血流量的影响

实验采用鞘内注射血小板活化因子（ＰＡＦ）及静脉注射ＰＡＦ受体拮抗剂ＢＮ５２０２１，观察其对猫脊髓损伤后伤区和邻近脊髓（Ｌ２－Ｌ４）血流量及血浆血栓素Ｂ２（ＴＸＢ２）、６－酮－前列腺１α（６－ｋｅｔｏ－ＰＧＦ１α）比值（Ｔ／Ｋ值）的影响。     

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。     

大鼠胚胎脊髓移植后对损伤脊髓神经营养因子表达的影响

目的：研究大鼠胚胎脊髓移植对损伤脊髓神经营养因子表达的影响。方法：将孕１４ｄ大鼠胚胎脊髓组织移植到成鼠半切洞损伤的脊髓中,手术后采用免疫组织化学技术,对损伤脊髓组织中神经生长因子（ＮＧＦ）、脑源性神经生长因子（ＢＤＮＦ）、神经生长因子３（ＮＴ－３）、睫状神经生长因子（ＣＮＴＦ）进行定量分析。结果：移植组神经营养因子１周、２周、４周、都明显高于单纯损伤组,４周时移植组ＢＤＮＦ表达高于其它各组（Ｐ〈０     

Changes of free iron contents and its correlation with lipid peroxidation after experimental spinal cord injury

Objective: To observe the dynamic changes of free iron contents and its relationship to the changes of lipid peroxidation after experimental spinal cord injury (SCI). Methods: Sprague Dawley rats were randomly divided into three groups: Group A (n=6) received no operation; Group B (n=48) received only laminectomy (sham) ; and Group C (n=48) received both laminectomy and traumatic injury ( SCI model). The SCI animal models were made by using an modified Alien‘s weight-drop device (50 g. cm) on T12. Rats were sacrificed at 0.5, 1, 3, 6, 12, 24 hours after injury. The levels of free iron involved in spinal cord segments at different time points were measured by blcomycin assay. The malondialdehyde (MDA) was also measured by the thiobarbituric acid (TBA). Results: After SCI in Group C, the level of free iron showed a significant increase at 0.5 hour compared to Groups B and A, restored to the control level at 6 h; the level of MDA was increased at 0.5 hour, peaked at 3 hours, returned to the control level at 12 hours; the concentrations of free iron and lipid peroxidation in injured rats were significantly and positively correlated at 0.5-3 hours. Conclusions: After SCI the levels of free iron are increased quickly and might be a major contributor to lipid peroxidation in injured spinal cord.     

神经毒素在脊髓损伤中的作用

目的 探讨神经毒素兴奋性氨基酸（ＥＡＡ）和神经肽在脊髓损伤的作用。方法 应用高效液相色谱法检测脊髓损伤后伤段组织中谷氨酸（Ｇｌｕ）天门冬氨酸（Ａｓｐ）两种ＥＡＡ的含量变化；应用放射免疫分析技术测定脊髓损伤段组织中神经肽之一强腓肽ＤｙｎＡ１－１３含量的变化；观察了蛛网膜下腔注射Ｇｌｕ，ＤｙａｎＡ１－１３兴奋性氨基酸受体拮抗剂３－（２－羧基哌嗪）丙基－１－磷酸（ＣＰＰ），ＤｙｎＡ１－１３抗血清（Ａｎ－     

Antioxidation of quercetin against spinal cord injury in rats

Objective : To observe the effect of quercetin on experimental spinal cord injury (SCI) in rats. Methods: Sixty Sprague-Dawley rats were randomly divided into four groups : Group A only for laminectomy, Group B for laminectomy with SCI, Group C for SCI and intraperitoneal injection with a bolus of 200 mg/kg quercetin and Group D for SCI and intraperitoneal injection of saline. SCI model was made by using modified Aliens method on T12. Six rats of each group were killed at 4 h after injury and the levels of free iron and malondialdehyde ( MDA) of the involved spinal cord segments were measured by bleomycin and thiobarbituric acid (TBA) assays separately. The recovery of hind limb function was assessed by Modified Tarlov 's scale and inclined plane method at 7 d,14 d and 21 d after SCI. The histological changes of the damaged spinal cord were also examined at 7 d after SCI. Results: After SCI, the levels of free iron and MDA were significantly increased in Groups B and D, while not in Group C. The Modified Tarlov 's score and the inclined plane angles were significantly decreased in Groups B, C and D. The histological findings were not improved. Conclusions: After SCI, quercetin can reduce the level of lipid peroxidation, but not improve recovery of function.     

创伤性上升性脊髓缺血损伤

脊椎损伤后,脊髓损伤平面上升较为少见。作者报告了５例,其中Ｔ１０－１１骨折脱位２例：１例于伤后２周内,截竣平面上升至Ｃ２,呼吸麻痹死亡,１例上升至颈部脊髓,双上肢无力;另３例为Ｔ１２骨折２例,Ｌ３骨折１例：其中截竣平面上升至Ｔ９至１例,Ｔ８者２例。５例患者双下肢皆呈软竣,１例死亡患者尸检见脊髓完整,Ｔ９－１０段脊髓前后动静脉血栓,其向上至Ｃ３,向下至Ｓ１,脊髓前血管、中央血管、髓内小血管多处 栓,     

