脊柱损伤的MRI分析与诊断

目的：分析和总结脊柱损伤的MRI表现和诊断意义。方法：80例脊柱外伤患者均作MRI检查。结果：80例中颈椎25例，胸椎26例，腰椎29例，其中包括椎骨骨折，椎体脱位，椎间盘突出，韧带损伤，脊髓损伤。结论：通过MRI对脊柱损伤的观察和诊断既能明确的显示脊髓、韧带、椎间盘和椎旁软组织受损伤的细节，还能明确椎骨受伤的情况。     

牵张性脊髓损伤动物模型制备及评价

背景:建立牵张性脊髓损伤动物模型,对进一步探讨其病理生理改变及临床意义提供了良好的基础。目的:就牵张性脊髓损伤动物模型的制备及评价方面做一综述。方法:应用计算机检索CNKI和PubMed数据库中关于牵张性脊髓损伤动物模型的文章,在关键词中以"牵张性;脊髓损伤;动物模型;神经功能;运动功能"或"tractive,spinal cord injury,animal model,neural function,motor function"为检索词进行检索。选择文章内容与牵张性脊髓损伤相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到285篇文献,根据纳入标准选择30篇文章进行综述。结果与结论:脊髓损伤模型繁多,包括挫伤模型、压迫损伤模型、牵张性损伤模型、缺血损伤模型、横断损伤和化学损伤等。牵张性脊髓损伤动物模型的建立,对进一步探讨其病理生理改变及临床意义提供了良好的基础。     

牵张性脊髓损伤动物模型制备及评价

背景：建立牵张性脊髓损伤动物模型,对进一步探讨其病理生理改变及临床意义提供了良好的基础.目的：就牵张性脊髓损伤动物模型的制备及评价方面做一综述.方法：应用计算机检索CNKI和PubMed数据库中关于牵张性脊髓损伤动物模型的文章,在关键词中以＂牵张性;脊髓损伤;动物模型;神经功能;运动功能＂或＂tractive,spinal cord injury,animal model,neural function,motor function＂为检索词进行检索.选择文章内容与牵张性脊髓损伤相关,同一领域文献则选择近期发表或发表在权威杂志文章.初检得到285篇文献,根据纳入标准选择30篇文章进行综述.结果与结论：脊髓损伤模型繁多,包括挫伤模型、压迫损伤模型、牵张性损伤模型、缺血损伤模型、横断损伤和化学损伤等.牵张性脊髓损伤动物模型的建立,对进一步探讨其病理生理改变及临床意义提供了良好的基础.     

国际脊髓损伤脊柱损伤基础数据集

收集脊柱损伤的信息对于脊髓损伤患者的诊断和治疗非常重要,设立脊髓损伤患者脊柱损伤基础数据集是为了规范脊柱损伤相关信息的收集方式和报告内容,学习并使用国际脊髓损伤脊柱损伤基础数据集,有助于规范和统一我国脊髓损伤患者脊柱损伤信息的收集,为相关治疗提供依据。本文将介绍国际脊髓损伤脊柱损伤基础数据集的研发过程,数据元素的内容以及数据编码的应用实例。     

Diagnostic capabilities of magnetic resonance imaging and computed tomography in acute cervical spinal column injury

The present study was conducted to evaluate the imaging capabilities of magnetic resonance imaging (MRI) in evaluating acute cervical spinal column injury and compare these results to that of computed tomographic (CT) imaging. Forty-nine patients undergoing MRI at a Level I and regional spinal cord trauma center to evaluate cervical spinal column injury were studied. Seventy-one injuries were identified by MRI. These injuries were classified as osseous (fracture/dislocation) (n = 21), disc herniation (n = 29), and spinal cord injury (edema/contusion/transection) (n = 21). Diagnostic imaging results in 33 of the 49 patients undergoing both MRI and CT were compared. CT demonstrated 22 fracture/dislocations compared to 10 on MRI. MRI demonstrated 19 disc protrusions compared to 7 on CT. Additionally, MR imaged 13 cord injuries as compared to 0 by CT. MR imaging proved superior in demonstrating spinal cord pathology and intervertebral disc herniation. CT was superior to MRI in demonstrating osseous injury. CT and MRI may be useful together in determining presence and extent of spinal column injury.     

