SPR治疗脊髓损伤后下肢痉挛的临床观察

目的:探讨采用选择性脊神经后根切断术(SPR)治疗脊髓损伤后下肢痉挛的效果。方法:16例患者术前3d进行步态分析,术中对支配痉挛下肢的L2～S1的脊神经后根进行分束,电刺激仪测阈值,将阈值较低神经束切断。神经根切断比例结合肌张力、肌力、体重及肌群功能进行量化,均小于30%。结果:术后步态有明显改善(P<0.01)。16例平均随访3年,痉挛解除率90%,功能改善率80%。结论:选择性脊神经后根切断术能较有效地治疗脊髓损伤后下肢痉挛。     

选择性骶神经根切断治疗脊髓损伤后痉挛性膀胱的实验研究

目的：观察选择性骶神经根切断治疗脊髓损伤痉挛性膀胱的实际疗效,探讨骶神经根高选择性切断的治疗机制及最佳手术方式。方法：雄性家犬１２ 只,制备成脊髓损伤后痉挛性膀胱模型,根据骶神经切断方式分为Ａ、Ｂ、Ｃ、Ｄ４ 组,通过尿流动力学检测及电生理观察,记录并计算骶神经切断前（ 对照组）及术后各组各项功能性指标的变化,并进行比较分析。结果：Ａ、Ｂ、Ｃ、Ｄ４ 组术后膀胱容量均明显高于术前对照组,尿道压力均低于术前对照组,其中Ｂ 组的膀胱贮尿功能、排空能力、尿道压力均接近正常,且对犬阴茎勃起功能无明显影响。结论：高选择性骶神经根切断治疗脊髓损伤后痉挛性膀胱有确实明显的疗效,是一种值得研究的新方法。     

汉防己甲素治疗急性脊髓损伤的实验研究

目的 探讨汉防己甲素(Tetrandrine，Tet)对急性脊髓损伤(Acute spinal cord injuries，ASCI)的保护作用。方法 74只Wistar大鼠随机分为4组，用改良Allen’s打击法制备大鼠截瘫模型，造模前各组分别投给相应的药物，伤后1h、4h取损伤区脊髓组织进行形态学观察和生化指标测定。结果 汉防己甲素能明显降低组织钙总量和MDA含量，防止镁总量和SOD含量的下降，稳定6-Keto-PGFla／TXB2的比值，减轻组织病损。结论 Tet对ASCI有保护作用，其作用机制为①扩张微血管，改善微循环，逆转ASCI后早期缺血倾向；②抗氧自由基，减轻组织过氧化损伤，稳定生物膜性结构；③减少ASCI后钙内流，从而阻断继发性损伤的链式反应。     

具有感觉传入通路的膀胱反射弧治疗脊髓损伤后弛缓性膀胱的实验研究

 目的 用SD大鼠构建具有感觉传入通路的膀胱反射弧,探讨其用于治疗脊髓损伤后弛缓性膀胱的有效性。方法 SD雄性大鼠24只,右侧为实验侧,先行L5前根近断端与S2前根远断端吻合,再将L5脊神经节周围突支近断端与S2后根远断端行端端吻合。左侧不做处理,为对照侧。术后3个月,破坏L6~S4节段脊髓造成弛缓性膀胱,于建模前后通过一般观察、神经电生理检测、神经示踪等方法观察反射弧构建情况。结果 21只大鼠存活至术后3个月,7只成功分离出吻合的脊神经。电刺激实验侧S2后根吻合口远端,均能检测到膀胱神经丛复合动作电位、膀胱平滑肌复合肌肉动作电位,截瘫前后动作电位差异无统计学意义;电刺激对照侧S2后根,在截瘫后未能检测到动作电位。实验侧膀胱神经丛复合动作电位和膀胱平滑肌复合肌肉动作电位平均波幅为截瘫前对照侧的71.9%和82.4%。神经示踪结果显示实验侧L5脊髓前、后角均可见青蓝色阳性反应颗粒。结论 构建具有感觉传入通路的膀胱反射弧,可使其运动、感觉神经通过轴突再生长入副交感神经纤维,并与脊髓前、后角重建轴突联系,轴浆运输功能得到重建,可用于弛缓性膀胱的治疗。     

