Effects of Epidural Spinal Cord Stimulation and Treadmill Training on Locomotion Function and Ultrastructure of Spinal Cord Anterior Horn after Moderate Spinal Cord Injury in Rats

Objective:To investigate the effects of epidural spinal cord stimulation (ESCS) and treadmill training on the locomotion function and ultrastructure of spinal cord anterior horn after moderate spinal cord injury in rats.Method:Nine adult female Sprague-Dawley rats were randomly distributed into three groups: ①spinal cord injury group (SI, n=3). ②spinal cord injury plus ESCS group (SE, n=3). ③spinal cord injury plus treadmill training group (TT, n=3). All rats received a moderate spinal cord injury surgery. Four weeks after surgery, rats in SE group received an electrode implantation procedure, with the electrode field covering spinal cord segments L2—S1. Four weeks after electrode implantation, rats received subthreshold ESCS for 30 min/d. Rats in TT group received 4cm/s treadmill training for 30min/d. Rats in SI group received no intervention, as a control group. All procedures in these three groups lasted four weeks.The open field Basso,Beattie and Bresnahan(BBB) scale was used before and after intervention to evaluate rats′ hindlimb motor function. Result:After four weeks intervention, rats in TT group improved their open field locomotion scores to 20. In contrast, no significant improvement was observed in groups SI and SE. The morphology of synapses and neurons were similar regardless of whether rats had undergone ESCS, treadmill training or not. Conclusion:ESCS alone was not sufficient to improve the walking ability of spinal cord injured rats. ESCS or treadmill training alone might not contribute to the changes of ultrastructure in anterior horn of spinal cord that underlie the recovery of walking ability. Further research is needed to understand the contributions of combination of ESCS and treadmill training to the rehabilitation of spinal cord injured rats.     

脊髓的可塑性

脊髓损伤后,脊髓的可塑性由损伤和特殊形式的训练启动,表现为自发性可塑性(损伤诱导的可塑性)和训练任务依赖性可塑性两种类型。自发性可塑性主要表现为轴突芽生、潜伏通路重启、突触效率改变等形式;训练任务依赖性可塑性表现为中枢模式发生器重新激活、脊髓神经元回路重组。对脊髓可塑性的深入探索、最大限度地增强脊髓的可塑性,将有助于优化现有治疗方案或研究新的治疗策略,进一步促进脊髓损伤患者的康复。     

以弛缓性瘫痪为特点的高位置脊髓损伤临床特征探讨

目的分析以弛缓性瘫痪为特点的高位置脊髓损伤发生原因。方法在1014例创伤性脊髓损伤患者中对以弛缓性瘫痪为特点的高位置脊髓损伤（骨折水平在T₁₀或以上）患者进行分析。结果6例患者被确认为以弛缓性瘫痪为特点的高位置脊髓损伤,其中男性5例,女性1例,平均年龄（42±12）岁。脊髓损伤水平分布在C₇～T₈水平,脊柱骨折水平在T₃～T₁₀。参考骨折水平,4例脊髓损伤水平上升超过3个脊髓节段,其中3例脊髓损伤水平上升出现在外科手术后;1例无明显诱因,伤后48 h出现神经损伤平面进行性上升至C₇水平,伴随胸部严重疼痛。伤后6个月MRI检查,5例患者显示广泛胸段脊髓萎缩变细。结论以弛缓性瘫痪为特点的高位置脊髓损伤非常罕见。其重要特点是病理上存在广泛胸段脊髓萎缩变细。发生原因尚不清楚。     

脊髓室管膜瘤MRI诊断

目的：探讨脊髓室管膜瘤的MRI特征性表现。方法：回顾分析18例经手术病理证实脊髓室管膜瘤MRI表现。结果；18例脊髓室管膜瘤中，主要位于颈髓11例，胸髓5例，马尾2例。肿瘤长度2～7个椎体高度。平均长度为3．5个椎体高度。肿瘤轴位相常表现位于脊髓中央长圆柱形占位，肿瘤实质在T2WI呈略高或高信号，83％肿瘤一端或两端可见囊腔。肿瘤边界清楚占89％，明显均匀强化占56％。明显不均匀强化39％。结论：脊髓室管膜瘤MRI表现颇具特征。术前正确诊断是可能，但不典型病例须与髓内星形细胞瘤和血管母细胞瘤鉴别。     

Spinal Cord Stimulation for Severely Ischemic Limbs

Severe atherosclerosis of the lower limbs causes rest pain, skin ulcerations and gangrene. In such situations and when standard surgical treatment had failed or it is impossible to employ, spinal cord stimulation (SCS) seems to be of value. Since April 1985, we have used this technique on 19 patients. The results have been beneficial in 70.6% of the cases and have shown some evidence of increasing cutaneous flow. However, randomized series are required before accepting it as having a special place in the fight against atherosclerotic disease.     

