胸腰段脊柱骨折伴脊髓损伤的治疗方法体会

目的分析后路椎弓根螺钉内固定和前路减压钉棒内固定两种方法治疗胸腰椎骨折伴脊髓损伤的临床疗效。方法将我院从2009年至2011年收治的120例胸腰段脊柱骨折伴脊髓损伤患者随机均分为后路组60例,行后路减压椎弓根螺钉内固定治疗,前路组60例,行前路减压钉棒内固定治疗。统计分析两组手术情况、神经功能恢复情况、治疗有效率和术后并发症等。结果经术后6～23个月随访,两组术前术后Cobb角的变化和神经功能Frankel结果显示两组术后均优于术前(P<0.05),组间比较差异无统计学意义(P>0.05);后路组总有效率为73.3%,前路组为71.7%,差异无统计学意义(P>0.05)。结论后路椎弓根螺钉内固定和前路减压钉棒内固定两种方法治疗胸腰椎骨折伴脊髓损伤均能取得较好疗效,但后路法并发症少于前路组。     

姜黄素修复脊髓损伤的信号通路研究进展

姜黄素是从中药姜黄中提取的天然多酚化合物,对于脊髓损伤的修复显示出良好的疗效。姜黄素可以抑制神经炎症反应;减少胶质瘢痕的形成;减少局部神经组织自由基释放和脂质过氧化;减少神经细胞凋亡和改善脊髓损伤微环境。综述目前姜黄素修复脊髓损伤研究所涉及8条信号通路（NF-κB、TLR4-TAK1-NF-κB、JAK/STAT、Nrf2、ERS、N-甲基-D-天冬氨酸受体-Ca²⁺诱导型一氧化氮合酶、SOX9和Wnt/β-catenin）及相关具有潜力的通路（mTOR）,为姜黄素治疗脊髓损伤作用机制的深入研究提供新思路。     

转NGF基因雪旺细胞和胚胎脊髓细胞悬液移植治疗脊髓损伤的实验研究

目的：探讨胚胎脊髓细胞悬液（FSCS），雪旺细胞（SC）和神经生长因子（NGF）修复脊髓损伤的疗效。方法：用改良Allen法制成4组脊髓损伤动物模型（80只），1周后分别行空白对照组（DMEM），FSCS，FSCS＋SC和FSCS＋NGFSC移植入脊髓损伤部位，脊髓移植1个月和3个月后分别采用免疫组化染色法观察神经丝蛋白（NF），髓基质蛋白（MBP），5羟色胺（5－HT）的表达情况，并根据图像分析各实验组脊髓移植物的免疫阳性反应变化；通过改良的Tarlov评分方法观察行为变化。结果：FSCS＋NGFSC联合移植治疗脊髓损伤能够明显促进脊髓再生和修复，改善脊髓功能，4组疗效之间有显著性差异（P＜0．01），结论：转NGF基因雪旺细胞和胚胎脊髓细胞悬液移植治疗脊髓损伤时NGF基因修饰的SC局部释放的NGF能够刺激受损轴突再生，促进FSCS移植物与受损脊髓的整合，促进脊髓损伤的再生修复。     

Oral Paracetamol Bioavailability in Rats Subjected to Experimental Spinal Cord Injury

The purpose of the present study was to examine the time dependence of oral paracetamol (acetaminophen) bioavailability in an experimental model of spinal cord injury (SCI). Female Sprague–Dawley rats were subjected to spinal cord contusion at the T8–T9 level by the weight drop method producing permanent paraplegia. Oral paracetamol bioavailability after administration of a single 100 mg kg⁻¹ dose was determined 1, 12, and 50 d after SCI. C_max and AUC were significantly decreased 1 d after SCI compared to sham-injured controls. This reduction, however, was temporary, as there was a recovery of bioavailability parameters which was partial 12 d after SCI, being complete by day 50. The present results confirm the usefulness of animal models for the characterization of the effect of SCI in drug kinetics. Data show that SCI induces significant changes in paracetamol pharmacokinetics. Nonetheless, despite the fact of a permanent loss of functions related to locomotion, pharmacokinetic alterations evolved with time. © 1997 John Wiley & Sons, Ltd.     

