Is the recovery of stepping following spinal cord injury mediated by modifying existing neural pathways or by generating new pathways? A perspective.

The recovery of stepping ability following a spinal cord injury may be achieved by restoring anatomical connectivity within the spinal cord. However, studies of locomotor recovery in animals with complete spinal cord transection suggest that the adult mammalian spinal cord can acquire the ability to generate stepping after all descending input is eliminated and in the absence of neuronal regeneration. Moreover, rehabilitative gait training has been shown to play a crucial role in teaching existing spinal pathways to generate locomotion and appropriately respond to sensory feedback. This brief review presents evidence that neural networks in the mammalian spinal cord can be modulated pharmacologically and/or with task-specific behavioral training to generate weight-bearing stepping after a spinal injury. Further, the role that spinal learning can play in the management of humans with spinal cord injury is discussed in relation to interventions that are designed primarily to enhance neuronal regeneration.     

颈脊髓损伤患者的呼吸道管理

探讨颈脊髓损伤患者呼吸道管理的方法,为提高临床疗效提供有效的保证。对我科2008年6月至2010年10月收治的38例颈脊髓损伤患者的呼吸道管理进行回顾性分析。38例颈脊髓损伤患者进行呼吸道管理后,呼吸功能完全恢复35例,3例发生急性呼吸衰竭死亡。颈脊髓损伤患者的呼吸道管理是颈椎骨折手术成功的关键性因素,合理可靠的呼吸道管理,为患者术后顺利恢复提供了有效的保障。     

Perceptions of pressure ulcers among young men with a spinal injury

About 1000 younger people each year suffer a traumatic spinal cord injury that leaves them wholly or partly paralysed. The majority of these individuals are male. Paralysis leads to a host of physical and often psychological problems. Among the major challenges is the management of pressure and the maintenance of skin integrity. Long periods of immobility and loss of sensation make people with a spinal cord injury prone to developing pressure ulcers. While specialist spinal injury units have pioneered a holistic approach to the rehabilitation of those with spinal cord injuries, there has been little research conducted in the UK on the experiences and coping mechanisms of these patients. The study reported here sought to examine the perceptions and experiences of a sample of young men with a spinal cord injury in relation to pressure management and skin integrity, and their experiences of care. The results suggest that these men were knowledgeable about pressure management and highly motivated to look after themselves, but there was an over-reliance on the specialist unit for support.     

Stress management with SCI clients

A spinal cord injury is a devastating event that totally disrupts a person's life. Stress management is an important consideration for individuals who have experienced a major loss. A program was developed to teach spinal cord injury clients the basic factors of stress and relaxation techniques to facilitate adaptation to their injury, as well as to help them deal with the daily frustrations of rehabilitation and disability. The stress management program was presented twice during an eight-week period to two different groups of spinal cord injury clients. The program was designed to be taught in conjunction with the formal training of the Spinal Injury Learning Series (SILS). Based on the data collected and the supported continuation of the program, it would appear that the program was beneficial to the participants.     

中央型颈段脊髓损伤的康复治疗

目的观察康复治疗对中央型颈段脊髓损伤患者的功能的影响。方法对7例中央型颈段脊髓损伤的患者进行6周针对性的康复治疗,治疗前、后采用Barthel指数法对患者的日常生活活动(ADL)能力进行评定。结果治疗后7例患者的ADL评分均明显高于康复治疗前(P<0.01)。结论本组患者评估结果提示,针对中央型颈段脊髓损伤所致功能障碍的特点,采取相应的康复治疗和训练有助于提高患者日常生活活动能力。     

Rehabilitation in spinal cord disorders. 3. Comprehensive management of spinal cord injury

This self-directed learning module highlights advances in the management of the person with a spinal cord deficit. Traumatic spinal cord injury is being used as the model, but the principles apply to all patients with spinal cord deficits. This article is part of the chapter on rehabilitation of spinal cord disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Specifically, this section contains information regarding prehospital care, acute assessment and management, primary rehabilitation by systems, sexuality and psychosocial issues, management of pain and spasticity, functional goals, the role of functional electrical stimulation, and long-term follow-up.     

脊髓损伤与脑卒中患者排尿情况的比较

目的比较脊髓损伤和脑卒中对患者排尿功能的影响。方法40例脊髓损伤患者和43例脑卒中患者进行连续1周的排尿日记记录、残余尿量测定。结果脊髓损伤组尿失禁次数平均每天11次,尿失禁量平均（180.6±21.4） ml,残余尿量平均(257±86.5) ml;脑卒中组尿失禁次数平均每天16次,尿失禁量平均(298.8±34.6) ml,残余尿量平均(28.5±18.5) ml。两组比较,尿失禁次数无显著性差异（P>0.05）,排尿量及残余尿量均有非常显著性差异（P<0.01）。超声检查,脊髓损伤组12%出现输尿管扩张或肾积水,脑卒中组未发现输尿管扩张和肾积水。结论脊髓损伤和脑卒中患者排尿功能存在明显差异,应根据具体损伤情况选择适当的治疗方法,保护上尿路功能。     