继发性脊髓损伤的细胞凋亡研究现状

细胞凋亡，又称程序性细胞死亡，在继发性脊髓损伤过程中起着关键作用。本文对继发性脊髓损伤细胞凋亡的作用、诱导因素和防治途径作一综述。     

颈椎前路椎体可控前移融合术和颈椎后路全椎板切除术治疗颈椎脊髓损伤的疗效分析

目的 比较颈椎前路椎体可控前移融合术（ACAF）和颈椎后路全椎板切除术治疗颈椎脊髓损伤的疗效。方法 2015年3月—2021年1月,上海第四人民医院、海军军医大学长征医院收治颈椎外伤患者42例,其中20例采用ACAF治疗（ACAF组）,22例采用颈椎后路全椎板切除术治疗（LAM组）。记录并比较2组术中出血量、手术时间、术后引流量、住院时间及并发症发生情况,采用美国脊髓损伤协会（ASIA）评分评价所有患者术前、术后2周及术后2年的神经功能。结果 所有手术顺利完成,所有患者随访> 24个月。2组减压节段数和手术时间差异无统计学意义（P> 0.05）。LAM组术中出血量、术后引流量和住院时间高于ACAF组,差异均有统计学意义（P <0.05）。术后24个月,2组患者神经功能ASIA评分均较术前明显改善,差异有统计学意义（P <0.05）;组间差异无统计学意义（P> 0.05）。ACAF组1例发生术后并发症,LAM组4例发生术后并发症。结论 2种术式均可显著改善患者颈椎脊髓功能,且ACAF可明显减少手术出血量及住院时间,术后并发症较少。     

Biological modalities for treatment of acute spinal cord injury: a pilot study and review of the literature

Objective： Paraplegia due to traumatic spinal cord injuries is one of the devastating effects of dorsolumbar vertebral fractures. Treatment modalities for such fractures, such as stabilization, have no effect on the neurological recovery. Thus, various pharmacological and biological treatment modalities have been used. The more recent trend of using autologous stem cells from the iliac crest has been used in some clinical trials with varying success. Thus, more clinical studies are required to study the effect of this novel approach Methods： This is a prospective hospital-based cohort study （level IV）. The study was conducted in the Dept. of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi from November 2010 to March 2012. Ten patients who had sustained traumatic dorsolumbar vertebral fractures with complete paraplegia were recruited for this study. Under suitable anaesthesia, at the beginning of surgery, 100 ml of bone marrow was aspirated. This was centrifuged and buffy coat isolated and then transferred into a sterile tube and sent to the operating room on ice packs. After surgical decompression and stabilization, the buffy coat isolate was injected into the dural sleeve at the site of the injury using a 21G needle. All the patients were evaluated for neurological improvement using the American Spinal Injury Association （ASIA） score and Frankel grade at 6 weeks and 3 months postoperatively. Results： The evaluation at 6 weeks showed some improvement in terms of the ASIA scores in 2 patients but no improvements in their Frankel Grade. The other 8 patients showed no improvements in their ASIA scores or their Frankel Grades. The current pilot study has shown that there has been no improvement in most of the recipients of the transplant （n=8）. Some patients （n=2） who did show some improvement in their sensory scores proved to be of no significant functional value as depicted by no change in their Frankel Grades. Conclusion： The outcome of current study shows th     

神经移植术治疗截瘫神经性膀胱的尿动力学观察

目的　评价神经转位移植术治疗陈旧性截瘫神经性膀胱病人的手术效果。　方法　回顾性分析40例胸腰段骨折致截瘫神经性膀胱病人肋间血管神经转位桥接骶神经根35例、尺神经转位吻合阴部神经5例手术前后尿动力学检测结果。　结果　骶根组35例术前最大尿流率(Qmax)均低于正常,术后20例恢复正常（57%）,10例明显改善(28.6%),术前后逼尿肌最大收缩力分别为（60±15cmH     

