脊髓损伤后膀胱功能障碍的药物治疗

对影响膀胱尿道功能神经递质及其药理作用 ,从4个方面进行了介绍 :中枢神经系统 ,交感、副交感神经节 ,外周传出纤维和传入神经。对目前常用的神经药物 ,从影响膀胱贮尿和排尿功能两方面进行了讨论 ,并介绍了最新研究进展。     

步态诱发功能性电刺激对不完全性脊髓损伤患者的疗效观察

目的:观察步态诱发功能性电刺激治疗不完全性脊髓损伤患者的疗效.方法:对40例不完全性脊髓损伤的患者,随机分为两组,对照组进行常规药物治疗、康复治疗,治疗组除常规药物治疗、康复治疗,每天佩戴步态诱发功能性电刺激进行患侧腓总神经、胫前肌电刺激同时步行训练,15-20min.每天2次,每周5-6d,共4周.分别在治疗前、治疗2周、4周行功能独立性评定(FIM)行走能力测评、10m最大步行速度测试、运动诱发电位(MEP)检测,治疗前后行胫前肌肌力评定.结果:治疗2周后,两组FIM行走能力、10m最大步行速度、胫前肌MEP潜伏期两组无明显差异(P＞0.05).治疗4周后,与对照组比较,FES治疗组FIM行走能力评分提高(P＜0.01)、10m最大步行速度提高(P＜0.05)、胫前肌MEP潜伏期缩短更明显(P＜0.01).胫前肌肌力治疗前两组比较无显著性意义(P＞0.05),治疗4周后,两组肌力比较有显著性意义(P＜0.05).结论:功能性电刺激能显著改善不完全性脊髓损伤患者步行功能,运动诱发电位为判断脊髓运动传导功能提供了客观、定量的依据,功能性电刺激是一种安全有效的训练方法.     

电针辅助治疗对急性不完全性脊髓损伤的疗效

目的探索针刺配合神经外科治疗急性不完全性脊髓损伤的方法和疗效。方法对照组9例，根据手术指征确定术式，并予药物治疗；治疗组7例，除上述神经外科治疗外，采用电针刺激夹脊穴及辨证取穴。比较两组疗效。结果对照组显效2例，好转4例，无效3例；治疗组治愈6例，好转1例。结论配合针刺治疗能提高急性脊髓损伤手术后疗效。     

Recovery of golfing ability in someone with an incomplete spinal cord injury: a case report

Abstract

Purpose: The purpose of this case report was to describe the elements needed to play golf, detail a rehabilitation program designed to teach someone with an incomplete spinal cord injury (SCI) to play golf and to document outcomes of such a program. Methods: The participant was a 58-year-old male who sustained an incomplete C3-C6 SCI. The program was divided into three phases. Phase one (nine sessions) consisted of balance, strengthening and flexibility activities to prepare him to play golf. During phase two (12 sessions), he practiced his golf swing in a clinical setting and in phase three (seven sessions) focused on task-oriented training at a golf course. The ability to play golf, putting accuracy, driving distance, quality of swing, balance, physical functioning, walking capacity, muscle strength, endurance and quality of life were measured before and after the intervention. Results: The participant was able to complete 9-holes of golf with assistance and demonstrated greater ability to drive the ball with better quality of swing. Improvements were observed in balance, physical functioning, walking capacity, endurance and quality of life but not in overall strength or putting accuracy. Conclusions: This individual was able to return to golf following an intense rehabilitation program even though he required an assistive device to walk.

• Implications for Rehabilitation

• Individuals with spinal cord injury often have impairments which make participation in leisure activities more difficult.

• Participation in leisure activities has been associated with better subjective well being and quality of life.

• Rehabilitation therapists should consider creating leisure goals with their patients.