脊髓损伤患者营养状况的研究进展

脊髓损伤患者的营养状况影响患者的康复及预后,未得到足够的重视,需要通过饮食控制及运动等联合措施来调节。此外,对医务人员的营养培训和对患者的营养教育都十分必要,医院的相关营养政策也应得到修订。目前关于脊髓损伤患者的营养评估标准还不健全,因脊髓损伤患者具有特殊性,对健康人群的评估标准并不适用,难以对营养不良进行早期发现。应利用评价量表、血液指标和皮肤皮褶厚度等建立适用于中国脊髓损伤患者的综合评估体系,并把营养评估作为日常管理的一部分。     

Emergency department approach to acute thoracolumbar spine injury

This review provides a literature-based approach to the management of acute thoracolumbar spine (TLS) injury. The epidemiology of spinal cord injury and pertinent spinal cord anatomy are reviewed. A review of current TLS fracture/dislocation classification schemes is provided. The principal focus of this review is the immediate diagnostic and therapeutic interventions needed to maximize the recovery of patients with acute TLS injury.     

Characteristics and rehabilitation for patients with spinal cord stab injury

[Purpose] The objective of the study was to compare the incidence, diagnosis, treatment, and prognosis of patients with spinal cord stab injury to those with the more common spinal cord contusion injury. [Subjects] Of patients hospitalized in China Rehabilitation Research Center from 1994 to 2014, 40 of those having a spinal cord stab injury and 50 with spinal cord contusion were selected. [Methods] The data of all patients were analyzed retrospectively. The cases were evaluated by collecting admission and discharge ASIA (American Spinal Injury Association) and ADL (activity of daily living) scores. [Results] After a comprehensive rehabilitation program, ASIA and ADL scores of patients having both spinal cord stab injury and spinal cord contusion significantly increase. However, the increases were noted to be higher in patients having a spinal cord stab injury than those having spinal cord contusion. [Conclusion] Comprehensive rehabilitation is effective both for patients having spinal cord stab injury and those with spinal cord contusion injury. However, the prognosis of patients having spinal cord stab injury is better than that of patients with spinal cord contusion.Key words: Spinal cord injury, Stab injury, Rehabilitation     

急性脊髓损伤后差异蛋白的表达

背景：在质谱分析中,任何一种同位素标记相对和绝对定量试剂标记的不同样本中的同一蛋白质表现为相同的质荷比,而在串联质谱中,信号离子表现为不同质荷EL（114—121）的峰,因此可以分析得到相关蛋白质的定量信息。目的：建立大鼠急性脊髓损伤后脊髓组织差异蛋白质谱,应用同位素标记相对和绝对定量技术联合LC．MS／MS质谱技术从分子水平来探索脊髓差异蛋白的表达情况。方法：取8只SD大鼠,参照Allen’s等方法建立大鼠急性脊髓损伤模型,随机分为脊髓损伤后0h组和8h组,每组各4只。损伤后取脊髓组织,用同位素标记相对和绝对定量技术分析大鼠急性脊髓损伤后脊髓组织的差异蛋白质。结果与结论：共鉴定到了220个差异表达的蛋白,上调的差异蛋白数是116个,下调的差异蛋白有104个。其中相关神经再生的差异蛋白12个,其中上调的有7个,下调的有5个。提示实验中检测到的多种差异蛋白及表达明显的神经生长因子可能作为急性脊髓损伤的生物标记物或可能作为临床管理监测急性脊髓损伤的损伤进程、靶向治疗及评估疗效的有力证据。     

Critical care management of the patient with acute spinal cord injury

The critical care management of acute injury to the cervical spinal cord is discussed from the perspective of the pathophysiology of the injury process and its ramifications. Emphasis is placed upon resolution of cardiovascular derangements, spinal cord resuscitation, and respiratory support utilizing practical therapeutic interventions.     

A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury.

OBJECTIVE: To assess whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality, mood, life satisfaction, health-related quality of life, sense of coherence and pain for patients with a spinal cord injury and neuropathic pain.Design: A prospective intervention study. PATIENTS: Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme in parallel with 11 patients in a control group. METHODS: A comprehensive pain management programme comprising educational, cognitive, and behavioural interventions was created for patients with spinal cord injury and neuropathic pain. The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions, behavioural therapy, relaxation, stretching, light exercise and body awareness training. All patients were followed-up 3, 6 and 12 months after completion of the programme. RESULTS: At the 12-month follow-up, levels of anxiety and depression in the treatment group decreased compared with baseline values, and a tendency towards better quality of sleep was seen. In comparison with the control group, patients in the treatment group improved regarding sense of coherence and depression. CONCLUSION: This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain.     

