脊髓损伤病人的运动功能评定

目的 脊髓损伤（ＳＣＩ）病人的分级多采用Ｆｒａｎｋｅｌ分级标准,我们根据２６０例ＳＣＩ病人的观察,认为对病人活动功能影响最大的最运动功能与排尿功能,且上肢与下肢评级标准不尽相同,从而对分级提出改进意见。方法 本组２６０例, 伤后观察时间达１以上者１５６例,占６０％。损伤部位：Ｃ３－４￣Ｔ１ ９０例,Ｔ ２￣１０ ３７例,Ｔ１１￣Ｌ１ １０５例,Ｌ２－３ ２８例。脊髓损伤类型：完全截瘫１６９例,不全     

Male Infertility Following Spinal Cord Injury

ABSTRACT

Ejaculatory dysfunction and poor semen quality are responsible for male infertility following spinal cord injury (SCI). Techniques which have been used to obtain semen include intrathecal neostigmine, subcutaneous physostigmine, direct aspiration of sperm from the vas deferens, vibratory stimulation and electroejaculation. Vibratory stimulation and electroejaculation are most widely used in the United States and have a 50–90% success rate at obtaining semen. Poor semen quality following SCI has been attributed to stasis of semen, testicular hyperthermia, urinary tract infections, sperm contact with urine, possible changes in the hypothalamic-pituitary axis, chronic use of various medications and possible sperm antibodies. The Outlook for having a child following SCI continues to improve with advancements in obtaining and processing sperm and assisted reproductive technologies.     

脊髓损伤细胞内Ca^2＋变化及其与脊髓神经功能损害的关系

目的：观察脊髓损伤（ＳＣＩ）后细胞内Ｃａ２＋（［Ｃａ２＋］ｉ）的动态变化，探讨其与脊髓神经功能损害的关系。方法：Ａｌｅｎ＇ｓ法致伤大鼠脊髓，于伤后１、４、８、２４、７２和１６８小时，采用原子吸收光谱分析和Ｌａ３＋阻断技术测定伤段脊髓［Ｃａ２＋］ｉ含量，参照Ｋｏｎｒａｄ的方法记录脊髓运动诱发电位（ＭＥＰ），应用斜板试验评价大鼠的运动功能。结果：ＳＣＩ后伤段脊髓［Ｃａ２＋］ｉ显著升高（Ｐ值＜０．０５或０．０１），与脊髓ＭＥＰ的变化和大鼠运动功能的损害呈显著相关关系。结论：ＳＣＩ后，伤段脊髓［Ｃａ２＋］ｉ超载可能在ＳＣＩ的病理发展机制中有重要意义。     

颈髓损伤后的神经恶化

目的：分析颈髓损伤后的病人出现神经恶化的原因,为临床治疗提供依据。方法：对２９５例颈髓损伤病人的临床资料进行分析,共有８例神经恶化,将其分为术前、术后及保守治疗３组,进一步分析引起神经恶化的原因。结果：颈椎颈髓损伤后神经恶化发生率为２．７％,恶化病人的死亡率为６２．５％。伤后５日之内手术和使用Ｈａｌｏ－Ｖｅｓｔ固定颈椎时出现的机械性不稳与神经恶化密切相关。结论：早期外科手术、Ｈａｌｏ－ｖｅｓｔ牵引     

胶质源性神经营养因子对脊髓损伤后功能及前角运动神经元酶组织化学改变的研究

目的　探讨胶质细胞源性神经营养因子 (GDNF)对损伤脊髓运动功能及前角运动神经元酶组织化学改变的影响。方法　改良Allen撞击致T13 脊髓不完全损伤 ,蛛网膜下腔分别给予生理盐水和GDNF ,不同时间分别 :①测定大鼠后肢神经功能 ;②利用酶组织化学染色方法显示脊髓侧前角运动神经元中胆碱酯酶 (ChE)和酸性磷酸酶 (ACP)活性并通过计算机图像分析系统将酶活性量化、比较。结果　①神经功能随时间延长而逐渐恢复 ,GDNF有助于功能恢复 ,但 3周时均未达正常标准 ;②ChE和ACP活性随时间延长而向正常趋近 ,GDNF显著加强了这一趋势 ;③随着ChE水平上升和ACP水平隆低 ,大鼠后肢运动功能逐渐恢复 ,两者呈现较强的相关性。结论　①前角运动神经元酶学改变与神经功能恢复密切相关 ;②GDNF加强前角运动神经元酶学改变 ,呈现对损伤神经元有保护作用。     

