脊髓损伤后弛缓性膀胱的治疗

目的探讨脊髓损伤后弛缓性膀胱的治疗方法。方法广泛查阅国内外相关文献，介绍几种弛缓性膀胱的治疗方法。结果脊髓损伤后弛缓性膀胱尚缺乏有效的治疗方法，与清洁间断导尿、加压排尿、药物治疗及重建逼尿肌功能等治疗方法相比，建立人工反射弧能实现膀胱的可控性排尿。结论人工反射弧的建立为脊髓损伤所致的弛缓性膀胱提供了一种新的膀胱功能重建方法。     

PHENOXYBENZAMINE IN THE MANAGEMENT OF NEUROPATHIC BLADDER FOLLOWING SPINAL CORD INJURY

Background : The present study aims to show the clinical and urodynamic effects of phenoxybenzamine on the neuropathic bladder of spinal cord-injured patients who failed to be free of catheter by attaining satisfactory voiding function, despite initial bladder training. Methods : Forty-six spinal cord-injured patients were subjected to pharmacological manipulation with phenoxybenzamine. It was used as an adjunct in the management of neuropathic bladder dysfunction that caused failure of the bladder to empty, by tapping or crede to achieve satisfactory residual urine volume of < 100 mL. Phenoxybenzamine was started with a dose of 10 mg daily, increased by 10 mg every 3 days to a dose of 30 mg daily; this was maintained from 3 weeks to 6 months (mean: 39 days). The pre-treatment residual urine volume ranged between 100 and 1050 mL (mean: 360 mL). Follow-up periods ranged between 12 and 36 months (mean: 16 months). Results : Five patients (11%) were excluded due to either inadequate treatment or inadequate follow-up. Nineteen patients (41%) with reflex (upper motor neurone) bladders showed improvement of bladder evacuation. There was a reduction of the maximum urethral closure pressure, which ranged between 10 and 32 cm of water (mean: 22 cm). Twenty-two patients (48%) did not respond, requiring other measures to be taken which included transurethral surgery (n = 19). Nine of the failures involved areflex (lower motor neurone) bladders, and seven failures involved reflex bladders with an extremely tight outlet and urethral closure pressure of > 50 cm of water. Six failures involved reflex bladders that were lacking strong enough detrusor contractions to attain a balanced bladder responsive to abdominal tapping; response was achieved by administration of a parasympatheticomimetic drug. Neuropathic bladders with uninhibited detrusor contractions responded well to phenoxybenzamine. Conclusions : Phenoxybenzamine proved useful in reducing bladder outlet resistance after spinal cord injury, provided that detrusor bladder contractions were present. It is useful in controlling detrusor–sphincter dyssynergia and autonomic hyperreflexia. It was not useful in areflex bladders, perhaps due to the development of spasticity of the striated muscle component of the external sphincter. The presence of bladder neck (internal sphincter) dysfunction may modify or abolish its effect.     

脊髓损伤后膀胱人工反射弧建立的实验研究

目的 通过建立家犬人工膀胱反射孤,以恢复脊髓损伤后的膀胱功能。它包含一个体反射孤,并将体反射运动冲动经异化的运动传出支传入膀胱,引起膀胱的自主性收缩．方法 将右Ｌ５前根近端与右Ｓ２前根远端在硬膜囊内行显微吻合,保持Ｌ５后根完整,经轴突再生后,建立膝腱－脊髓中枢－膀胱这一新人工反射通路,通过刺激右侧膝腱激发排尿。神经根吻合术后６个月和１８个月,分别进行神经电生理、膀胱测压、膀胱逼尿肌肌电图等早期和远     