椎管内胸神经根移位至腰神经根的解剖学研究

目的 了解椎管内T9～12神经根移位修复L2～4神经根、恢复截瘫后股四头肌功能的解剖学基础.方法 5 具成人尸体标本,其中男性2具,女性3具.完全显露胸段及腰段椎管,观察T9～L4神经根在脊髓上发出的部位,T12及L1椎体水平与椎管内各神经根之间的关系;测量T9～L4神经根在椎管内的长度,T9～L4神经根的直径,T9～L4各神经根起始部之间的距离,T9～12神经根自硬脊膜穿出到L2椎体中部水平的距离.结果 T9神经根发自T9椎体中部,L4神经根发自L2椎体中部;T9～L4神经根在椎管内的长度均值分别为16.12、22.97、30.43、43.47、56.02、70.03、88.70和113.65mm.T9～L4神经根的直径均值分别为2.45、2.04、1.96、2.18、2.32、2.56、3.10和3.26 mm.各神经根起始部之间的距离均值分别为22.87、25.08、28.47、27.38、29.78、31.93和31.00 mm.T9～12神经根自硬脊膜穿出到L2椎体中部水平的距离均值分别为118.69、95.82、70.74和42.27 mm.结论 T9～12神经根均可以作为动力神经;可以将L2椎体的中部作为受体神经吻合平面修复L2～4神经根.     

脊髓缺血再灌注损伤中运动诱发电位的监测作用

目的　探讨运动诱发电位（ＭＥＰ）对脊髓缺血再灌注损伤中神经功能的监测作用。　方法　对２６ 只大鼠腰骶段脊髓缺血前、缺血１５、２５ 、４０ 分钟及再灌注后５、１５、３０ 分钟、１、２ 和２４ 小时ＭＥＰ变化进行监测。　结果　在缺血１５ 分钟时ＭＥＰ潜伏期明显延长（Ｐ＜ ０．０１） ,波幅在缺血２５ 分钟时明显减小（ Ｐ＜ ０－０１） ,缺血４０ 分钟时波形消失;再灌注后５ 分钟时波形恢复,但潜伏期大于正常（Ｐ＜０－０１） ,波幅小于正常（Ｐ＜０－０１）;再灌注后１５ 分钟至２ 小时波幅恢复正常（Ｐ＞ ０－０５）,潜伏期无恢复;再灌注后２４ 小时潜伏期虽然呈恢复趋势,但与再灌注早期相比,差异无显著性意义,此时波幅又明显下降低于正常（Ｐ＜０－０１） ,再灌注后２４ 小时双下肢运动功能比再灌注早明显降低（ Ｐ＜ ０－０５） 。　结论ＭＥＰ能够准确监测脊髓神经功能在缺血再灌注损伤中的变化     

无放射影像脊柱骨折脱位颈髓损伤30例

无放射影像脊柱骨折脱位颈髓损伤(Spinalcord injury without radiographic spinal fracture--dislocation,SCIWORSFD)是脊髓损伤一种特殊类型.既往报告称之为无骨折脱位型脊髓损伤或无放射影像异常脊髓损伤,命名较为混乱,含义不确切.大多数专家学者建议更名为"无放射影像脊柱骨折脱位脊髓损伤"[1].此类损伤临床并非少见,且有逐年上升趋势.我科自1997年5月～2000年4月共收治此类损伤30例,结合文献,我们对这组病例进行分类讨论.     

Prognostic validity of a clinical trunk control test for independence and walking in individuals with spinal cord injury

Objective: The objective of the present work was to determine the prognostic validity of the trunk control test for walking and independence in individuals with SCI.

Design: A cohort, prospective study was carried out in all individuals with sub-acute SCI.

Setting: All inpatients at the Mexico City based National Rehabilitation Institute (INR).

Participants: Ninety individuals with a clinical diagnosis of sub-acute SCI, American Spinal Injury Association Impairment Scale (AIS) A-D, and that have not participated in a rehabilitation program were included. Thirty-five individuals had good initial trunk control and the remaining 55 had poor trunk control. All individuals participated in a standard rehabilitation program subsequently.