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。     

Quantitative Computed Tomography in the Evaluation of Spinal Osteoporosis Following Spinal Cord Injury

Disuse osteoporosis occurs in the lower extremities of patients with spinal cord injury (SCI). However, spinal osteoporosis is not usually observed in these patients. We investigated lumbar spine bone mineral density (BMD) in SCI patients using single energy quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA). Our study population consisted of 64 patients with long-standing SCI. Spine BMD (g/cm³) was assessed by QCT at four vertebrae ranging from T11 to L4 with single midvertebral CT slices 1 cm thick parallel to the vertebral end-plates. Confounding variables affecting normal trabecular bone pattern, such as compression fractures, surgical hardware or fat replacement, were excluded. For a subset of 29 patients, DXA values of the spine and femoral neck were also measured, and QCT and DXA Z-scores were compared On the average, the 64 SCI patients had Z-scores 2.0 ± 1.2 below those of age-matched controls. In the subset of 29 patients with both QCT and DXA measurements, the QCT and DXA Z-scores were 2.4 ± 1.1 below and 1.3 ± 2.3 above the mean, respectively (p<0.0001). Our results indicate that QCT reveals osteoporosis of the spine after SCI, in contrast to DXA. We postulate that QCT is more valuable for evaluating spinal osteoporosis following SCI than DXA and thus recommend QCT for spinal BMD studies in SCI. Received: 20 December 1999 / Accepted: 17 April 2000     

Serum Leptin Levels Following Acute Experimental Spinal Cord Injury

Background/Objective:

Spinal cord injury influences many hormones that are known to be involved in the modulation of neurotrophic, neurogenic, and neuroprotective events. Recent studies showed that leptin could be neuroprotective, enhancing neuronal survival in vitro and in vivo. The objective of this study was to evaluate the pattern of the serum leptin levels in rats during acute traumatic SCI.

Methods:

Forty male Sprague-Dawley rats were divided randomly into 4 groups. In the control group, neither laminectomy nor SCI was performed; only laminectomy was performed without SCI in the sham group. In the cervical and thoracic spinal trauma groups, laminectomies were performed following the same trauma procedure. Blood samples were drawn 2, 6, 12, and 24 hours after the procedures and assayed immediately.

Results:

In the first 2 hours, levels of leptin were similar in control and sham-operated groups and higher in neurotrauma groups (P < 0.05). At the sixth hour, leptin levels increased in the sham-operated group, decreased in the neurotrauma groups (P < 0.05), and did not change in the control group (P > 0.05). At the 12th hour, the levels of leptin increased in all groups (P > 0.05). At the 24th hour, they decreased in the control, sham-operated, and cervical groups (P < 0.05); levels did not change in the thoracic group (P > 0.05). The decrease was higher in the control group than in the other groups (P < 0.05).

Conclusions:

Activation of endogenous leptin secretion started immediately after the SCI. The level of neurologic lesion (either cervical or thoracic regions) affected the levels of serum leptin differently, but with the exception of the first 12-hour period, this difference did not reach a statistically significant level.     

兔脊髓缺血再灌注损伤时凝血功能的变化及意义

目的：探讨兔脊髓缺血再灌注损伤（SCIRI）时凝血功能的变化、意义。方法：采用Zivin法建立SCIRI模型,动态观察SCIRI时血液PT、APTT、TT和FIB的变化。结果：假手术组PT,APTT,FIB逐渐升高,但不具有统计学意义,TT逐渐降低,145时显著降低（P〈0．05）后逐渐升高;I／R组凝血四项各项指标逐渐升高,在I／R2h达到最高峰后逐渐下降,I／R12h降到缺血前水平;除门外I／R2,I／R6与缺血前比较均显著差异（P〈0．05）。结论：SCIRI引起凝血状态显著改变,可能为凝血因子水平、活性及功能改变导致。     