钙调素拮抗剂对大鼠脊髓损伤的作用及意义

目的观察钙调素（ＣａＭ）特异性拮抗剂三氟啦嗪（ＴＦＰ）对脊髓损伤（ＳＣＩ）的影响,探讨ＣａＭ在ＳＣＩ病理机制中的作用。方法采用氢清除法、斜板试验和电生理技术,以６４只大鼠为实验对象观察ＴＦＰ对ＳＣＩ后脊髓血流量（ＳＣＢＦ）、运动功能和诱发电位（ＭＥＰ）的影响。结果在肾上腺素维持系统动脉压的条件下,ＴＦＰ可明显改善ＳＣＩ后ＳＣＢＦ、ＭＥＰ和运动功能。结论ＣａＭ拮抗剂对ＳＣＩ具有保护作用,ＣａＭ可能是参与ＳＣＩ病理机制的重要因素     

重视地震中脊柱脊髓损伤的现场救治及后期治疗

2008年5月12日下午14时28分，四川省汶川发生了里氏8．0级特大地震，此次地震突发性强、破坏性巨大、人员伤亡和财产损失重大。5月13日上午10时，我院迅速组织了一支20名医护人员的医疗救护队和一批抢救器械及药品，奔赴四川灾区抗震救灾，开展了卓有成效的医疗救治工作。5月23日我院还接收了一批从四川地震灾区转运来的重伤员，全部伤员均得到了积极有效的治疗。     

扩大半椎板切除术治疗颈脊髓损伤

OBJECTIVE: To treat cervical spinal cord injury (SCI) accompanied with narrowing spinal canal by expanded hemilaminectomy. METHODS: From 1995 January to 1998 April 51 patients of cervical SCI were treated by expanded hemilaminectomy. Spinal injury classified in to 3 types: no fracture-dislocation (39 patients) fracture dislocation at the lower cervical spine (11), and burst fracture (1). The types of SCI included central cord injury (18 patients) incomplete cord injury (19), and complete cord injury (14). MR imaging in 23 patients showed degenerative changes with normal intensity of the cord in 14 patients, multiple level hyperintensity in 3, cystic changes in 3, myelomalasia in 3, and cord brocken in 1. Expanded hemilaminectomy was performed in 24 hours in 3 patients, in 48 hours in 9, in one week in 2, after one week in 35, and after one year in 2. The left or right laminae were removed from C(7) to C(3) in 42 patients, C(3) - T(1) in 3, C(2) - C(7) in 2, C(3) - C(6) in 3 and C(4) - C(7) in 3. Hemilaminectomy was expanded lateral to the inner of apophyseal joint and medial to the inner lamina beneath the spinal process. RESULTS: Follow-up lasted for 1 year and 7 months. Six patients with complete cord injury had of the no recovery lower extremity but recovery of the brachialis and extensor radial longus. 12 patients of central cord injury had full recovery except intrinsic muscles of the hand (5). They operated were on 2 weeks after injury. 17 patients of incomplete cord injury recovered to Frankel IV. CONCLUSIONS: Expanded hemilaminectomy is indicated for patients of cervical SCI with narrowing spinal canal or without fracture dislocation. Best results can be obtained in patients of central cord injury, and incomplete cord injury. Even in complete cord injury, 1 - 2 forearm muscle may recover (24.8%), securing a pinch grip reconstruction.     

脊髓损伤后的免疫抑制研究进展

脊髓损伤（SCI）致死率高、预后差,常导致患者终身瘫痪,可引起系统性神经源性免疫抑制综合征（SCI-IDS）^[1]。SCI后的免疫抑制会增加机体对病原体感染的易感性,导致患者并发症发生率及病死率增高。近年,国内外SCI的临床及动物模型研究证实,SCI可导致机体免疫细胞功能受损,免疫因子也发生一定程度的变化,从而引起免疫功能障碍^[2-3],但具体机制尚不明确。由于免疫系统可由中枢神经系统通过下丘脑-垂体-肾上腺轴（HPA）、交感神经系统（SNS）和副交感神经系统（PNS）进行调节,所以中枢神经系统的损伤可引起免疫相关的神经功能受损,进而引起免疫抑制,同时亦可造成内分泌功能障碍,间接引起免疫功能障碍^[4-5]。明确SCI导致机体防御系统受损的相关机制及脊髓平面、损伤程度等相关因素对发生SCI后免疫功能的影响,对治疗SCI、提高患者的生存质量至关重要。本文就HPA、SNS与SCI后的免疫抑制的可能关联、产生的适应性免疫抑制的相关机制及与其相关方向的治疗前景作如下综述。     

Changes of intracellular calcium and the correlation with functional damage of the spinal cord after spinal cord injury

OBJECTIVE: To observe dynamic changes of intracellular calcium ([Ca(2+)]i) after spinal cord injury, and to study the relationship between the changes of [Ca(2+)]i and the functional damage of the spinal cord. METHODS: The rats were subjected to a spinal cord contusion by using a modified Allen's method. The [Ca(2+)]i in the injured segment of the spinal cord was measured by the technique of La(3+) blockage and atomic absorption spectroscopy at 1, 4, 8, 24, 72, and 168 hours after injury. The motor function on the inclined plane was measured at the same time. RESULTS: The spinal cord [Ca(2+)]i increased significantly (P<0.05 or P<0.01) aft er spinal cord injury. There was a significant correlation (P<0.05) between the changes of [Ca(2+)]i and the motor function. CONCLUSIONS: [Ca(2+)]i overload may play an important role in the pathogenesis of spinal cord injury.