SD大鼠股骨骨折合并脊髓损伤模型的构建

背景：骨折合并脊髓损伤的动物模型创伤大,造模后存活率较低,而改良Al en法和股骨开放截骨法制作动物模型时操作简单,不需要特殊器械,建模时间及出血较少,适用于骨折合并脊髓损伤动物模型的制作。 目的：建立一种既能成功维持长时间存活,并符合临床特征,又简便易行的实验动物模型。 方法：将48只SD雄性大鼠随机数字表法均分为单纯股骨骨折组和股骨骨折合并脊髓损伤组,通过双侧小切口开放截骨造成股骨中端横行骨折并植入内固定建立股骨骨折模型,改良Al en法自制打击装置造成大鼠T10段脊髓急性挫伤性损伤,两种方法融合制造股骨骨折合并脊髓损伤模型,观察大鼠制模成功后不同时间点大体情况及4周后骨折断端愈合情况。 结果与结论：建模后骨折合并脊髓损伤动物模型均成活,双下肢感觉及运动功能丧失,但可利用双上肢缓慢匍匐向前移动,前3d进食少,活动少,夜间采用尾端悬吊后,骨折患肢未出现缺血坏死,到达第4周时,单纯股骨骨折组死亡1只,股骨骨折合并脊髓损伤组共死亡4只,成活率为83.33%,髓腔内固定未见脱出,两组骨折断端均有连续骨痂生成,从体积上来看,股骨骨折合并脊髓损伤组骨痂组织明显大于单纯股骨骨折组。证实将改良Al en法与小切口股骨外侧开放截骨法结合后,简单易行,可以成功制作股骨骨折合并脊髓损伤动物模型并成活至第4周。     

构建脊髓慢性压迫损伤模型大鼠巢蛋白的表达规律

背景:既往应用的脊髓损伤动物模型难以达到一种慢性渐进性的压迫效果,与人体慢性脊髓压迫损伤机制有很大的不同。目的:构建一种新的脊髓慢性压迫性损伤模型大鼠,探究慢性压迫损伤后脊髓损伤区域巢蛋白的表达规律及其意义。方法:Wistar大鼠40只随机分为实验组30只和对照组10只。实验组大鼠取下胸7、8椎板,植入压迫材料,形成慢性压迫脊髓损伤模型。植入后第1,3,7,14,28天,取压迫处脊髓组织,行病理学检查及巢蛋白免疫组织化学染色,半定量反转录PCR反应测定巢蛋白mRNA的表达,同时测量压迫段椎管直径及缓膨胀材料侵占厚度。结果与结论:随压迫时间的延长,实验组大鼠椎管侵占率逐渐增加,脊髓组织出现坏死等情况,大鼠BBB评分降低,压迫处脊髓组织中Nestin mRNA及蛋白表达至伤后7d时达到高峰,而后表达逐渐下降,说明实验成功建立慢性脊髓压迫损伤动物模型,且慢性脊髓压迫损伤大鼠脊髓组织Nestin mRNA及蛋白呈动态变化。     

构建脊髓慢性压迫损伤模型大鼠巢蛋白的表达规律

背景：既往应用的脊髓损伤动物模型难以达到一种慢性渐进性的压迫效果,与人体慢性脊髓压迫损伤机制有很大的不同。目的：构建一种新的脊髓慢性压迫性损伤模型大鼠,探究慢性压迫损伤后脊髓损伤区域巢蛋白的表达规律及其意义。方法：Wistar大鼠40只随机分为实验组30只和对照组10只。实验组大鼠取下胸7、8椎板,植入压迫材料,形成慢性压迫脊髓损伤模型。植入后第1,3,7,14,28天,取压迫处脊髓组织,行病理学检查及巢蛋白免疫组织化学染色,半定量反转录PCR反应测定巢蛋白mRNA的表达,同时测量压迫段椎管直径及缓膨胀材料侵占厚度。结果与结论：随压迫时间的延长,实验组大鼠椎管侵占率逐渐增加,脊髓组织出现坏死等情况,大鼠BBB评分降低,压迫处脊髓组织中Nestin mRNA及蛋白表达至伤后7d时达到高峰,而后表达逐渐下降,说明实验成功建立慢性脊髓压迫损伤动物模型,且慢性脊髓压迫损伤大鼠脊髓组织Nestin mRNA及蛋白呈动态变化。     