The Role of Astrogliosis in Formation of the Syrinx in Spinal Cord Injury

A massive localized trauma to the spinal cord results in complex pathologic events driven by necrosis and vascular damage which in turn leads to hemorrhage and edema. Severe, destructive and very protracted inflammatory response is characterized by infiltration by phagocytic macrophages of a site of injury which is converted into a cavity of injury (COI) surrounded by astroglial reaction mounted by the spinal cord. The tissue response to the spinal cord injury (SCI) has been poorly understood but the final outcome appears to be a mature syrinx filled with the cerebrospinal fluid with related neural tissue loss and permanent neurologic deficits. This paper reviews known pathologic mechanisms involved in the formation of the COI after SCI and discusses the integrative role of reactive astrogliosis in mechanisms involved in the removal of edema after the injury. A large proportion of edema fluid originating from the trauma and then from vasogenic edema related to persistent severe inflammation, may be moved into the COI in an active process involving astrogliosis and specifically over-expressed aquaporins.     

龟板对脊髓损伤后脊髓雌激素α受体及其基因表达的影响

目的 :观察龟板对脊髓损伤后脊髓雌激素α受体 (ER -α)及其基因表达的影响。方法 :以改良的Allen法建立大鼠脊髓损伤模型 ,随机分为对照组、模型组和龟板治疗组 ,用免疫组织化学和原位杂交方法检测脊髓中ER -α及其mRNA的表达。结果 :模型组中脊髓ER -α受体及其mRNA的阳性细胞数与对照组比较显著减少 ;治疗组中ER -α及其mRNA的阳性细胞数与模型组比较显著增加。结论 :龟板可增加脊髓损伤后脊髓ER -α及其基因的表达。     

盐酸左氧氟沙星软膏联合rhEGF治疗外伤性脊髓损伤患者压疮的疗效观察

目的:观察盐酸左氧氟沙星软膏联合重组人表皮生长因子凝胶(rhEGF)治疗外伤性脊髓损伤患者压疮的临床疗效。方法:将56例压疮患者均分为2组:治疗组采用盐酸左氧氟沙星软膏联合rhEGF治疗;对照组仅采用rhEGF治疗,观察、对比2组疗效。结果:治疗组总有效率为93.7%,对照组为73.3%,2组比较差异有统计学意义(P<0.01),且治疗组治愈时间显著短于对照组(P<0.05)。2组均未见明显不良反应发生。结论:盐酸左氧氟沙星软膏联合rhEGF治疗外伤性脊髓损伤患者压疮具有协同作用,临床疗效、安全性较好。     

Annexin A2对小鼠脊髓损伤后神经元的保护作用

目的 研究钙依赖性膜磷脂结合蛋白Annexin A2对脊髓损伤后神经元的保护作用。方法 制作稳定的脊髓横断模型小鼠,随机分为Annexin A2组(A2组)、神经生长因子组(NGF组)、阴性对照组和假手术组。在术前、术后1,2,4周分别观察运动功能恢复情况,记录小鼠每天的存活情况。术后4周取材制作病理切片,苏木精-伊红染色,观察脊髓神经元的恢复情况。结果 A2组术后每天的存活率高于阴性对照组但低于NGF组。在脊髓横断损伤4周后,A2组的小鼠后肢运动功能评分显著高于阴性对照组(P<0.05),脊髓损伤处神经元的数目大于阴性对照组,并且神经元的修复更趋向于正常的神经元细胞。结论 Annexin A2对脊髓神经元有保护作用,有助于小鼠恢复运动功能。     

Early Detrusor Application of Botulinum Toxin A Results in Reduced Bladder Hypertrophy and Fibrosis after Spinal Cord Injury in a Rodent Model

Following spinal cord injury (SCI), pathological reflexes develop that result in altered bladder function and sphincter dis-coordination, with accompanying changes in the detrusor. Bladder chemodenervation is known to ablate the pathological reflexes, but the resultant effects on the bladder tissue are poorly defined. In a rodent model of contusion SCI, we examined the effect of early bladder chemodenervation with botulinum toxin A (BoNT-A) on bladder histopathology and collagen deposition. Adult female Long Evans rats were given a severe contusion SCI at spinal level T9. The SCI rats immediately underwent open laparotomy and received detrusor injections of either BoNT-A (10 U/animal) or saline. At eight weeks post injury, the bladders were collected, weighed, and examined histologically. BoNT-A injected bladders of SCI rats (SCI + BoNT-A) weighed significantly less than saline injected bladders of SCI rats (SCI + saline) (241 ± 25 mg vs. 183 ± 42 mg; p < 0.05). Histological analyses showed that SCI resulted in significantly thicker bladder walls due to detrusor hypertrophy and fibrosis compared to bladders from uninjured animals (339 ± 89.0 μm vs. 193 ± 47.9 μm; p < 0.0001). SCI + BoNT-A animals had significantly thinner bladder walls compared to SCI + saline animals (202 ± 55.4 μm vs. 339 ± 89.0 μm; p < 0.0001). SCI + BoNT-A animals had collagen organization in the bladder walls similar to that of uninjured animals. Detrusor chemodenervation soon after SCI appears to preserve bladder tissue integrity by reducing the development of detrusor fibrosis and hypertrophy associated with SCI.     

