脊髓损伤两种修复方法的比较研究

目的：比较脊髓损伤后两种修复方法的效果。方法：损伤成鼠胸髓左后术,移植孕１４ｄ３胚胎脊髓（Ｆ组）,胚胎脊髓加自体带蒂正中神经（Ｖ＋Ｆ组）及不移植（对照组）,观察胚胎脊髓的生长、分化情况及对宿主的修复能力。结果：Ｖ＋Ｆ组胚胎脊髓体积增长速度、神经纤维数量和神经元密度显著高于Ｆ组（Ｐ〈０．０１）,细胞分化较好,突触较成熟,界面区无明显的胶质增生。Ｖ＋Ｆ组ＳＥＰ的Ｐ１、Ｎ１波潜伏期显著缩短（Ｐ〈０．０１     

胚胎脊髓移植联合反应MK—801促进大鼠脊髓损伤后功能恢复

目的 研究胚胎脊髓移植并应用Ｎ－甲基－Ｄ－天门冬氨酸（ＮＭＤＡ）受体拮抗剂ＭＫ－８０１能否促进半切洞脊髓损伤后功能恢复。方法 将成年大鼠分为３组,Ａ组：单纯脊髓半切洞损伤组;Ｂ组：脊髓半切洞损伤＋胚胎脊移植组;Ｃ组：脊髓半切洞损伤＋胚胎脊髓移植＋ＭＫ－８０１组。手术后应用联合行为评分（ＣＢＳ）、感觉诱发电位（ＳＥＰ）、运行诱发电位（ＭＥＰ）检查。结果 ３组ＣＢＳ得分Ａ组〉Ｂ组〉Ｃ组;ＳＥＰ和ＭＥＰ     

胚胎脊髓移植联合应用神经生长因子及尼莫地平对成鼠损 …

目的：研究胚胎脊髓移植联合应用神经生长因子（ＮＧＦ）及尼莫地平（ＮＤ）对损伤脊髓的修复作用。方法：９０只Ｗｉｓｔａｒ大鼠半切洞脊髓损伤后,随机分为３组：⑴单纯胚胎脊髓移植组（Ａ组）,⑵移植＋ＮＧＦ组（Ｂ组）,⑶移植＋ＮＧＦ＋ＮＤ组（Ｃ组）。观察组织形态学、运动诱发电位及行为学变化。结果：Ｃ组的运动诱发电位潜伏期在早期比Ａ组、Ｂ组皆有明显缩短（Ｐ〈０．０５）。以后肢运动功能的Ｔａｒｌｏｖ评分看,Ｂ组     

pSVP0Mcat微基因修饰雪旺细胞脊髓内移植对损伤脊髓再生的影响

采用ｐＳＶＰ０Ｍｃａｔ微基因修饰雪旺细胞（ＳＣ）脊髓内移植，观察其对损伤脊髓再生的影响。将ＳＤ大鼠脊髓半横断损伤模型随机分为ｐｚＤＳＶ０Ｍｃａｔ微基因修饰ＳＣ移植组（Ａ组）、ＳＣ移植组（Ｂ组）及损伤对照组（Ｃ组），每组１０只大鼠术后３个月，用辣根过氧化物酶（ＨＲＰ）行示踪技术及体视学计量法，检查移植术后脊髓的再生能力。结果：（１）Ａ、Ｂ两组的ＨＲＰ标记细胞在近损伤区上段、红核、动眼神经核等中脑水平     

大鼠胚胎脊髓不同移植方法对成鼠损伤脊髓血流量的影响

目的： 研究胚胎脊髓不同移植方法对成鼠损伤脊髓血流量的影响。方法： 将 Ｗｉｓｔａｒ 大鼠分为正常对照组, 单纯脊髓损伤组, 单纯胚胎脊髓移植组, 大网膜＋ 胚胎脊髓移植组, 椎旁肌＋ 胚胎脊髓移植组, 用氢清除法测定宿主脊髓的血流量。结果： 术后１５ｄ 大网膜＋ 移植组血流量已基本恢复正常 （６９０６ ±１３８０） ; 术后６０ｄ 单移植组也基本恢复正常 （６９９２ ±１５１３） , 单损伤组 （２９０５ ±１０８３） 和椎旁肌＋ 移植组 （６２１４ ±１３２６） 仍未到正常水平。结论： 实验结果表明大网膜＋ 胚胎脊髓移植对恢复损伤脊髓血流量效果最好, 单纯移植次之, 椎旁肌＋ 移植效果较差, 但好于单纯脊髓损伤组。     