     

不完全性脊髓损伤患者与健康人步态变异性、对称性和协调性的对照研究

目的:通过观察不完全性脊髓损伤患者的步态变异性、对称性和协调性,更加全面了解脊髓损伤患者的步态特点。方法:选取22例不完全性脊髓损伤患者(观察组)及健康人(对照组),健康人按正常歩速及匹配患者速度行走分为(对照组A)及(对照组B),采用三维运动采集系统及足底压力采集系统进行步态测试。用步态变异值、对称值和相位协调指数表示步态变异性、对称性和协调性,比较3组受试者步态变异性、对称性和协调性的差异及与步行功能相关性。结果:观察组的步长变异值、站立相变异值及迈步相变异值均高于对照组A,观察组的步长对称值、站立相对称值、迈步相对称值和相位协调指数均低于对照组,且差异有统计学意义(P<0.05)。观察组的步态变异值、对称值和相位协调指数与脊髓损伤步行能力负相关。多元线性回归分析显示站立相变异值、站立相对称值和PCI对WISCI-II步行指数均有显著负影响,PCI对FIM步行指数有显著负相影响。结论:不完全性脊髓损伤患者的步态变异性、对称性和协调性均低于健康人,在为不完全性脊髓损伤患者制定康复训练方案时,应考虑步态变异性、对称性和协调性等指标对步行功能的影响。     

Antibiotic therapy for patients with spinal cord injury undergoing urologic procedures

This prospective study was performed to determine whether gentamicin can be prescribed routinely to patients with spinal cord injury undergoing urologic procedures, or whether antibiotic therapy must be selected on the basis of recent urine microbiologic test results. Between January 2004 and June 2005, procedures were performed on 38 patients, all of whom were prescribed antibiotics on the basis of a microbiology report. Sixteen patients who underwent urologic surgery during 2003 and received gentamicin empirically served as a control group. The patients clinical course was monitored for postprocedure sepsis. Only 12 patients received gentamicin as the sole antibiotic; 10 patients required an additional antimicrobial for urine samples that grew more than 1 organism and contained bacteria resistant to gentamicin; 26 patients needed antibiotics other than gentamicin for gentamicin-resistant uropathogens. Three patients with organisms sensitive to gentamicin as well as another antibiotic received an agent considered less nephrotoxic than gentamicin. After the procedure, sepsis occurred in only 1 patient, a man with chronic lymphocytic leukemia and small cell carcinoma of the urinary bladder. Three control group patients developed a fever in excess of 39°C. One of these patients did not require a change of antibiotic, another patient recovered after 3 changes of antibiotic, and the third patient recovered from septicemia after receiving ventilatory support. Antibiotics should be prescribed on the basis of recent urine microbiologic test results, and empiric therapy with gentamicin should be avoided in patients with spinal cord injury who are scheduled to undergo urologic procedures.     

Long-term body-weight-supported treadmill training for incomplete cervical spinal cord injury: a case report

[Purpose] To investigate the effects of long-term body-weight-supported treadmill training on walking ability and physical function in an elderly individual with incomplete cervical spinal cord injury. [Participant and Methods] The patient was a 68 year-old male with an incomplete spinal cord injury at the C3/C4 level, incurred when he was 56 years old. He initiated home-based body-weight-supported treadmill training using a body-weight-supported treadmill installed at his home. His walking ability was measured as the percentage of body weight load reduction, and his physical function was evaluated using manual muscle testing and measuement of the range of motion of his lower limbs. [Results] The physical function of the lower limbs was improved, maintained, or showed delayed decline until 9.5 years post-injury. [Conclusion] Long-term body-weight-supported treadmill training may improve, maintain, or at least delay the decline of the physical function of participants for several years, without causing any remarkable complications.     

持续性脊髓压迫对脊髓损伤程度的影响

目的 探讨脊髓损伤(SCI)后脊髓压迫时间对损伤程度的影响。方法 以大脑皮层诱发电位(CSEP)和不同压迫时间为参数,自行设计一种犬的运动—静止压迫型SCI模型,选择T13为损伤中心,压迫脊髓,当 CSEP波幅下降达基础值的 50%时,维持静止压迫。将28只犬随机分为A、B、C、D 4组,A、B、C组脊髓分别受压30 min、90 min和180 min,D组为对照组,观察各组动物的组织病理学、影像学和行为学变化。结果 损伤组脊髓组织学均有损害,MRI显示损害程度随脊髓受压时间的延长逐渐加重( P<0.01);至术后28 d,各损伤组动物后肢功能均有恢复,BBB分级评分法评估组间有显著性差异( P <0.05)。结论 SCI后持续性脊髓压迫能加重损伤程度,应尽早解除脊髓压迫。     