Cervical fractures and spinal cord injury: outcome of surgical and nonsurgical management

Data were collected retrospectively for 102 consecutive patients with a cervical spinal cord injury admitted to a spinal cord injury center between 1976 and 1986. Frankel's classification and level of spinal cord injury stayed the same or improved in all patients. The complications that occurred compared favorably with outcomes reported in the literature. Approximately 60% of patients achieved a catheter-free voiding status before dismissal from primary rehabilitation. Patients treated with early surgical stabilization of the cervical column were hospitalized a mean of 21 fewer days than their nonsurgical counterparts. In addition, patients treated with early surgical stabilization achieved their first therapeutic leave of absence from primary rehabilitation approximately 40 days sooner than patients stabilized nonsurgically. At final follow-up, however, no appreciable differences in achievement in activities of daily living and mobility were noted between patients treated with surgical stabilization of the cervical spinal column and those treated nonsurgically.     

急性脊髓损伤后血清中ALT和AST活性变化的临床初步观察

目的：探讨血清中谷丙转氨酶（ＡＬＴ）和谷草转氨酶（ＡＳＴ）的活性与急性脊柱脊髓损伤的关系。并评价ＡＬＴ和ＡＳＴ活性的主民脊髓损伤严重程度的关系。方法：测定１３６例急性脊柱脊髓损伤患者在急性期及恢复期血清中ＡＬＴ和ＡＳＴ的水平,以及３０例急性仍柱骨折患者血清中ＡＬＴ和ＡＳＴ的浓度,分别进行统计学处理分析。结果：急性脊柱脊髓损伤患者血清中ＡＬＴ和ＡＳＴ活性显著高于其恢复期及单纯脊柱骨折患者,并且在急性     

Rehabilitation in spinal cord disorders. 2. Anatomy, pathogenesis, and research for neurologic recovery

This self-directed learning module highlights advances in this topic area. It is part of the chapter on rehabilitation in spinal cord disorders in the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This article contains learning objectives on the anatomy of the spine and spinal cord, pathogenesis of spinal cord trauma, mechanisms of spinal fractures and dislocations, causes of nontraumatic spinal cord disorders, and research on neurologic recovery. Advances that are covered in this section include various experimental animal models for producing spinal cord injury and new approaches to limit damage in acute injury and to promote recovery in chronic injury.     

脊柱骨折合并截瘫CT扫描的临床价值

脊柱骨折合并截瘫50例采用CT扫描,能明确脊柱骨折、椎管狭窄、脊髓受压或损伤的程度,及时进行手术治疗,效果满意。并讨论了CT为手术提供的指征和CT扫描的适应证。     

嗅鞘细胞移植治疗慢性脊髓损伤的临床研究进展

背景：虽然迄今为止大量的体外和动物实验都证实了嗅鞘细胞对脊髓损伤的修复作用,但是利用嗅鞘细胞移植治疗脊髓损伤的临床试验尚处于起步阶段.目的：观察嗅鞘细胞移植治疗慢性脊髓损伤的临床安全性、有效性及实用性.方法：由第一作者检索至2012年5月为止 PubMed数据及CNKI中国期刊全文数据库有关嗅鞘细胞移植治疗慢性脊髓损伤的临床试验研究及安全性、疗效方面相关的报道,以“olfactory ensheathing cel s, spinal cord injury, clinical research”为英文检索词,“嗅鞘细胞移植,脊髓损伤”为中文检索词.结果与结论：计算机初检得到133篇文献,阅读标题和进行初筛,排除重复性研究,共34篇文献符合纳入标准.结果显示,利用嗅鞘细胞移植治疗脊髓损伤,在体外试验和动物模型中获得了良好的效果.在临床试验方面,到目前为止,嗅鞘细胞病灶直接移植治疗慢性脊髓损伤按嗅鞘细胞来源分主要集中在以下几个方面：①胚胎嗅鞘细胞移植.②嗅黏膜移植.③嗅黏膜源性嗅鞘细胞移植.3种嗅鞘细胞移植方法的总体安全性（96.4%）和有效性（23.4%）较高,但是其移植方法均存在明显的不足.提示嗅鞘细胞移植治疗慢性脊髓损伤的安全性和有效性还需要进一步验证,转化为临床应用还有很长的路要走.     