Urinary tract infection in spinal cord injury

Loss of normal bladder function results in increased risk of developing urinary tract infection. Recurrent bacteriuria continues to be a problem in most spinal cord injured persons regardless of the bladder emptying method used. Lower urinary tract complications have decreased with intermittent catheterization, but the effect of increased intravesical pressure and presence of bacteriuria on renal function are still undetermined. Current methods of neurogenic bladder management are often based on professional or institutional presuppositions rather than scientific data. Although there are many unanswered questions about the role of urinary tract infection in spinal cord injury patients, treatment should be based on scientific knowledge, even though the knowledge base is still limited. Preservation of renal function is the ultimate goal of any method of neurogenic bladder management. Although a person with spinal cord injury is described, the material covered is applicable to other neurogenic bladder disturbances.     

急性颈髓损伤术后急性呼吸衰竭的原因分析及护理

笔分析了17例急性颈髓损伤手术后，发生急性呼吸衰竭的主要原因是脊髓继发性机械损伤，包括呼吸肌麻痹、膈肌运动受限、气管和支气管分泌物潴留、颈髓广泛性水肿和内源性继发性损伤。阐述了术后的观察与护理：包括面部观察与护理，按时准确的静脉给药，呼吸道的保护与管理，认为做好局部护理，早发现、早处理及有效的进行呼吸道管理是抢救呼吸衰竭的关键。     

老年外伤性脊柱脊髓损伤

对老年脊髓损伤的发病率、病因、临床特征统计资料进行综述,并指出其定义、鉴别、特殊的处理方法和治疗策略.     

老年脊髓损伤患者的临床特点分析

目的 探讨老年脊髓损伤患者的临床特点。方法 收集2013年1月1日至2019年12月31日在本院住院康复治疗的386例老年(≥ 60岁)脊髓损伤患者的临床资料。分析患者的性别、年龄、病因、美国脊髓损伤协会残损分级(AIS)及并发症等临床特点。结果 老年脊髓损伤患者中,男性多为外伤性损伤(71.17%),女性多为非外伤性损伤(56.19%)。平地跌倒是老年男性(28.83%)和女性(24.76%)脊髓损伤患者的首要病因。肿瘤(19.05%)是老年女性脊髓损伤患者最主要的非外伤性病因。颈段(78.46%)是老年外伤性脊髓损伤中最常见的受损部位;胸段(52.14%)是非外伤性脊髓损伤中最常见的受损部位。老年脊髓损伤患者中最常见的AIS为D级(38.08%),其余依次为C级(28.76%)、A级(21.50%)、B级(11.66%)。椎管狭窄(23.31%)在老年脊髓损伤的病因中占重要地位。老年脊髓损伤患者的最常见并发症依次为神经痛、下肢静脉血栓形成及泌尿系感染。结论 平地跌倒是老年脊髓损伤患者的首要病因。随着年龄增长,跌倒在老年脊髓损伤病因中的比例有增高的趋势。采取有效的预防跌倒措施以避免脊髓损伤对老年人非常重要。     

完全性颈段脊髓损伤患者术后呼吸道管理的循证护理策略分析

目的探讨循证护理在完全性颈段脊髓损伤患者术后呼吸道管理中的应用效果。方法对符合标准的200例完全性颈段脊髓损伤患者术后呼吸道管理实施循证护理,与实施传统护理的160例患者进行对照,比较两组患者呼吸道并发症的发生率、拔管时间和气道湿化程度。结果干预组患者呼吸道并发症的发生率明显低于对照组（P〈0．01）,拔管时间缩短,气道湿化程度好（P〈0．01）。结论对完全性颈段脊髓损伤患者术后呼吸道管理实施循证护理,可减少并发症,缩短拔管时间,改善气道湿化状况,可在临床推广应用。     

Chronic spinal cord injury: management of patients in acute hospital settings

Spinal cord injury (SCI) is a lifelong condition affecting over 40,000 people in the UK. When an individual with established SCI is admitted to hospital for a procedure or because of illness, hospital teams need to manage both the acute condition and the spinal cord injury. These guidelines aim to assist in their assessment and management to avoid the common problems of hospital-acquired morbidity in this potentially vulnerable group of people. Key steps are: gaining an understanding of the common patho-physiological consequences of SCI; listening to the person and their family who are often expert in managing the condition; and maintaining close contact with the individual's regular team/specialist spinal cord injury centre.     

脊髓型鞭击损伤综合征的MR诊断

目的 认识脊髓型鞭击损伤综合征的MR影像表现。方法 本文从数百例脊椎外伤，选择最后诊断为脊髓鞭击损伤综合征的21例MR资料做回顾性分析(均进行轴位T2、矢状位T1wI和T2wI扫描，部分加冠状T2wI扫描)。结果 MR检查能安全迅速客观地反映脊髓损伤程度，推测判断预后。结论 MR检查是脊髓鞭击损伤综合征的首选检查方法；早期确诊，对临床早期治疗、早期康复有其不可估量的临床意义和特殊价值。