氨基胍对大鼠急性脊髓损伤后脊髓水肿的作用机制研究

目的氨基胍(aminoguanidine,AG)能显著减轻脑外伤及中风动物模型脑水肿,提高神经功能恢复程度。探讨AG对大鼠急性脊髓损伤(spinal cord injury,SCI)后脊髓水肿的作用及相关机制。方法取成年雄性SD大鼠150只(体重230～255 g),分为对照组(A组,25只)、假损伤组(B组,25只)、SCI后未治疗组(C组,25只)和SCI后AG治疗组(75只);AG治疗组按给药剂量分为AG 75 mg/kg组(D组,25只)、AG 150 mg/kg组(E组,25只)和AG300 mg/kg组(F组,25只)。A组未行任何处理,B组仅行椎板切除术但不治疗;C、D、E、F组制备静压型大鼠SCI模型后,C组腹腔注射5%DMSO,D、E、F组腹腔注射相应剂量AG。于造模后0、12、24、48 h用干湿重法检测受损脊髓组织含水量以筛选最佳剂量,进一步用伊文思兰(Evans blue,EB)法评测血-脊髓屏障功能,用RT-PCR检测水通道蛋白4(aquaporins 4,AQP4)mRNA表达,Western blot和免疫组织化学染色检测AQP4蛋白表达。结果脊髓组织含水量检测示,E组在造膜后12、24、48 h对SCI后脊髓组织水肿有明显抑制作用(P<0.05),选择该剂量组用于后续实验。造模后12、24、48 h,E组EB含量明显低于C组(P<0.05),降低血-脊髓屏障通透性。RT-PCR检测结果示造模后12、24、48 h,B、E组AQP4 mRNA表达明显低于C组;Western blot检测示造模后24、48 h,B、E组AQP4蛋白表达明显低于C组;免疫组织化学染色示造模后48 h,B、E组AQP4蛋白表达明显低于C组,差异均有统计学意义(P<0.05);但各指标各时间点B、E组间比较,差异均无统计学意义(P>0.05)。结论急性SCI后大鼠经150 mg/kg AG治疗后,能降低AQP4表达,改善脊髓水肿,减轻损伤。     

MECHANISM OF EXTENSION OF SPINAL ANAESTHESIA BY EXTRADURAL INJECTION OF LOCAL ANAESTHETIC

We have examined the effect of extradural injection of 0.5%bupivacaine or normal saline on the progression of spinal anaesthesiain 28 patients undergoing Caesarean section. Three groups werestudied. Subarachnoid anaesthesia was established in all patients.Group A (n = 10), the control, received no extradural injectionfor 20 min. Group B (u= 9) received extradural bupivacaine 10ml and group C (n = 9) received extradural saline 10 ml 5 minafter the subarachnoid injection. Sensory levels were comparedat 5-min intervals and extension of the block was found to besimilar in groups B and C and significantly faster than thecontrol (P < 0.05). The quality of anaesthesia and incidenceof adverse effects was similar for all three groups. We concludethat the mechanism of extension of spinal anaesthesia by extraduralinjection of local anaesthesia is largely a volume effect. (Br.J. Anaesth. 1992; 69: 457–460) ^*Present address, for correspondence: Department of Anaesthetics,Freeman Hospital, High Heaton, Newcastle Upon Tyne NE7 7DN.     

大鼠胚胎脊髓移植物对成体损伤脊髓运动功能修复的影响

为了探讨胚胎脊髓移植物对成体损伤脊髓运动功能修复的效应，取妊娠１４天胚胎大鼠脊髓组织，移植到成年大鼠脊髓半切洞损伤模型，术后进行联合行为记分（ＣＢＳ）和运动诱发电位（ＭＥＰ）检查。结果发现，移植组ＣＢＳ与对照组比较相差显著（Ｐ＜０．０５），移植术后４周以内两者相差非常显著（Ｐ＜０．０１）。移植组ＭＥＰ早期反应（Ｐ１，Ｎ１）的峰潜伏时恢复优于对照组（Ｐ＜０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤脊髓的功能修复具有促进作用。这可能与胚胎脊髓组织能分泌多种神经营养因子、神经生长因子、神经递质，或激素的调节作用有关。     

骨髓间充质干细胞移植治疗脊髓损伤的研究现状

目的综述有关骨髓间充质干细胞（marrow mesenchymal stem cells,MSCs）移植治疗脊髓损伤（spinal cord injury,SCI）的新进展。方法广泛查阅近年来国内外相关文献,对MSCs生物学特性、移植治疗SCI的实验研究、移行机制、治疗机制和存在的问题进行讨论和分析。结果动物实验和临床研究表明,MSCs移植治疗SCI已有很大进展,移植治疗后,移植细胞能向损伤部位移行,并能分化为神经样细胞和分泌神经营养物质,具有促进损伤脊髓修复和神经功能恢复的作用,但也存在许多问题。结论MSCs移植治疗SCI是一种行之有效的方法,但仍有许多问题有待解决。     