大鼠脊髓受压后的病理学变化

目的　观察脊髓受压后的病理学变化。方法　通过注射 1 0 6Walker 2 5 6癌细胞液到大鼠 T1 3椎体前 ,建立脊髓硬膜外压迫实验模型。大约 1 6天左右所有动物产生瘫痪 ,快速切取受压处的脊髓组织作透射电镜观察。结果　电镜发现脊髓白质细胞间隙扩大 ,含有外渗的血液细胞 ,并见髓鞘退变。结论　研究提示脊髓受压后的水肿在神经功能障碍的形成中起着重要作用。     

Changes in Properties of Spinal Dorsal Horn Neurons and Their Sensitivity to Morphine after Spinal Cord Injury in the Rat

Background: To gain a better understanding of spinal cord injury (SCI)-induced central neuropathic pain, the authors investigated changes in properties of spinal dorsal horn neurons located rostrally and caudally to the lesion and their sensitivity to morphine in rats after SCI.

Methods: The right spinal cord of Sprague-Dawley rats was hemisected at the level of L2. At 10 to 14 days after the SCI, when mechanical hyperalgesia/allodynia had fully developed, spontaneous activity and evoked responses to mechanical stimuli of wide-dynamic-range (WDR) and high-threshold neurons rostral and caudal to the lesion were recorded. Effects of cumulative doses of systemic (0.1-3 mg/kg) and spinal (0.1-5 [mu]g) administration of morphine on spontaneous activity and evoked responses to the stimuli of the neurons were evaluated.

Results: Spontaneous activity significantly increased in WDR neurons both rostral and caudal to the SCI site, but high-frequency background discharges with burst patterns were only observed in neurons rostral to the SCI site. Significant increases in responses to the mechanical stimuli were seen both in WDR and high-threshold neurons located both rostrally and caudally to the lesion. The responses to nonnoxious and noxious stimuli were significantly greater in caudal WDR neurons than in rostral WDR neurons. In contrast, the responses to pinch stimuli were significantly higher in rostral high-threshold neurons than those in caudal high-threshold neurons. Systemically administered morphine had a greater effect on responses to nonnoxious and noxious stimuli of rostral WDR neurons than those of caudal WDR neurons. Spinally administered morphine significantly suppressed responses of WDR neurons in SCI animals to nonnoxious stimuli compared with those in sham-operated control animals.     

Prognostic Significance of the Delayed Plantar Reflex Following Spinal Cord Injury

Abstract

The delayed plantar reflex (DPR) is a pathologic flexor variant which requires unusually strong stimulation of the sole of the foot and is characterized by a prolonged interval between the stimulus and the response, slow and protracted plantarflexion of the great toe and/or other toes and slow return to the neutral position. The purpose of this study was to evaluate prospectively the functional outcome of spinal cord injury (SCI) patients based on the presence or absence of a DPR immediately following injury. Thirty-six subjects were evaluated within one week of injury. A complete neurological evaluation following American Spinal Injury Association (ASIA) standards was performed and the presence or absence of a DPR was noted on admission. Ambulation status and ASIA Impairment Scales were recorded at discharge from the rehabilitation unit and the data were analyzed by the Chi-square method with Yates’ correction for continuity. The data demonstrated a high correlation of the DPR with motor complete injuries (p <0.01) and a poor prognosis for recovery of ambulation (p <0.01). Clinicians should recognize this abnormal reflex, which may be used in conjunction with a complete neurological examination, to help prognosticate future function in the acute SCI patient. (J Spinal Cord Med 1997; 20:207-211)     

应用激光多普勒血流仪监测兔急性脊髓缺血损伤后腰髓血流动力学变化及病理学观察的研究

目的：应用激光多普勒血流仪监测兔脊髓缺血再灌流后腰髓血流的动态性变化，讨论腰髓血流的动力学特点。方法：通过阻断腹主动脉，造成脊髓腰尾段缺血。按缺血和再灌流各时间段分别连续测定腰髓血流变化。取缺血前、缺血４０分钟、再灌流４小时局部脊髓行组织病理和透射电镜检查。结果：在缺血４０分钟腰髓局部血灌流量迅速下降至基线值的－８１．５７％（Ｐ值＝２．０１Ｅ－１７）。再灌流时，局部血流迅速增高并超过基线水平。再灌流１０分钟，局部血灌流量与基线的百分比变化值为５７．９８％（Ｐ值＝３．３Ｅ－０７）。随后逐渐降低，再灌流１小时后，局部血灌流量基本恢复基线水平（３．９７％，Ｐ值＝０．５５７８９９）。以后血灌流量低于基线水平，出现缺血后延迟性低灌流。直至再灌流４小时（－２３．５％，Ｐ值＝１．８４Ｅ－０３）低灌流保持相对稳定，血流未见恢复。缺血４０分钟，有明确病理学改变；再灌流４小时后，病理学改变明显进一步加重。结论：上述结果对于脊髓缺血性损伤后继发性功能障碍提供了理论依据。     