Epidemiology, physiopathology, and experimental therapeutics of acute spinal cord injury

This article analyzes the epidemiological factors relating to acute spinal cord injury. It also delineates the anatomical and rheological characteristics of the spinal cord and denotes the latest concepts in autoregulation of spinal cord blood flow. The physiopathology of spinal cord injury is examined in terms of existing animal models, responses of the white and grey matter, and biochemical and biomechanical correlates. Experimental and clinical therapeutic modalities ranging from hypothermia to opioid antagonists, and adrenergic blockers to free radical scavengers are evaluated.     

Early mobilization of patients with unstable fractures of the thoracic and lumbar spine. A 2-year follow-up study.

During the acute immobilization period 18 patients, with unstable fractures of the spine together with, in most cases, a spinal cord lesion, caudally of T2, were tilted in bed or on a tilting table. Twelve of these patients began the tilting already in the second week after the injury and reached +30 degrees on the 15th day, +50 degrees on the 37th day and +90 degrees on the 65th day following the injury. All patients were kept under observation at regular intervals up to 2 years. A comparison between similar patient groups, treated strictly conservatively, and the present patient groups did not show any differences either in respect to deformities in the spinal column, expected reduction in the spreading of the spinal cord lesions or in the subjective symptoms of the patients. In the hope of reducing the complications induced by protracted immobilization, the authors recommend that patients with unstable fractures of the spinal column, caudally of T2, with or without spinal cord lesion, begin a specified tilting program already in the second week following the injury.     

Nerve injury-induced tactile allodynia is mediated via ascending spinal dorsal column projections

Peripheral nerve injury produces signs of neuropathic pain including tactile allodynia and thermal hyperalgesia, sensory modalities which may be associated with different neuronal pathways. Studies of spinally-transected, nerve-injured rats have led to suggestions that thermal hyperalgesia may be mediated predominately through local spinal circuitry whereas ascending input to supraspinal sites is critical to the manifestation of tactile allodynia. Here, the nature of ascending spinal input mediating tactile allodynia was explored using selective spinal lesions. Male Sprague-Dawley rats received L(5)/L(6) spinal nerve ligation (SNL) and ipsilateral or contralateral (relative to the SNL side) lesions including spinal hemisections and bilateral and unilateral dorsal column lesions. The rats were maintained in a sling and monitored for tactile allodynia by measuring withdrawal thresholds to probing with von Frey filaments 24 h after the hemisection. Rats receiving dorsal column lesions demonstrated no motor deficits while rats receiving spinal hemisection showed paralysis of the paw which nevertheless responded to strong noxious stimulation. Spinal hemisection ipsilateral, but not contralateral, to SNL completely abolished tactile allodynia while maintaining spinal nocifensive reflexes to noxious pinch. Bilateral and ipsilateral dorsal column lesions blocked tactile allodynia while contralateral dorsal column lesions did not. Administration of lidocaine into the nucleus gracilis ipsilateral to SNL also blocked tactile allodynia, but did not alter thermal hyperalgesia in SNL rats or increase thermal nociceptive responses in sham-operated rats. Lidocaine microinjected into the contralateral nucleus gracilis produced no changes in responses to tactile or thermal stimuli in either group. These results indicate that tactile allodynia after peripheral nerve injury is dependent upon inputs to supraspinal sites. Furthermore, it is apparent that afferent signals interpreted as tactile allodynia course through the ipsilateral dorsal columns and are relayed through the nucleus gracilis. This neuronal pathway is consistent with the interpretation that tactile allodynia pursuant to peripheral nerve injury is transmitted to the central nervous system by means of large diameter, myelinated fibers.     

干细胞移植治疗脊髓损伤的研究进展

背景:干细胞移植作为治疗脊髓损伤最具前景的方法,已经在大量的动物实验和临床试验中得到证实.目的:综述干细胞移植治疗脊髓损伤的相关研究进展.方法:应用计算机检索2006-01/2010-12中国知网、Medline数据库相关文章,中文检索词"干细胞,脊髓损伤,细胞移植",英文检索词"stem cells,spinal cord injury,cells transplantation",共检索到文献494篇,最终纳入符合标准的文献24篇.结果与结论:研究发现,移植的干细胞可以在脊髓内迁移、分化为神经元并分泌神经营养物质,促进神经组织的修复,改善神经功能.胚胎干细胞最早用于治疗脊髓损伤,但潜在的致瘤性等成为其临床应用的障碍;神经干细胞理论上是治疗脊髓损伤的首选干细胞,由于分离纯化技术要求严格,费用昂贵等使其在研究中进展缓慢;骨髓间充质干细胞来源丰富、取材方便,可行自体移植,避开了伦理学和移植后排斥等问题,目前被认为是一种理想的自体干细胞移植来源.随着细胞联合移植、基因修饰及组织工程支架移植治疗脊髓损伤的研究不断取得进展,许旺细胞、嗅鞘细胞的应用范围和治疗效果也得到提升.     