骶神经根选择性切断治疗截瘫后痉挛性膀胱的实验及临床研究

目的观察高选择性骶神经根前根切断术治疗脊髓损伤后痉挛性膀胱的疗效,探讨其治疗机制、最佳手术方法及临床实际疗效. 方法雄性家犬12只,制成脊髓损伤后痉挛性膀胱模型,根据骶神经根切断方式:切断S2前根,切断S2前根 S3 1/2前根,切断S2、S3前根,完全切断S2～4神经根,依序分为A、B、C、D 4个组,通过尿动力学检测及电生理观察,分析比较骶神经根切断前、后各组功能性指标的变化,确定其最佳手术方案.临床治疗则根据实验结果,选择性切断脊髓损伤后痉挛性膀胱患者S2前根或 S3 1/2前根共32例.术前膀胱容量平均(120±30) ml,术前排尿量平均(100±30) ml,尿道压力平均为(120±20) cm H2O. 结果 4个组术后膀胱容量分别为:(150±50)、(180±50)、(230±50)、(400±50) ml;排尿量分别为:(130±30)、(180±50)、(100±50)、(50±30) ml.临床治疗32例,术后膀胱容量平均增加至410 ml左右,排尿量平均增加至350 ml左右,所有患者尿失禁消失.有13例获22个月远期随访,无复发. 结论高选择性骶神经根切断治疗脊髓损伤后痉挛性膀胱疗效显著,是一种值得研究、推广的新方法.     

干细胞修复脊髓损伤的研究现状及应用前景

目的 综述有关干细胞移植治疗脊髓损伤(spinal cord injury,SCI)的现状及前景.方法 广泛查阅近年国内外相关文献,对干细胞生物学特性、移植治疗SCI的实验研究、治疗机制和存在的问题进行讨论和分析.结果 基础实验和临床研究表明,干细胞治疗SCI研究已有很大进展,它可以在脊髓内迁移、分化为神经元以及分泌神经营养物质,具有促进SCI后神经功能恢复的作用,但也存在很多问题.结论 干细胞治疗SCI是一种有前景的治疗方法,但尚有很多问题亟待解决.     

胚胎脊髓移植加神经生长因子和尼莫地平对成年大鼠脊髓继发性损伤的影响

目的：用神经生长因子（NGF）和尼莫地平（ND）增强胚胎脊髓移植修复成年大鼠损伤脊髓的效果,缓解脊髓继发性损伤。方法：采用脊髓半切洞损伤模型,分为单纯胚胎脊髓移植组,移植加NGF组,移植加NGF和ND组,术后移植部位脊髓细胞内游离钙离子浓度,超氧化物歧化酶（SOD）,丙二醛（MDA）的变化,并比较各组死亡率,结果：移植加NGF组较单纯移植组,MDA明显下降,SOD显著升高,有统计学意义（P＜0．05）,但两组间细胞内游离钙离子浓度差别不显著（P＞0．05）,移植加NGF和ND组更有效地升高SOD浓度,降低钙离子浓度和MDA含量,与其它两组比较有显著性差异（P＜0．05）,移植加NGF和ND组的死亡率明显低于其它两组,有非常显著性差异（P＜0．01）,结论：NGF和ND能较好地改善继发性脊髓损伤,明显降低经胚胎脊髓移植术皇的成年大鼠死亡率,。。     

RUPTURE OF DIAPHRAGM ASSOCIATED WITH SPINAL CORD INJURY

A review of 1,007 patients treated at a spinal Injuries unit revealed 11 instances of rupture of the diaphragm. In five patients It took more than 48 hours before the ruptured diaphragm was diagnosed. The hazards of delay In diagnosis and treatment were highlighted by three Instances of gastric perforation - two due to attempted pleural aspiration and one spontaneous. There Is a need for the greater use of contrast radiology In the assessment of these patients.     

胚胎脊髓不同移植方法对成年大鼠损伤脊髓神经元的影响

目的：探讨胚胎脊髓不同移植方法防止成年鼠脊髓轴突损伤后引起的神经元萎缩的作用。方法：采用Wistar成年大鼠腰脊髓半切洞损伤模型。将实验动物分为五组：A组为正常对照组,B组为损伤组;C组为损伤＋移植组;D组为损伤＋移植＋椎旁肌组;E组为损伤＋移植＋大网膜组,手术后应用行为学和电生理检查观察大鼠神经功能恢复情况,应用尼氏染色方法观察神经元的大小,采用计算机图像分析技术,进行定量分析。结果 胚胎脊髓不同移植方法均可以防止老年鼠脊髓轴突损伤引起的神经元萎缩,图像分析发现其作用为E组＞D组＞C组＞B组＞A组,尤以E组效果最好,可以完全恢复损伤神经元的形态,大鼠神经功能的恢复也出现了相同的变化趋势。结论 鼠胚胎脊髓不同移植方法能维持神经元的细胞形态,对成年大鼠损伤脊髓功能恢复有促进作用。     