Case report: community rehabilitation for a patient with incomplete spinal cord lesion

This is a case report of Mr S, a 43‐year‐old man with a spinal cord lesion caused by tuberculosis resulting in incomplete paraplegia. He was discharged from hospital with significant residual disability. He received a major part of his rehabilitation in the community from an interdisciplinary neuro rehabilitation team with good results. Because Mr S was overweight, over 20 stones, the therapists had to use considerable creativity and imagination to facilitate his rehabilitation. Mr S's high level of motivation and courage was essential to the success achieved. The purpose of the case report is to demonstrate that a positive outcome can be achieved despite the many difficulties faced in the rehabilitation of an overweight patient with an incomplete spinal cord lesion in a community setting. Copyright © 2005 John Wiley & Sons, Ltd.     

Work-rate-guided exercise testing in patients with incomplete spinal cord injury using a robotics-assisted tilt-table

Purpose: Robotics-assisted tilt-table (RTT) technology allows neurological rehabilitation therapy to be started early thus alleviating some secondary complications of prolonged bed rest. This study assessed the feasibility of a novel work-rate-guided RTT approach for cardiopulmonary training and assessment in patients with incomplete spinal cord injury (iSCI). Methods: Three representative subjects with iSCI at three distinct stages of primary rehabilitation completed an incremental exercise test (IET) and a constant load test (CLT) on a RTT augmented with integrated leg-force and position measurement and visual work rate feedback. Feasibility assessment focused on: (i) implementation, (ii) limited efficacy testing, (iii) acceptability. Results: (i) All subjects were able follow the work rate target profile by adapting their volitional leg effort. (ii) During the IETs, peak oxygen uptake above rest was 304, 467 and 1378?ml/min and peak heart rate (HR) was 46, 32 and 65 beats/min above rest (subjects A, B and C, respectively). During the CLTs, steady-state oxygen uptake increased by 42%, 38% and 162% and HR by 12%, 20% and 29%. (iii) All exercise tests were tolerated well. Conclusion: The novel work-rate guided RTT intervention is deemed feasible for cardiopulmonary training and assessment in patients with iSCI: substantial cardiopulmonary responses were observed and the approach was found to be tolerable and implementable.

• Implications for Rehabilitation

• Work-rate guided robotics-assisted tilt-table technology is deemed feasible for cardiopulmonary assessment and training in patients with incomplete spinal cord injury.

• Robotics-assisted tilt-tables might be a good way to start with an active rehabilitation as early as possible after a spinal cord injury.

• During training with robotics-assisted devices the active participation of the patients is crucial to strain the cardiopulmonary system and hence gain from the training.

     

中西医结合治疗不完全性脊髓损伤后中枢性疼痛

目的探讨中西医结合疗法治疗不完全性脊髓损伤中枢性疼痛的治疗效果。方法采用耳压、生物反馈、电动按摩器和经皮神经电刺激仪相结合的中西医结合疗法治疗不完全性脊髓损伤中枢性疼痛患者12例,以McGill疼痛问卷(MPQ)和视觉模拟评分(VAS)于治疗前后对中枢性疼痛进行评测。结果与治疗前相比,治疗后MPQ中的PRI-S、PRI-T、NWC以及VAS有明显降低(P<0.01),PRI-A、PPI最大值降低(P<0.05)。结论中西医结合疗法对治疗脊髓损伤中枢性疼痛有一定的疗效。     

The effect of an isocentric reciprocating gait orthosis incorporating an active knee mechanism on the gait of a spinal cord injury patient: A single case study

Objective: The aim of this study was to identify the effect of induced knee flexion during gait on the kinematics and temporal-spatial parameters during walking by a patient with spinal cord injury (SCI) through the application of an isocentric reciprocating gait orthosis (IRGO) with a powered knee mechanism.