莫匹罗星联合rhEGF治疗外伤性脊髓损伤患者并发压疮的疗效观察

目的:观察莫匹罗星联合重组人表皮生长因子(rhEGF)治疗外伤性脊髓损伤患者并发压疮的临床疗效。方法:将62例外伤性脊髓损伤并发压疮的患者随机分为2组,治疗组31例先将莫匹罗星软膏涂在伤口创面上,然后涂上rhEGF凝胶(厚度约2mm,宽度以超过创面2cm为宜);对照组31例仅采用rhEGF凝胶治疗,比较2组患者的疗效。结果:治疗组总有效率为94.3%,对照组为71.9%,2组疗效比较差异有统计学意义(P<0.05),且治疗组治愈时间和换药次数均显著少于对照组(P<0.05)。2组治疗过程中均未见不良反应发生。结论:莫匹罗星联合rhEGF治疗外伤性脊髓损伤患者并发压疮,临床疗效较好,安全性高。     

选择性线粒体分裂抑制剂对大鼠急性脊髓损伤后神经细胞的保护作用及其机制

【摘要】目的 检测选择性线粒体分裂抑制剂-1（Mdivi-1）对大鼠急性脊髓损伤（ASCI）后神经细胞线粒体中丙二醛（MDA）、谷胱甘肽（GSH）、细胞色素C（Cyt-C）及神经细胞凋亡的影响。方法成年雌性SD大鼠36只,体质量 250~300g,随机分为假手术组（Sham组）、单纯脊髓损伤组（SCI组）、Mdivi-1预处理组（1.20mg/kg,Mdivi-1组）,各12 只。Sham组只暴露脊髓,不打击。SCI组和Mdivi-1组采用Allen’s方法制备脊髓损伤模型。Mdivi-1组在脊髓打击之前15min尾静脉给予Mdivi-1,而SCI组给予等量二甲基亚砜（DMSO）。Sham组在暴露脊髓8h后立即处死,SCI组和Mdivi-1组均于脊髓损伤后8h处死;然后取出脊髓节段T9~T11,用分光光度计检测各组脊髓组织线粒体中MDA 和GSH的含量,Western Blot法检测线粒体及胞浆内Cyt-C表达情况,荧光TUNEL法观察神经细胞凋亡情况。结果与Sham组相比,SCI组线粒体中Cyt-C和GSH明显减少,但线粒体中的MDA,胞浆中Cyt-C及神经细胞凋亡数目明显增多（P<0.01）;与SCI组相比,Mdivi-1组线粒体中Cyt-C和GSH明显增多,但线粒体中MDA,胞浆中Cyt-C以及神经细胞凋亡数目明显减少（P<0.01）。结论Mdivi-1具有减轻ASCI后神经细胞线粒体氧化损伤,抑制线粒体中Cyt-C 的释放及神经细胞凋亡的作用,促进了脊髓功能恢复。     

中青年颈椎无骨折脱位的急性颈脊髓中央型损伤的手术效果分析

目的观察分析对中青年颈椎无骨折脱位的急性颈脊髓中央型损伤进行手术的临床疗效。方法从我院收治入院的无骨折脱位的急性颈脊髓中央型损伤患者中抽取60例,随机分为观察组与对照组,观察组实施手术治疗,对照组实施非手术保守治疗。对比两组患者的治疗效果。结果两组患者入院时ASIA评分无明显差异(P>0.05);治疗后随访1年观察组患者的ASIA运动、感觉及总评分均明显高于对照组,差异有统计学意义(P<0.05)。结论对颈椎无骨折脱位的急性颈脊髓中央型损伤的中青年患者实施手术治疗,相比保守治疗,能明显提高患者的ASIA评分,具有更为理想的临床治疗效果。     