Interventions: N/A

Outcome Measures: The trunk control test was performed at baseline. At 1, 3, 6, 9 and 12 months after the first evaluation, walking and independence were assessed.

Results: Survival Analysis revealed that 62.5% and 100% individuals with good trunk control at baseline assessment were respectively walking and independent in ADL at 12 months and 14% and 48% individuals with poor trunk control were walking and independent in ADL. Cox regression analysis revealed that individuals with good trunk control were 4.6 times more likely to walk independently at 12 months and 2.9 times more likely to be independent in activities of daily living.

Conclusion: The present study revealed that the trunk control test is useful for providing a prognosis of independence and walking at 1 year in individuals with SCI, independently of the neurologic level and the severity of the injury.     

The feasibility study of extradural nerve anastomosis technique for canine bladder reinnervation after spinal cord injury

Objective: Intradural nerve anastomosis for bladder innervation has been demonstrated to be useful. However, its clinical application remains limited because of the complex surgery, its complications and extensive bony destruction. The purpose of the current study was to demonstrate the feasibility of extradural spinal root anastomosis for bladder innervation in canines.

Methods: Ten beagle dogs were used. The length of the extradural segment of the nerve root, upper nerve root outlet (the point at which it emerges from the spinal dura mater) to S2 (dS2), the S3 (dS3) nerve root outlet distance, and the diameters of the extradural spinal roots were measured. The numbers of nerve fibers from L6 to S3 ventral roots were calculated using immunohistochemical staining.

Results: The extradural spinal roots could be divided into a ventral root (VR) and a dorsal root (DR) before the ganglionic enlargement of the dorsal root, and the extradural motor nerve roots situate ventrally to their corresponding sensory nerve roots. The extradural nerve root lengths of S1 and parts of L7 were longer than the corresponding dS2. The numbers of nerve and motor nerve fibers, and the diameters of extradural nerve roots, were gradually descending from L6 to S3.

Conclusion: The S1 VRs and parts of the L7 VRs can be extradurally anastomosed to the S2 nerves without tension. A nerve graft was needed for extradural anastomosis of L6 VRs and parts of L7 VRs to S2 VRs. This study demonstrated the feasibility of extradural spinal nerve anastomosis for treating neurogenic bladder in canines.     

胚胎脊髓移植联合甲基强的松龙治疗脊髓损伤的实验研究

目的采用胚胎脊髓移植及大剂量甲基强的松龙联合应用治疗脊髓损伤,观察两者有无协同作用.方法雄性SD大鼠50只,随机分为5组,A、B、C、D组为T12急性脊髓右侧半横断损伤后治疗组,A组给大剂量甲基强的松龙及胚胎脊髓移植联合治疗;B组行大剂量甲基强的松龙治疗;C组行胚胎脊髓移植治疗;D组为单纯损伤;E组为空白对照.治疗后24 h及8周后观察大鼠一般行为及运动功能变化,评分分析.病理观察包括治疗后8周神经纤维记数对比及辣根过氧化物酶示踪观察.结果病理学形态观察示A组损伤区横断面神经纤维记数较B、C、D组明显增多(P＜0.01);A、C组在损伤区注入的辣根过氧化物酶可扩散至损伤区远、近端各约1.0 cm处.除A组左下肢感觉有部分恢复外,无明显行为学改变.结论大剂量甲基强的松龙及胚胎脊髓移植可协同修复损伤脊髓.     