pSVP_0Mcat微基因修饰雪旺细胞脊髓内移植对损伤脊髓再生的影响

采用ｐＳＶＰ０Ｍｃａｔ微基因修饰雪旺细胞（ＳＣ）脊髓内移植，观察其对损伤脊髓再生的影响。将ＳＤ大鼠脊髓半横断损伤模型随机分为ｐＳＶＰ０Ｍｃａｔ微基因修饰ＳＣ移植组（Ａ组）、ＳＣ移植组（Ｂ组）及损伤对照组（Ｃ组），每组１０只大鼠。术后３个月，用辣根过氧化物酶（ＨＲＰ）逆行示踪技术及体视学计量法，检查移植术后脊髓的再生能力。结果：①Ａ、Ｂ两组的ＨＲＰ标记细胞在近损伤区上段、红核、动眼神经核等中脑水平均有发现，Ａ组多于Ｂ组，Ｃ组损伤近端未发现ＨＲＰ标记细胞。②损伤区脊髓前角灰质神经元密度及１００μｍ白质范围内有髓神经纤维计数：Ａ组＞Ｂ组＞Ｃ组。提示，ｐＳＶＰ０Ｍｃａｔ微基因修饰ＳＣ脊髓内移植有促进损伤脊髓再生的作用     

不同方法移植胚胎脊髓促进成鼠损伤脊髓功能恢复的研究

目的：研究提供血运的胚胎脊髓移植对成鼠损伤脊髓功能恢复的作用。方法：将成年Ｗｉｓｔａｒ大鼠作为脊髓半切洞损伤模型,应用单纯胚髓组织、胚胎脊髓＋大网组织、胚社以半切洞损伤的脊髓中,手术后１、２、４、１２周进行联合行为发,感觉诱闰（ＳＥＰ）和运动诱发电位（ＭＥＰ）检查,并与一言堂３组为单纯损伤线比较。结果：联合行为评分,单纯移植级和胚胎脊髓＋大网膜组织移植组优于单纯损伤组,ＳＥＰ和ＭＥＰ潜峰时的恢复,     

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     

胚胎脊髓细胞悬液植入急性成年大鼠损伤脊髓

目的：建立胚胎脊髓细胞悬液移植于脊髓损伤模型，以评价其治疗脊髓损伤的可能性。方法：４２只Ｗｉｓｔａｒ大鼠以改良Ａｌｅｎ法（５０ｇｃｍ）打击脊髓，３天后将孕１４天（Ｅ１４）ＦＳＣＳ２０μｌ植入损伤空腔，移植后２、４、６、８、１０、１２周，以光、电镜、免疫组织化学观察移植物存活、分化及其与宿主之间关系。结果：移植细胞逐渐长大。充满不规则空腔，宿主ＮＦ、５－ＨＴ、ＣＧＲＰ纤维分别出现于移植物，ＧＦＡＰ纤维于宿主移植物交界处适量存在。移植成神经细胞、成少突胶质细胞、成星形细胞的细胞器日渐完善，细胞功能活跃。复杂及多样突触与细胞连接，将上述细胞与神经纤维、胶质纤维、毛细血管网在三维空间内连接成一体，并与宿主紧密嵌合。结论：（１）成年大鼠脊髓损伤３天后植入ＦＳＣＳ可以存活。（２）移植物进入宿主后，出现再分布，继而器官样分化。（３）长、短传导束进入移植物，显示了移植物的桥作用。（４）成少突胶质细胞的神经营救作用。（５）移植区内出现多种突触，提示移植物中继作用的可能性。     

大鼠胚胎脊髓移植物对成体损伤脊髓运用能修复的影响

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）的峰潜代恢复优于对照组（Ｐ〈０．０５）。结果提示，胚胎脊髓移植对成年宿主损伤     

脊髓损伤大鼠脊髓组织的病理形态学观察

目的：研究脊髓损伤（SCI）用高压氧（HBO）处理后脊髓的病理学变化。方法：用SD大鼠复制SCI模型，0．1MPa和0．25MPaHBO处理后，取损伤脊髓作HE染色。结果：正常对照组脊髓结构完整，细胞形态正常，分布均匀，胞膜，胞核正常，组织间隙正常，单纯损伤组示组织出血，疏松水肿，细胞空泡变性，神经纤维溶解，消失；处理后，0．25MPaHBO组及0．25MPaHBO＋激素（L，M）组脊髓恢复最明显，组织水肿，细胞空泡变性减轻，细胞形态恢复，结构排列完整，结论：HBO治疗可明显阻止或减轻脊髓损伤的病理变化，有利于脊髓功能的恢复。     

Spinal Myoclonus After Spinal Cord Injury

Abstract

Background/Objective: In the course of examining spinal motor function in many hundreds of people with traumatic spinal cord injury, we encountered 6 individuals who developed involuntary and rhythmic contractions in muscles of their legs. Although there are many reports of unusual muscle activation patterns associated with different forms of myoclonus, we believe that certain aspects of the patterns seen with these 6 subjects have not been previously reported. These patterns share many features with those associated with a spinal central pattern generator for walking.