探讨前、后路减压治疗胸腰段脊柱骨折合并脊髓损伤的临床对照分析

目的对比分析前、后路减压治疗胸腰段脊柱骨折合并脊髓损伤的临床效果。方法收集我院2011年8月至2013年8月期间诊治的胸腰段脊柱骨折合并脊髓损伤患者66例作为研究对象,以抛硬币的方式分为试验组与对照组,每组患者各33例。对照组患者采用后路减压手术治疗,试验组采用前路减压手术治疗,对两组患者的治疗效果进行分析对比。结果研究结果显示,试验组术后运动评分、触觉评分、伤椎高度、Cobb's角恢复情况明显优于对照组(P<0.05)。结论前路减压手术治疗胸腰段脊柱骨折合并脊髓损伤的临床效果优于后路减压治疗,能有效促进术后运动评分、触觉评分改善及伤椎高度、Cobb's角恢复,值得在临床应用上推广。     

利多卡因辅助局部麻醉在老年外伤性颈胸段脊髓损伤减压手术的应用

目的：探讨利多卡因辅助局部麻醉在老年外伤性颈胸段脊髓损伤减压手术的应用方法与效果。方法：采用前瞻性研究方法,选择2013年2月至2015年12月在我院进行诊治的外伤性颈胸段脊髓损伤老年患者78例,根据入院顺序分为观察组与对照组各39例,两组都给予减压手术治疗,对照组选择全身麻醉,观察组选择利多卡因辅助局部麻醉,观察两组预后情况。结果：两组患者在麻醉前后的收缩压、舒张压、心率未出现明显变化,对比差异均无统计学意义（P>0.05）。观察组术中神经损伤、术后呼吸道不适等并发症发生率与住院时间分别为2.6%和（7.11±0.45d）,而对照组分别为23.1%和（9.33±0.51d）,观察组的两项指标明显低于对照组（P<0.05）。术后观察组与对照组的麻醉满意度分别为100.0%和84.6%,观察组明显高于对照组（P<0.05）。观察组与对照组术后3个月的JOA评分分别为（12.94±2.84）分和（10.49±2.44）分,都明显高于术前的（5.37±1.49）分和（5.42±1.33）分,组间对比差异也有统计学意义（P<0.05）。结论：利多卡因辅助局部麻醉在老年外伤性颈胸段脊髓损伤减压手术的应用具有较好的安全性,能提高麻醉效果,减少并发症的发生,缩短住院时间,促进颈椎功能的恢复。     

Video-Urodynamic Characteristics and Predictors of Switching from Botulinum Neurotoxin a Injection to Augmentation Enterocystoplasty in Spinal Cord Injury Patients

Botulinum neurotoxin type A (BoNT-A) injection and augmentation enterocystoplasty (AE) are alternative and effective management strategies for neurogenic detrusor overactivity (NDO) refractory to pharmacotherapy. A great majority of patients with spinal cord injury (SCI) may, however, prefer BoNT-A injections to AE, due to the less invasive characteristics. In this study we evaluated the influence of various video-urodynamic study (VUDS) parameters in SCI patients who continuously received repeat BoNT-A detrusor injections or switched to AE to improve their bladder conditions. We compared the changes in the urodynamic parameters before and after each mode of treatment. In this retrospective study, all SCI patients with refractory NDO who had received at least one BoNT-A injection were enrolled. VUDS was performed before and after both BoNT-A injection and AE. All of the urodynamic parameters of the storage and micturition—including the bladder capacity of every sensation, maximal flow rate (Qmax), post-voiding residual volume, detrusor pressure at Qmax, and bladder contractility index—were recorded. A total of 126 patients, including 46 women and 80 men, with a mean age of 41.8 ± 13.1 years, were recruited for this study. All of the patients receiving either BoNT-A injection or AE had a statistically significant increase of bladder capacity at every time-point during filling and a decrease in detrusor pressure at Qmax during voiding. Patients who switched from BoNT-A to AE had greater improvements in their urodynamic parameters when compared with those who continued with BoNT-A injections. Accordingly, SCI patients receiving BoNT-A injections but experiencing few improvements in their urodynamic parameters should consider switching to AE to achieve a better storage function and bladder capacity.     

