脊髓损伤后大鼠后肢运动功能恢复的评分标准比较

目的：比较脊髓损伤（SCI）后大鼠后肢运动功能恢复的不同评分标准的优劣。方法：40只SD成熟雌性大鼠随机分为：正常组（Normal组）、急性脊髓中度损伤组（SCI组）及对照组（CON组），其中SCI组采用改良的Allen打击法，CON组仅行T10椎板切除术。术后1、2、3、4、6周观察大鼠后肢神经功能恢复的情况，并记录结果。评价标准分别为：斜板试验评分、改良Tarlov评分及BBB评分。结果：SCI组与CON组比较，斜板试验临界角度在1-6周时，均有所减小（P〈0．05），尤以第1周时减少更甚（P〈0．01）；改良Tarlov评分第1、2、3、4周时，分值间的差别非常明显（P〈0．01）第6周时，未见变化（P〉0．05）：而BBB评分各时间点的区分程度非常明显（P〈0．01）。结论：BBB评分对SCI模型运动功能评价具有明显优势，可作为今后研究的标准评分法。     

神经营养素3对大鼠脊髓损伤后运动功能恢复的影响

目的 探讨神经营养素3(neurotrophin-3,NT-3)对大鼠急性脊髓损伤的治疗作用.方法 实验于2005-01/06在解放军第三军医大学中心实验室完成.选择60只健康SD大鼠,随机分为3组:对照组(生理盐水组),实验组(NT-3组),假手术组(n=5);用改良Allen's法以30gcm致伤SD大鼠制作大鼠T8全瘫模型,实验组经蛛网膜下腔导管于术后即刻,4h,8h,12h,24h,3d,7d注入NT-320μl(含NT-3 200ng),对照组在相同时间点给予等量生理盐水,假手术组只打开椎板后蛛网膜下腔置管,不致伤,不给药.各组动物分别于术后24h,3d,7d、14d行BBB评分和MEP检查.结果 60只大鼠全部进入结果分析,①实验组在24h、3d、7d、14d较对照组BBB评分分值提高[0.22±0.43/0.70±0.48(P＜0.05);3.2 2.39/8.01 2.05;9.30 1.49/14.32 2.11;12.80±0.92/18.40±1.08(P＜0.01)],②实验组MEP的N1波潜伏期在24h、3d、7d、14d均较对照组明显缩短[80.90±7.49/49.9±2.44(P＜0.01);54.05±8.52/40.55±4.72(P＜0.05);43.10±1.53/33.65±2.78(P＜0.01);38.45±3.98/22.25±2.84(P＜0.01)].结论 神经营养素3能明显促进脊髓损伤后运动功能的恢复,对大鼠脊髓损伤有明显治疗作用.     

新生鼠和成年鼠脊髓损伤后胚胎脊髓移植对大鼠损伤脊髓功能恢复的影响

目的研究新生鼠和成年鼠脊髓损伤后胚胎脊髓移植对大鼠损伤脊髓功能恢复的影响。方法将新生鼠和成年鼠腰段脊髓半切洞损伤,取E14胚胎脊髓组织移植到损伤区,手术后4、8、12周,进行组织学检查,联合行为评分,感觉诱发电位,运动诱发电位检查。结果组织学检查发现移植的胚胎脊髓在宿主脊髓中存活。联合行为评分,感觉诱发电位,运动诱发电位潜峰时的恢复,新生鼠移植组均优于成鼠移植组(P<0.05)。结论通过各种功能检查(CBS,SEP,MEP)表明胚胎脊髓移植能够促进脊髓损伤后新生鼠和成鼠运动功能的恢复。     

胚胎脊髓组织移植合用神经生长因子对损伤脊髓功能恢复的影响

将１４－１５天的胚胎脊髓组织移植到成年Ｗｉｓｔａｒ大鼠半横断脊髓损伤腔，术后１－６个月，通过爬坡，网格板走步，Ｔａｒｌｏｖ运动分级和电生理的检查，评价损伤脊髓的功能恢复程度，在移植组动物，术后可见后肢运动功能逐渐恢复，６个月时，恢复的程度接近正常水平，对照组运动功能检查未见明显的改善，结果提示，胚胎脊髓组织移植在一定程度上有助于损伤脊髓的功能恢复。     

损伤区上下神经根吻合对大鼠损伤脊髓神经元的影响

目的：探讨损伤区上下神经根吻合对防止成鼠脊髓轴突损伤后引起神经元萎缩和凋亡的作用。方法：采用改良的Ａｌｌｅｎ‘ｓ打击法致伤大鼠脊髓,将实验动物分为单损伤组（Ａ组）,损伤＋上下神经根吻合组（Ｂ组）。手术后应用这和电生理检查,观察大鼠功能恢复情况;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：损伤区上下神经根吻合,可以防止成鼠脊髓轴突损伤后引起的神经元萎缩,图像分析发现     

脊髓损伤的病理变化及其与磁共振成像演变

脊髓损伤的病理变化及其与磁共振成像演变贾宁阳综述肖湘生审校本文就脊髓损伤后的病理变化及其与ＭＲＩ图像之间信号变化演变特点和预后作一文献复习，综述如下：１脊髓损伤的主要病理变化特点１．１脊髓损伤急性期的病理变化脊髓急性损伤后数秒钟，即于灰质及蛛网膜发生...     