选择性骶神经前后根组合切断恢复脊髓损伤后膀胱功能的实验研究

目的：探讨脊髓损伤后膀胱完全性去神经传入手术的替代方法。方法：健康杂种犬16只经T10平面截瘫后,按L7－S3神经根切断程度的不同,从完全保留到完全切断分成六组,比较术中神经根（总根和后根）电刺激时的膀胱尿道压力变化和术后膀胱压力容积曲线（CMG）变化。结果 （1）电刺激研究：犬磅胱的神经支配以S2为主,S1次之,尿道的神经支配以S1为主,S2次之,在保留S1或S2前后根完整的情况下,刺激同平面S1或S2的总根或后根,膀胱尿道的压力反应相同,切断S1或S2前根,刺激同平面的S1或S2后根,膀胱尿道的压力反应显著降低。（2）CMG研究：保留同一平面S1或S2前后根的完整,其CMG曲线与完全不切断的对照组相似,形成痉挛性膀胱,不保留同一平面前后根的完整,即切断S1或S2前根,其CMG曲线与切断全部后根的对照组相似,形成驰缓性膀胱,结论 不同平面的骶神经前后根组合切断,能获得与完全性后根切断相同的膀胱去神经效果。     

无脊髓损伤的颈椎骨折脱位临床分析

目的　探讨外伤性无脊髓损伤的颈椎骨折脱位的发病原因、机制及治疗方法。方法　对 9例外伤后颈椎骨折脱位者进行全面的影像学检查 ,通过临床症状及影像学改变分析颈椎骨折脱位的损伤机制 ,总结病变特点 ,提出治疗原则。 9例全部采用颈前路椎体复位术。结果　完全复位 8例 ,部分复位 1例。全部患者术后获得随访 1～ 3年 ,症状明显好转 2例 ,完全恢复 7例。未发现有神经症状加重 ,均可从事日常工作。结论　无脊髓损伤的颈椎骨折脱位 ,发病机制特殊 ,采用手术治疗颈椎固定稳定、脊髓致压因素去除彻底 ,不易引起迟发性神经症状     

急性脊髓损伤动物模型的建立

目的：建立一种不同程度的脊髓损伤动物模型。方法：自行设计一种脊髓损伤动物模型，以一恒定的外力和打击时间，以观察35只大鼠在不同的打击深度下的运动功能和病理变化。结果：假手术组大鼠，苏醒后能站立行走，脊髓结构正常；打击深度为0.5mm时，动物苏醒后能站立行走，脊髓结构正常，打击度为0.8mm 时，动物出现不瘫，数天后能站立行走，脊髓结构破坏较轻；打击深度为1．0 mm时，动物出现全瘫，4周后不能站立行走，脊髓结构破坏，打击深度为1．5 mm时，动物出现全瘫，4周后不能站立行走，脊髓结构破坏严重。结论：以打击深度为参数建立不同程度的脊髓损伤动物模型，重复性好较     

PREDICTORS OF NECROSPERMIA IN MEN WITH SPINAL CORD INJURY

Purpose

We identify predictors of the lowest yield of dead sperm in ejaculates of men with spinal cord injury.

Materials and Methods

The percentages of dead immotile sperm and dead total sperm were compared in 141 spinal cord injured and 52 normal men. Predictors of necrospermia investigated in spinal cord injured men included specimen collection by vibratory stimulation versus electroejaculation, residence of sperm in antegrade versus retrograde specimens and level of injury.

Results

Spinal cord injured subjects had a significantly higher percentage of dead sperm in the immotile fraction and total specimen than control subjects. The percentage of dead sperm was lower in antegrade versus retrograde specimens and in specimens produced by vibratory stimulation versus electroejaculation. There was no difference in the percentage of dead sperm by level of injury.

Conclusions

Of the parameters evaluated only method and type of specimen collection were predictive of the degree of necrospermia in men with spinal cord injury. Level of injury was not predictive. The ratio of dead-to-live immotile sperm in spinal cord injured men was double that in normal men, indicating a pathological mechanism for sperm cell death.