Methods: Two orthoses were considered and evaluated for an ISCI subject with a T8 level of injury. An IRGO was initially manufactured by incorporating drop lock knee joints and was fabricated with custom molded AFOs to block ankle motion. This orthosis was also adapted with electrically-activated knee joints to provide active knee extension and flexion when disengaged.

Results: Walking speed, stride length and cadence were increased 37.5%, 11% and 26%, respectively with the new orthosis as compared to using the IRGO. The vertical and horizontal compensatory motions reduced compared to mechanical IRGO. At end of stance phase, knee joint flexion was 37.5° for the AKIRGO compared to 7° of movement when walking with the IRGO. The overall pattern of walking produced was comparable to that of normal human walking.

Conclusion: Knee flexion during swing phase resulted in an improved gait performance and also reduction in compensatory motions when compared to a mechanical IRGO.

Implications for Rehabilitation

• Powered orthosis could be used by spinal cord injury subjects.

• A major advantage of this new orthotic mechanism was regeneration of knee movement closer to that of normal human walking.

• The IRGO with a powered knee joint mechanism improved the speed of walking, step length, cadence and vertical displacement in a spinal cord injury patient which also produced near-normal knee joint angle patterns during gait.

     

胚胎脊髓对损伤脊髓的修复作用研究

目的探讨不同条件下胚胎脊髓移值修复成鼠急性脊髓损伤(SCI)的能力。方法成鼠胸髓损伤后分别移植孕14d胚胎脊髓(FSC组)、游离正中神经加胚胎脊髓(P＋F组)、带血管蒂正中神经加胚胎脊髓(V＋F组),术后8周行组织学检查。结果V＋F组胚胎脊髓与受体融合佳,体积增长速度、神经纤维和神经元数目显著高于P＋F、FSC组（P<0.01）,细胞分化比较好,突触较成熟,界面区也无明显的胶质增生。结论带血管蒂周围胚胎脊髓联合移植,对FSC的生长发育、对损伤神经元的再生能力均有一定的促进作用。     

急性颈髓损伤患者的预见性护理

目的探讨急性颈髓损伤患者预见性的护理措施。方法回顾性分析、总结41例急性颈髓损伤患者早期的治疗与护理。结果除1例死亡,1例放弃治疗外,余39例患者均能控制病情、治愈并发症后出院。结论有预见性、针对性地实施护理措施,能有效减少并发症的发生,促进患者康复。     

甲泼尼龙早期冲击治疗急性脊髓损伤

目的:总结急性脊髓损伤(ASCI)早期甲泼尼龙(MP)冲击治疗的经验,指导今后的诊治工作.方法:对2009年3月-2010年3月我科诊治的36例ASCI患者的临床资料进行回顾性分析.A组14例未接受MP冲击治疗,为对照组.B、C两组均接受MP冲击治疗,为治疗组.其中B组20例,伤后就诊时间＜3 h;C组16例,伤后就诊时间为3～8 h.三组患者的一般资料比较差异无统计学意义(P＞0.05).按照美国第2次急性脊髓损伤研究(NASCISⅡ)推荐甲泼尼龙使用方法和剂量,进行MP冲击治疗.同时积极行手术椎管减压、植骨融合内固定.治疗过程中根据患者情况给予抗炎、止血、脱水、机械通气、预防应激性溃疡及营养支持等治疗.治疗后2周、1年分别按美国脊髓损伤协会(ASIA)损伤分级评分标准、日本骨科学会(JOA)脊髓功能评分标准及日常生活活动(activity of daily living,ADL)评分.结果:治疗前三组间各项评分比较差异无统计学意义(P＞0.05).治疗后2周、1年随访,治疗组各项评分均优于对照组(P＜0.01),治疗组各项评分均较治疗前显著提高(P＜0.01);治疗后各时问点B组评分均优于C组,差异有统计学意义(P＜0.01).结论:对于ASCI患者,早期诊断,早期干预,预防各种并发症,是成功治疗的关键.     