Repetitive Treatment with Diluted Bee Venom Attenuates the Induction of Below-Level Neuropathic Pain Behaviors in a Rat Spinal Cord Injury Model

The administration of diluted bee venom (DBV) into an acupuncture point has been utilized traditionally in Eastern medicine to treat chronic pain. We demonstrated previously that DBV has a potent anti-nociceptive efficacy in several rodent pain models. The present study was designed to examine the potential anti-nociceptive effect of repetitive DBV treatment in the development of below-level neuropathic pain in spinal cord injury (SCI) rats. DBV was applied into the Joksamli acupoint during the induction and maintenance phase following thoracic 13 (T13) spinal hemisection. We examined the effect of repetitive DBV stimulation on SCI-induced bilateral pain behaviors, glia expression and motor function recovery. Repetitive DBV stimulation during the induction period, but not the maintenance, suppressed pain behavior in the ipsilateral hind paw. Moreover, SCI-induced increase in spinal glia expression was also suppressed by repetitive DBV treatment in the ipsilateral dorsal spinal cord. Finally, DBV injection facilitated motor function recovery as indicated by the Basso–Beattie–Bresnahan rating score. These results indicate that the repetitive application of DBV during the induction phase not only decreased neuropathic pain behavior and glia expression, but also enhanced locomotor functional recovery after SCI. This study suggests that DBV acupuncture can be a potential clinical therapy for SCI management.     

大鼠T7脊髓半横切损伤模型的建立及饲养护理

目的制备SD大鼠T7脊髓半横切动物模型,模拟脊髓损伤,为后期治疗脊髓损伤研究提供实验数据。方法24只健康SD大鼠随机分为对照组及脊髓损伤组,每组12只。SCI组咬除T6～8棘突及相应椎板,暴露相应脊髓,定量切除T7右半侧脊髓组织;对照组仅切除相应椎板。术后行人工排尿、排便等护理,于3d、7d分别进行BBB运动功能评分及感觉诱发电位（sensory evoked potentials,SEP）检测,并取T7脊髓行组织学观察。结果SCI组所有动物在术后均表现出典型的脊髓半切症状;BBB运动功能评分低于8分;术后3d及7d损伤组检测不到SEP,而对照组潜伏期轻度延长及波幅轻度下降;脊髓形态学观察显示该方法达到脊髓半横切要求;术后SCI组大鼠无死亡。结论大鼠T7脊髓半横切损伤模型建立成功,有效的术后护理可提高模型大鼠的生存率。     

罗格列酮和甲基泼尼松龙联合治疗大鼠脊髓损伤的实验研究

目的通过建立脊髓损伤动物模型,探讨甲基泼尼松龙(MP)、罗格列酮联合用药与单独用药对脊髓损伤的疗效差别。方法参照动脉瘤夹压迫法制作大鼠的脊髓损伤模型,并随机分为6组,分别为假手术组、单纯损伤组、脊髓损伤后生理盐水注射组、MP注射组、罗格列酮注射组、MP和罗格列酮联合应用治疗组。于伤后3、7、14、21、28d行神经功能评分,RT-PCR检测脊髓损伤12、24h、3、7、14、21、28d后炎性因子肿瘤坏死因子α(TNF-α)和白细胞介素1β(IL-1β)的mRNA的表达,Western-bloting法检测伤后24h凋亡相关蛋白Bax和Bcl-2的表达。结果伤后各个时间点的神经功能评分上,两药联合应用组较其他各组显著增高(P<0.01),伤后炎性因子TNF-α和IL-1β的mRNA表达方面,两药联合应用治疗后炎性因子mRNA表达均显著降低(P<0.05),脊髓损伤24h后,Bax蛋白表达升高,Bcl-2蛋白表达下降,两药联合应用组表现Bax蛋白表达下降Bcl-2蛋白表达升高更明显(P<0.05)。结论脊髓损伤后应用MP及罗格列酮治疗均有效,二者合用显示出明显的协同作用。     

Effect of the Combination of CI-988 and Morphine on Neuropathic Pain after Spinal Cord Injury in Rats

Cholecystokinin is known to be involved in the modulation of nociception and to reduce the efficacy of morphine analgesia. This study investigated the effects of intrathecal administration of morphine and the cholecystokinin type B antagonist CI-988 on below-level neuropathic pain after spinal cord injury in rats. We also examined the interaction of morphine and CI-988 in the antinociceptive effect. Both morphine and CI-988 given individually increased the paw withdrawal threshold to mechanical stimulation in a dose-dependent manner. The combination of ineffective doses of intrathecally administered CI-988 and morphine produced significant analgesic effects and the combination of effective doses resulted in analgesic effects that were greater than the sum of the individual effects of each drug. Thus, morphine showed a synergistic interaction with CI-988 for analgesia of central neuropathic pain.