应用功能性磁共振及其他无创影像技术评价脊髓损伤后的结构与功能

自20世纪90年代以来,在传统磁共振成像(magnetic resonance imaging, MRI)技术的基础上发展的功能磁共振成像(functional magnetic resonance imaging, fMRI)技术已广泛应用于脑功能的临床和基础研究.     

应用功能性磁共振及其他无创影像技术评价脊髓损伤后的结构与功能

自20世纪90年代以来,在传统磁共振成像（magnetic resonance imaging,MRI）技术的基础上发展的功能磁共振成像（functional magnetic resonance imaging,fMRI）技术已广泛应用于脑功能的临床和基础研究。fMRI结合功能、解剖和影像3方面的因素,为临床磁共振诊断从单一形态学研究到与功能相结合的系统研究提供强有力的技术支持。该技术具有无创性、无放射性、可重复性、较高的时间和空间分辨率、     

胚胎脊髓移植对成鼠损伤脊髓血流量恢复的影响

以往有过不少脊髓损伤移植修复的研究报道，但有关移植后宿主脊髓血流量变化的研究却未见报道。为此，作者将胎鼠脊髓植入成鼠损伤脊髓后，用氢清除法测量了宿主脊髓血流量（Spinalcordbloodflow，SCBF），旨在探讨胚胎脊髓移植对宿主脊髓血流量恢复的影响。材料与方法以成年Wistar大鼠脊髓为移植受体。乌拉坦1．259从g腹腔麻醉后，暴露脊髓腰膨大。半切左侧脊髓，并搅毁局部脊髓组织，尔后用吸引器吸除损毁的脊髓组织。如此在半切脊髓的基础上制造了一个直径约Zmm、深达脊髓腹侧硬脊膜的盲洞、取妊娠14d服鼠颈胸段脊髓，剔除与之相连的…     

Functional recovery of the spinal cord following ischemia and reperfusion injury

OBJECTIVE: To study the changes of excitatory amino acids (EAAs) and intracellular calcium ([Ca2+]i), and the protective effect of EAAs receptor antagonists in the tissues of rabbit lumbar spinal cord after 40-minues ischemia and 4-hours reperfusion. METHODS: Thirty healthy rabbits were divided into six groups: sham-operation, 40-minues ischemia, 4-hour reperfusion, ketamine and MgSO4 treatment, ketamine treatment, and saline treatment groups. The contents of EAAs (glutamate and aspartate) and [Ca2+]i were measured. RESULTS: The contents of glutamate and aspartate were decreased to 15.18 micromol/g+/-2.33 micromol/g and 9.99 micromol/g+/-0.69 micromol/g, respectively; 13.75 micromol/g+/-2.58 micromol/g and 6.49 micromol/g+/-1.39 micromol/g after reperfusion. In the ischemia group, the [Ca2+]i was elevated to 221.2 microg/g+/-4.27 microg/g, and elevated further to 298.3 microg/g+/-9.26 microg/g after reperfusion, being significantly higher than that of ischemia and control groups. Ketamine could obviously increase the level of glutamate and aspartate and decrease the level of [Ca2+]i during the ischemia and reperfusion injury. CONCLUSIONS: The excitotoxicity of EAAs and the overload of calcium induced by EAAs play a harmful role in ischemia and reperfusion injury. Ketamine has an effective inhibitory effect.     

Post-traumatic growth following spinal cord injury

Context/objective

Examine the relationship of post-traumatic psychological growth (PTG), depression, and personal and injury characteristics in persons with spinal cord injury (SCI).

Design

Cross-sectional survey.

Setting

Community.

Participants

Eight hundred and twenty-four adults with SCI.

Interventions

None.

Outcome measures

Five items from the Post-traumatic Growth Inventory, reflecting positive change after injury in life priorities, closeness to others, new opportunities being available, stronger faith, and personal strength.

Results

Initial structural equation model testing of a conceptual model of personal and injury characteristics, violent etiology, depression, and PTG resulted in a poor fit. Model modifications resulted in an improved fit, but explained only 5% of the variance in PTG. Being female, younger, having less formal education, and less time since injury had significant relationships with PTG, whereas depression, violent etiology, and injury level/severity did not. In each PTG domain, between 54 and 79% of the sample reported at least some positive change after injury.