The spinal cord independence measure: how much change is clinically significant for spinal cord injury subjects

Abstract

Purpose: To calculate the clinical significance of the SCIM III according to distribution-based approaches. Method: Retrospective review of the charts of 255 patients with registration of the total SCIM and of the four subscales. Clinical significance was calculated per several distribution-based approaches. The calculated clinical significance was compared with improvements by the patients to determine the percentage of patients who achieved significant improvement. Results: An improvement of at least 4 points of the total SCIM is needed to obtain a small significant improvement and of 10 points to obtain a substantial improvement. Based on these results, the percentages of patients who achieved an improvement varied from 60% to 100%. Conclusions: The results provide benchmarks for clinicians and researchers to interpret whether patients’ change score on the SCIM III can be interpreted as true or clinically meaningful and to make clinical judgments about the patients’ progress.

• Implications for Rehabilitation

• An improvement of at least four points of the total SCIM is needed to obtain a small significant improvement and of 10 points to obtain a substantial improvement.

• The results provide benchmarks for clinicians and researchers to interpret whether patients’ change score on the SCIM III can be interpreted as true or clinically meaningful and to make clinical judgments about the patients’ progress.

     

早期高压氧治疗对脊髓损伤患者功能恢复的影响

目的 探讨早期与晚期高压氧治疗对脊髓损伤患者功能恢复的影响.方法 选择216例脊髓损伤患者,其中早期组与晚期组各108例.早期组在患者术后生命体征平稳3～14 d开始治疗;晚期组在术后15～30 d开始治疗.采用ASIA残损量表及改良巴氏指数（MBI）进行康复评价.结果 两组入选时差异无显著性（P〉0.05）,治疗60 d后,两组均较治疗前明显改善（P〈0.01）,早期治疗组较晚期治疗组改善程度更大（P〈0.05）.结论 早期与晚期高压氧治疗均可明显促使功能恢复,但早期介入治疗的临床疗效明显优于晚期介入治疗.     

大鼠脊髓损伤后神经源性膀胱模型的制备

摘要 目的：提供一套较系统、可重复率高、可变系数低的神经源性膀胱模型的制备方案。 方法：采用Hassan Shaker脊髓横断法并加以改良,在Hassan Shaker法的基础上改用国内动物造模常用的水合氯醛行腹腔麻醉,用牙科钩沿横断椎间隙横向钩出脊髓,手术刀切断脊髓后反复刮扫以确定脊髓完全横断;并将此法运用于不同节段的大鼠脊髓损伤模型的制作,根据骶上和骶髓的分组选择不同的位置（T10/11和L2/3椎间隙）进行手术完全切断脊髓,并配合相应的术前、术后护理方案。 结果：改良后的造模方案提高了造模后大鼠的存活率（骶上组80%,骶髓组90%）、成模率（骶上组70%,骶髓组80%）并降低了并发症的发生率（骶上组70%,骶髓组60%）;造模后大鼠最大膀胱容量较空白组明显升高（P＜0.01）,与脊髓休克期相比,骶上组大鼠休克期后的最大膀胱容量明显降低（P＜0.01）,骶髓组大鼠容量较前无明显变化（P>0.05）,脊髓休克期后骶髓组大鼠最大膀胱容量明显高于骶上组（P＜0.01）;经光镜观察,造模后大鼠的膀胱组织形态均发生了不同程度的病理损害。 结论：采用改良Hassan Shaker法可制备大鼠骶上和骶髓不同节段脊髓损伤后神经源性膀胱模型。     

电针结合耳针治疗急性脊髓损伤的临床研究

目的评估电针结合耳针治疗急性脊髓损伤的疗效和安全性。方法我院1999年1月～2004年5月期间急性脊髓损伤美国脊髓损伤学会（ASIA）损伤分级A级和B级患者56例，随机分为针灸治疗组和对照组。针灸治疗组采用双侧后溪和申脉点电针，与脊髓相关耳穴的耳针，同时配合康复治疗。对照组仅仅采用康复治疗。分别记录入院时、出院时及出院后1年ASIA损伤分级及ASIA神经（运动、感觉）功能状况评分、独立性功能评定（FIM）及不良反应。结果在神经（感觉和运动）功能和FIM评分方面针灸治疗组优于对照组（P〈0．05），无明显不良反应。结论早期采用电针结合耳针治疗急性脊髓损伤有较好的疗效和安全性。