颈髓损伤早期急诊手术的可行性及疗效评价

目的:探讨颈髓损伤早期急诊减压内固定手术的可行性及疗效。方法:回顾性分析2000年6月～2007年6月我科治疗的颈髓损伤患者68例,按是否进行急诊手术分为急诊手术组22例和非急诊手术组46例。所有患者均采集一般资料、神经功能状况(入院时和最后一次随访时)、术后并发症、重症监护时间和住院时间等临床资料,并进行统计学分析。结果:2组患者在一般资料、受伤节段、手术方式、随访时间及入院时神经功能状况等方面均无统计学差异;最后一次随访时2组相比神经功能无显著性差异,但急诊手术组的并发症发生率、重症监护时间和住院时间均低于非急诊手术组。结论:颈髓损伤后早期急诊手术可行、安全,有利于减少术后并发症,但对神经功能的恢复无明显帮助。     

Spinal Cord Stimulation and Motor Disorders

Spinal cord stimulation has been investigated by us during the past 10 years in the treatment of various disorders of the motor system. The effectiveness was studied in 735 cases, including cerebral palsy (212), dystonia (129), torticollis (66), spinal cord injury (169), and degenerative diseases (159). Our resuits indicate that in properly selected patients, stimulating the spinal neural axis is therapeutically effective in the majority of the cases treated. Our data demonstrate that the level stimulated, the pattern and the polarity of the applied field, and the frequency of the stimulation are critical to achieve a satisfactory therapeutic result and must be individualized in each patient.     

脊髓损伤患者营养状况的研究进展

脊髓损伤患者的营养状况影响患者的康复及预后,未得到足够的重视,需要通过饮食控制及运动等联合措施来调节。此外,对医务人员的营养培训和对患者的营养教育都十分必要,医院的相关营养政策也应得到修订。目前关于脊髓损伤患者的营养评估标准还不健全,因脊髓损伤患者具有特殊性,对健康人群的评估标准并不适用,难以对营养不良进行早期发现。应利用评价量表、血液指标和皮肤皮褶厚度等建立适用于中国脊髓损伤患者的综合评估体系,并把营养评估作为日常管理的一部分。     

脊髓损伤后脊髓内神经递质含量的变化及其作用

脊髓损伤后脊髓内神经递质分泌量的变化在一定程度上影响脊髓损伤模型动物或患者神经功能恢复,近年来有关神经递质的研究在脊髓神经恢复中越来越受关注,本文对脊髓损伤后脊髓内主要神经递质及其在不同措施干预下含量的变化进行综述。     

Malignant Spinal Cord Compression

Malignant spinal cord compression (MSCC) occurs in the setting of primary or metastatic cancer. It is the result of primary tumor invasion into the spinal canal or metastatic spread to the vertebrae resulting in collapse onto the spinal cord or, less commonly, direct metastatic spread into the epidural space or cord. MSCC may lead to progressive and permanent motor and sensory deficits if untreated. Although not life-threatening, MSCC is a true medical emergency that requires early recognition and prompt intervention in order to provide the best chance for clinical recovery. Nurses play a pivotal role in identifying patients at risk, recognizing the symptoms signifying the onset of MSCC, implementing evidence-based strategies, and educating at-risk patients about the manifestations of MSCC and actions they should take. Although these roles are not specific to nurses in radiology or procedural areas, knowledge of MSCC is essential. Understanding MSCC will enhance the nurses’ ability to field questions and clarify misconceptions about this emergency and mitigate procedure-related complications (e.g., positioning, pain).     

New Approach for Spinal Cord Stimulation Trial

Abstract:   Spinal cord stimulation trial phase has remained unchanged for years. The common practice to connect a lead to an external transmitter is not optimal. The operational mode of transmitter is different from implanted system and external bulky device interferes with patient's daily routine. Optimization in the trial period may increase patient's satisfaction and improve outcome of upcoming permanent implantation. The proposed new trial design can be a simple and logical solution of the problem.     

脊髓动静脉畸形围手术期的护理

目的：探讨脊髓动静脉畸形患者科学的围手术期护理方法。方法：对31例脊髓动静脉畸形围术期患者进行了科学的护理,即心理,术前、术后以及特殊症状护理,并分析护理效果。结果：31例患者中治愈27例,好转4例。结论：脊髓动静脉畸形手术难度大,危险性高,科学的围手术期护理是促进治疗效果的重要保证。     

医源性脊髓损伤患者流行病学特征分析

目的:分析医源性脊髓损伤(ISCI)的流行病学特征.方法:对纳入患者的临床资料进行回顾性分析,分析患者年龄段、性别、损伤脊柱节段、初始疾病及损伤原因的构成比及其差异.结果:≤50岁人群中,ISCI的危险性随年龄而增加;男性的罹患危险性高于女性;病变发生于上胸椎及初始疾病为脊柱退变性疾病者罹患ISCI的危险性高;置钉失误...     