脊髓3/4横断伤动物模型的建立及其电生理评价

背景：建立稳定、标准的脊髓损伤动物模型是研究脊髓损伤修复的前提。目的：建立一种实用、标准、可靠的急性大鼠脊髓损伤模型。方法：将60只成年雌性Wistar大鼠随机均分成两组。脊髓损伤组：打开T8胸椎对应脊髓,剪开硬膜,用特殊设计的眼科维纳斯剪横跨脊髓背侧中线剪断脊髓的后3/4,深度1.5mm。1h后行感觉诱发电位和运动诱发电位检查。对照组：只打开椎板,剪开硬膜,暴露脊髓进行假手术。结果与结论：造模成功率为100%。对照组造模后1周功能恢复接近正常;脊髓损伤组造模后第2周开始恢复,到第4周基本停止,最终运动功能评分未超过10分,两组比较差异有显著性意义。脊髓损伤组可以明显看到感觉诱发电位与运动诱发电位的波幅值急剧降低,且潜伏期明显延长,差异有显著性意义（P〈0.01）。说明3/4横断伤急性大鼠脊髓损伤模型制作法操作简便、重复性好,是研究脊髓再生修复的理想模型。     

脊髓3/4横断伤动物模型的建立及其电生理评价

背景:建立稳定、标准的脊髓损伤动物模型是研究脊髓损伤修复的前提.目的:建立一种实用、标准、可靠的急性大鼠脊髓损伤模型.方法:将60只成年雌性Wistar大鼠随机均分成两组.脊髓损伤组:打开T8胸椎对应脊髓,剪开硬膜,用特殊设计的眼科维纳斯剪横跨脊髓背侧中线剪断脊髓的后3/4,深度1.5 mm.1 h后行感觉诱发电位和运动诱发电位检查.对照组:只打开椎板,剪开硬膜,暴露脊髓进行假手术.结果与结论:造模成功率为100%.对照组造模后1周功能恢复接近正常;脊髓损伤组造模后第2周开始恢复,到第4周基本停止,最终运动功能评分未超过10分,两组比较差异有显著性意义.脊髓损伤组可以明显看到感觉诱发电位与运动诱发电位的波幅值急剧降低,且潜伏期明显延长,差异有显著性意义(P < 0.01).说明3/4横断伤急性大鼠脊髓损伤模型制作法操作简便、重复性好,是研究脊髓再生修复的理想模型.     

A clonal cell line from immortalized olfactory ensheathing glia promotes functional recovery in the injured spinal cord.

Immortalized cell lines of olfactory ensheathing glia (OEG) that maintain the proregenerative properties of primary cultures provide an unlimited source of OEG for both basic and applied studies. Indeed, one specific immortalized rat OEG clonal line (TEG3) proved to be as good as primary OEG in promoting neuritogenesis and axon regeneration in culture models. Thus, we examined the capacity of TEG3 to promote axonal repair in an animal model of spinal cord injury, dorsal column crush. TEG3 cells can acquire astrocyte-like or Schwann cell-like morphology depending on the conditions under which they are cultured. In the injured spinal cord, prelabeled TEG3 survived for at least 10 weeks after grafting and they integrated into the spinal cord, adopting Schwann cell-like, astrocyte-like, or intermediate morphologies. In TEG3-transplanted animals, sensory projection axons grow into the lesion site and there was robust sprouting/axonal growth of the corticospinal tract, both into and beyond the lesion site, after crushing of the spinal cord-dorsal columns. TEG3-transplanted animals also recovered sensory and motor function in tape removal and beam walking behavioral tests. These data indicate that certain immortalized cell lines derived from a single cell can maintain the regenerative properties of primary OEG.