Methods: Subjects in this case series had a history of chronic injury to the cervical spinal cord, resulting in either complete (ASIA A; n = 4) or incomplete (ASIA D; n = 2) quadriplegia. We used multi-channel electromyography recordings of trunk and leg muscles of each subject to document muscle activation patterns associated with different postures and as influenced by a variety of sensory stimuli.

Results: Involuntary contractions spanned multiple leg muscles bilaterally, sometimes including weak abdominal contractions. Contractions were smooth and graded and were highly reproducible in rate for a given subject (contraction rates were 0.3-0.5 Hz). These movements did not resemble the brief rapid contractions (ie, "jerks") ascribed to some forms of spinal myoclonus. For all subjects, the onset of involuntary muscle contraction was dependent upon hip angle; contractions did not occur unless the hips (and knees) were extended (ie, subjects were supine). In the 4 ASIA A subjects, contractions occurred simultaneously in all muscles (agonists and antagonists) bilaterally. In sharp contrast, contractions in the 2 ASIA D subjects were reciprocal between agonists and antagonists within a limb and alternated between limbs, such that movements in these 2 subjects looked just like repetitive stepping. Finally, each of the 6 subjects had a distinct pathology of their spinal cord, nerve roots, distal trunk, or thigh; in 4 of these subjects, treatment of the pathology eliminated the involuntary movements.

Conclusion: The timing, distribution, and reliance upon hip angle suggest that these movement patterns reflect some elements of a central pattern generator for stepping. Emergence of these movements in persons with chronic spinal cord injury is extremely rare and appears to depend upon a combination of the more rostrally placed injury and a pathologic process leading to a further enhancement of excitability in the caudal spinal cord.     

脊柱外伤的MRI表现

本文报告了50例急、慢性脊柱外伤病人MRI的检查结果,描述了15例急性期脊髓损伤后水肿和出血的MRI信号改变和35例慢性期脊髓损伤后脊髓囊变、纤维化和脊髓萎缩的MR信号改变。探讨不同MR信号与预后的关系。     

应用中医传感针观察伤段脊髓氧分压的变化

目的：探讨应用中医传感针观察脊髓损伤（SCI）后伤段脊髓氧分压的变化及其与病理变化、神经功能损害的关系。方法：改变Allen法致伤大鼠脊髓，于伤前和伤后1／2、1、3、6、24、72、168h，用中医传感针技术测量脊髓氧分压，应用光、电镜观察脊髓病理变化，应用斜板试验评价大鼠运动功能。结果：SCI后伤段脊髓氧分压明显下降（P＜0．01），与病理变化及神经功能损害的发生发展一致。结论：中医传感针可应用于测量SCI后脊髓氧分压；脊髓氧分压是脊髓损伤研究中的重要观察指标。     

实验性胚胎脊髓移植进展

目的：研究胚胎脊髓移植治疗脊髓损伤的作用。方法：将胚胎脊髓移植到各种动物模型,以及在临床的初步应用。结果和结论：胚肿脊髓移植能够促进脊髓环路的再生和功能恢复。     

Autonomic Hyperreflexia With Spinal Cord Injury

ABSTRACT

Autonomic hyperreflexia occurs in up to 85 percent of individuals with spinal cord injuries above the major splanchnic sympathetic outflow. In such cases, paroxysmal reflex sympathetic activity develops in response to noxious stimuli below the level of the neurologic lesion. The clinical features of autonomic hyperreflexia are due largely to reflex sympathetic adrenergic and cholinergic discharges with dysfunctional supraspinal regulatory control. Cephalgia, diaphoresis, flushing, tachycardia or bradycardia, and paroxysmal hypertension are most commonly observed. Although a variety of stimuli can provoke autonomic responses of variable magnitudes, bladder and bowel distention continue to account for most episodes. Removal of the offending stimulus is important to restoring the autonomic nervous system to its baseline activity. Current understanding of the pathophysiology, clinical features, and medical management of this fascinating but potentially serious complication of spinal cord injury are reviewed.