脊髓重建管对T8损伤大鼠后肢运动终板的调节与维持

目的观察大鼠脊髓损伤后及脊髓重建管诱导脊髓再生修复过程中后肢骨骼肌运动终板形态结构与不同类型肌纤维终板区乙酰胆碱酯酶(AChE)的变化情况。方法43只成年Wistar大鼠随机分为脊髓T₈单纯损伤组（Cx组）、脊髓T₈损伤+脊髓重建管移植修复组（CxTp组）和正常对照组（Co组）,术后2周、4周、3个月、6个月、12个月经灌注固定后取出大鼠双下肢腓肠肌、比目鱼肌和趾长伸肌,分别用氯化金染色（压片法）观察运动终板结构形态和Karnovsky-Roots直接法染色检测AChE的变化。结果Cx组和CxTp组大鼠术后运动终板结构形态与AChE活性均发生改变。Cx组终板自术后3个月起发生明显的退行性改变,AChE活性亦呈线性下降;CxTp组终板结构与形态相对稳定,没有退变迹象,术后3个月起AChE 活性显著高于同时间点Cx组。结论大鼠脊髓损伤后,运动终板发生进行性退变,脊髓重建管移植修复可以阻止终板的退行性变,使其向着利于神经康复的方向发生着AChE的复活与结构形态的可塑性变化。     

脊髓损伤的移植物研究现状

通过移植的方法促进轴突的再生和部分功能的恢复是目前脊髓损伤治疗的重要研究方向,这些方法在脊髓损伤的动物模型中和一些临床试验中已经取得了一些进展。本文综述目前应用于临床或基础研究的植入物种类及其作用机制。     

Spinal Cord Stimulation for the Treatment of Refractory Angina Pectoris: A Two-Year Follow-Up

Twenty-three patients affected by severe, refractory angina were submitted to permanent spinal cord stimulation (SCS) and then followed in our outpatient clinic for 24 months. During the follow-up period, the number of weekly angina episodes drastically dropped from 9.2 (preimplant) to 1.8 in the 3rd, 2.5 in the 6th, 4.5 in the 12th, and 4.2 in the 24th month, with a statistically significant difference (P < 0.01) between the first and last values. A significant increase in the average exercise time from 320 ± 120 seconds (in baseline condition) to 410 ± 115 seconds (during SCS) was observed at the treadmill stress test (P < 0.01). SCS was well tolerated by all the patients. However, 7 patients died during follow-up (3 myocardial infarctions, 2 noncardiac deaths, and 2 sudden deaths). Three generators were replaced because of battery depletion after 15, 17, and 21 months. No serious complication was observed. In conclusion, in patients with otherwise intractable angina or already submitted to myocardial revascularization, SCS is very effective in reducing the number of angina episodes. The time of the work during exercise stress test is also significantly prolonged.     

NT-3对大鼠脊髓损伤后神经细胞凋亡及脊髓损伤修复的作用

【目的】研究神经营养素-3（NT-3）对大鼠皮质脊髓束横断后神经细胞凋亡及脊髓损伤修复的影响及意义。【方法】健康Sprague-Dawley大鼠100只,分为损伤对照组（C组）和损伤NT_3注射组（NT-3组）。各组内分别行BBB评分、神经元中丝蛋白（NF）染色及RT—PCR检测Bax和Bcl-2基因表达的变化。【结果】①损伤后C组和NT-3组Bax及Bcl-2基因转录水平升高;②NT-3组与损伤对照组相比Bax基因转录水平下降而Bcl-2基因转录水平升高;③NT-3组NF平均灰度值小于C组。【结论】NT-3可能通过影响凋亡基因Bax和Bcl-2表达的变化对脊髓损伤起保护作用及修复促进作用。     

神经干细胞与脊髓脱细胞支架体外共培养的可行性

目的 观察大鼠神经干细胞(NSCs)在脊髓脱细胞支架(SCAS)上黏附、生长和分化情况,评价其构建脊髓组织工程的可行性.方法 新生Sprague-Dawley大鼠大脑皮质来源NSCs传代培养并鉴定;Sprague-Dawley雌性大鼠脊髓组织改良物理振荡结合化学萃取法制备SCAS,并行基础评估;将第三代NSCs种植在S...     

高颈位脊髓肿瘤误诊分析

目的　探讨高颈位脊髓肿瘤误诊原因。方法　选择 42例高颈段脊髓肿瘤临床资料进行回顾性综合分析。结果　 42例患者中 ,误诊 35例 ,误诊率 83.0 %。影像学检出率颈椎正侧位片为 4.78% ,脊髓造影为 96 .6 7% ,CT平扫为76 .19% ,MRI为 10 0 %。结论　高颈位脊髓肿瘤临床表现复杂多样。提高医生诊断水平 ,选择正确的影像学检查是减少误诊的关键。