Applying Functional Analysis to Psychological Rehabilitation Following Spinal Cord Injury

ABSTRACT

There have been numerous attempts to categorize the responses of individuals to spinal trauma on the basis of generalized stage theories of grief reaction, and personality theory. A number of these studies are critically appraised and a behavioral model, based on functional analysis, is proposed as a more constructive framework for future research.

Such an approach is applied clinically to the activities and development of the Clinical Psychology Service provided to the Mersey Regional Spinal Injuries Centre in Southport, England. A number of examrles of clinical and research practice are included, highlighting the applicability of functional analysis to individual and systems level investigations.     

Recovery Off-Kinetics Following Exhaustive Upper Body Exercise in Spinal Cord Injury

Background:People with spinal cord injury (SCI) present with impaired autonomic control when the lesion is above T6. This could lead to delayed cardiorespiratory recovery following vigorous physical activity.Objectives:To characterize and compare gas exchange off-kinetics following exhaustive exercise in individuals with SCI and an apparently healthy control group.Methods:Participants were 19 individuals with SCI who presented with the inability to voluntarily lift their legs against gravity (age, 44.6 ± 14.2 years; AIS A, n = 5; AIS B, n = 7; AIS C, n = 7; paraplegia, n = 14; tetraplegia, n = 5) and 10 healthy comparisons (COM; age, 30.5 ± 5.3 years). All participants performed an arm ergometer cardiopulmonary exercise test (aCPET) to volitional exhaustion followed by a 10-minute passive recovery. O₂ uptake (V̇o₂) and CO₂ output (V̇co₂) off-kinetics was examined using a mono-exponential model in which tau off (τ_off) and mean response time (MRT) were determined. The off-kinetics transition constant (Kt_off) was calculated as ΔV̇o₂/MRT. Student t tests were used to compare SCI versus COM group means.Results:COM had a significantly higher relative peak V̇o₂ compared to SCI (1.70 ± 0.55 L/min vs 1.19 ± 0.51 L/min, p = .019). No difference was observed for τ_off between the groups, however Kt_off for both V̇o₂ and V̇co₂ was significantly lower in the SCI compared to the COM group.Conclusion:A reduced Kt_off during recovery may suggest inefficiencies in replenishing muscle ATP stores and lactate clearance in these participants with SCI. These findings may contribute to the observed lower cardiorespiratory fitness and greater fatigability typically reported in individuals with SCI.     

兔牵张性脊髓损伤的病理形态学改变

为了探索牵张性脊髓损伤的病理机制。我们选用４０只健康日本大耳白兔，随机分成对照组、体感皮层诱发电位波幅下降３０％组，５０％５分钟组、５０％１０分钟组。通过对动物运动功能评价、脊髓组织内丙二醛（ｍａｌｏｎｙｌｏｄｉａｌｄｅｈｙｄｅ，ＭＤＡ）和过氧化物歧化酶（ｓｕｐｅｒｏｘｉｄｅｄｉｓｔｕｍａｓｅ，ＳＯＤ）定量分析、组织形态等方法，研究牵张性脊髓损伤。结果显示：随着撑开负荷增加和作用时间延长。导致脊髓灰白质内血管充盈不足、痉挛直至血管破裂出血。脊髓组织内ＳＯＤ含量下降、ＭＤＡ含量升高。５０％５分钟组和５０％１０分钟组的Ｔａｒｌｏｖ评分障碍率和Ｍｏｌｔ斜板障碍率增大。与对照组相比，其差异有显著性。研究证明脊髓血管的改变是牵张性脊髓损伤的早期病理机制，而自由基介导的脂质过氧化反应则参与了牵张性脊髓损伤的继发性损害过程。