Conclusions

The results of this study, while promising, explained only a small portion of the variance in PTG. A majority of the sample experienced some positive change after injury, with the greatest change in discovering that they were stronger than they thought they were. Comparing means previously reported in a non-SCI sample of those who experienced trauma, positive change after injury was comparable for each PTG item except for new opportunities being available, which was significantly lower for those with SCI. Future directions of research include the development of theoretical models of PTG after SCI.     

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,     

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.     

颈髓急性损伤后的磁共振波谱评价

目的:探讨颈髓急性损伤后磁共振波谱(1H-MRS)的诊断价值。方法:对19例急性颈髓损伤患者根据神经功能分为完全性损伤及不全性损伤两组,选取创区与创区头侧远端颈髓行1H-MRS,半定量分析氮-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)和乳酸(Lac)含量的比值。结果:颈髓完全性损伤组中NAA/Cho、NAA/Cr显著减低,Lac/Cho显著增高,其创区头侧远端Lac/Cho含量也增高(P<0.05);不完全损伤组中仅Lac/Cho含量增加,头侧远端乳酸含量亦增高(P<0.05)。颈髓损伤不同程度组间NAA/Cho、NAA/Cr有显著性差异(P<0.05)。结论:1H-MRS所测NAA/Cho、NAA/Cr从代谢水平反映颈髓损伤的不同程度,创区头侧远端Lac/Cho比值增高提示颈髓隐匿损伤的存在。     

脊髓血管母细胞瘤的MRI特点

【摘要】〓目的〓分析探讨脊髓血管母细胞瘤的MRI表现特征。方法〓回顾性分析经手术病理证实的7例脊髓血管母细胞瘤的临床及MRI表现。全部患者均行MRI平扫及增强扫描。结果〓单发6例,多发1例,共有脊髓血管母细胞瘤病灶8个,所有病灶均位于髓内。其中,延髓1个,颈段4个,胸段2个,腰段1个。肿瘤多呈点状、结节状、香肠状或不规则形状,肿瘤在MRI T1WI呈等或稍低信号,T2WI呈稍高信号,增强扫描上下径<20 mm的病灶呈明显、均匀强化,上下径>20 mm的病灶呈明显不均匀强化,其内可见多发流空的血管影;7例患者均伴有不同程度脊髓空洞或水肿。结论〓脊髓血管母细胞在MRI中具有特征性的影像表现,MRI对诊断脊髓血管母细胞瘤具有重要价值。     

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.     

胶质细胞源性神经营养因子对大鼠脊髓损伤后运动功能的影响

目的:研究胶质细胞源性神经营养因子（GDNF）对大鼠脊髓损伤后后肢运动功能恢复的影响。方法:采用改良Nystr(?)m法后路压迫大鼠胸段脊髓造成损伤模型,经蛛网膜下腔置管局部连续给予NGF （10μg/d）或GDNF（10μg/d）1周,对照组给予生理盐水。伤后4周3组分别观测:①伤段脊髓残存组织面积;②采用斜板试验和运动功能评分观察大鼠后肢运动功能恢复情况。结果:大鼠脊髓损伤后4～14d,GDNF治疗组后肢运动功能评分明显高于NGF组和生理盐水对照组（P<0.05）。伤后28d GDNF组伤段残存脊髓组织面积大于对照组和NGF组（P<0.01）。结论:外源性GDNF能减少脊髓损伤后伤区的坏死、萎缩并促进大鼠后肢运动功能的早期恢复。     

Prediction of functional recovery six months following traumatic spinal cord injury during acute care hospitalization

Objectives: To determine factors associated with functional status six months following a traumatic cervical and thoracic spinal cord injury (SCI), with a particular interest in factors related to the acute care hospitalization stay.

Design: This is a prospective cohort study. Sixteen potential predictive variables were studied. Univariate regression analyses were first performed to determine the strength of association of each variable independently with the total Spinal Cord Independence Measure (SCIM) score. Significant ones were then included in a General linear model in order to determine the most relevant predictive factors among them. Analyses were carried out separately for tetraplegia and paraplegia.

Setting: A single specialized Level I trauma center.

Participants: One hundred fifty-nine patients hospitalized for an acute traumatic SCI between January 2010 and February 2015.

Interventions: Not applicable.

Main outcome measure: The SCIM (version 3) functional score.

Results: Motor-complete SCI (AIS-A,B) was the main predictive factor associated with decreased total SCIM score in tetraplegia and paraplegia. Longer acute care length of stay and the occurrence of acute medical complications (either pneumonia, urinary tract infections or pressure ulcers) were predictors of decreased functional outcome following tetraplegia, while increased body mass index and higher trauma severity were predictive of decreased functional outcome following paraplegia.

Conclusions: This study supports previous work while adding information regarding the importance of optimizing acute care hospitalization as it may influence chronic functional status following traumatic SCI.     

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－