脊髓损伤后膀胱尿流动力学检查及分类

目的：检测脊髓损伤患者膀胱功能并分类。探讨并发症与膀胱功能的关系。方法：采用尿流动力学四导程测压仪对３６例脊髓损伤患者进行下尿路功能分组检测。结果：各组患者因脊髓损伤节段及程度的不同，会有不同的尿流动力学表现及不同的膀胱功能，而且有相应的并发症发生，这之间有一定的规律及内在联系，并据此将膀胱分为三类。结论：根据尿流动力学表现对脊髓损伤后膀胱进行分类，对临床有一定的指导意义。     

颈髓挥鞭样损伤的回顾性研究

目的通过对临床资料的回顾性分析,探讨颈髓挥鞭样损伤病例手术的必要性。方法根据治疗方式和损伤后MR I所示脊髓受压程度的不同,将2004年4月～2006年4月收治的36例过伸性颈椎损伤患者分成3组：非手术治疗组（8例）、受压不明显者手术组（10例）、受压明显者手术组（18例）;比较3组间治疗前后的ASIA评分及Frankel分级改变。结果所有患者获得12～24个月随访,神经功能行ASIA评分及Frankel分级,手术组均高于非手术治疗组（P〈0.05）。结论过伸性颈脊髓损伤尽早手术减压是最大限度恢复神经功能的关键。凡存在明显神经功能障碍、MR I提示有颈髓损伤,无论是否有明显脊髓受压者都应早期手术。手术可避免因颈椎管高压和颈椎不稳造成的继发性脊髓损伤,保证其远期疗效。     

颈髓损伤四肢瘫的手功能重建

目的　介绍重建颈髓损伤四肢瘫患者手功能的临床经验。方法　对 5例颈髓损伤伴手部功能障碍者 ,利用其残留的有功能的前臂肌肉进行肌腱转位术 ,重建拇指的侧捏和手指的抓握功能。结果　术后平均随访 1.5年 ,5例患者的手功能明显改善 ,提高了生活自理能力 ,并恢复了部分工作自立能力 ,如操作电脑 ,经营小杂货店等。结论　颈髓损伤伴手部功能障碍患者 ,后期施行手功能重建是有效的 ,是一个具有社会意义的举措     

周细胞在脊髓损伤中的作用

脊髓损伤(SCI)会导致患者自主神经功能、运动和感觉功能丧失,对患者的生活质量产生极大影响[1].SCI的病理变化包括损伤部位缺血、缺氧、神经元受损、瘢痕组织形成和炎性反应等[2].近年来, SCI的病理变化机制研究日趋深入,周细胞作为脊髓微环境的重要组成部位,在SCI的病理过程中发挥着重要作用.SCI发生后神经元轴突遭到破坏,这一过程伴随着血-脊髓屏障的破坏,神经胶质细胞和神经元细胞活化,并分泌多种副产物(包括基质金属蛋白酶、游离氧自由基、趋化因子和细胞因子)[3].各种免疫细胞渗入损伤部位[4],受损区域周围还会产生星形胶质细胞,小胶质细胞同样会被激活[5-6].     

Control of demyelination for recovery of spinal cord injury

Since loss of oligodendrocytes and consequent demyelination of spared axons severely impair the functional recovery of injured spinal cord, it is reasonably expected that the reduction of oligodendroglial death and enhanced remyelination of demyelinated axons will have a therapeutic potential to treat spinal cord injury. Amelioration of axonal myelination in the injured spinal cord is valuable for recovery of the neural function of incompletely injured patients. Here, this article presents an overview about the patho-physiology and mechanism of axonal demyelination in spinal cord injury and discusses its therapeutic significance in the treatment of spinal cord injury. Moreover, it further introduces the recent strategies to improve the axonal myeliantion to facilitate functional recovery of spinal cord injury.     

人工反射弧重建脊髓损伤后弛缓性膀胱排尿功能的临床初步报告

目的 探索建立人工反射弧恢复脊髓圆锥损伤后所致弛缓性膀胱排尿功能的治疗方法。方法 对临床1例圆锥脊髓损伤（SCI）所致弛缓性膀胱的患者行单侧T11与S2／S3神经前根经移植吻合，经一定时间轴突再生后，通过尿流动力学、尿检及排尿情况检测膀胱功能。结果 随访55个月，患者膀胱充盈后可引起自控性排尿，尿流动力学显示排尿完全是由膀胱逼尿肌的收缩引发。结论 建立新的人工反射弧能恢复SCI患者排尿功能，实现自控性排尿。