Percutaneous puncture of spinal cysts in the diagnosis and therapy of syringomyelia and cystic tumors

Summary The experience with percutaneous puncture of intraspinal cystic lesions is reported in four cases: an extradural cyst demonstrated with air, a spinal cord tumor with lipiodol and two cases of syringomyelia with metrizamide. Percutaneous puncture of cystic lesions makes possible an accurate delineation of the lesion and a histological approach through biochemical and cytological analysis of the aspirated cystic fluid, while aspiration of the fluid of cystic tumors decompresses the spinal cord and thus plays a therapeutic role.     

Morphology of the cervical spinal cord on computed myelography

Summary To ensure adequate use of the technique of computed myelography (CM) it is necessary to have an exact picture of the morphology of the normal spinal cord as demonstrated by this technique. This has been obtained by studying the morphology and measuring the frontal and sagittal diameter of the cervical cord in 20 patients. The normal values are presented. The changes of this morphology in one patient with a tumour, one patient with atrophy of the spinal cord and in some patients with congential malformations are also reported.     

Computed tomography in cervical spondylotic myelopathy and radiculopathy: visualisation of structures,myelographic comparison,cord measurements and clinical utility

Summary Sixty-nine patients with cervical spondylotic myelopathy (CSM), radiculopathy (CSR), or both (CSMR) were studied with computed tomography (CT). Computer-assisted myelography (CAM) accurately determines the site and nature of spondylotic protrusions and provides good visualisation of the subarachnoid space and cord deformities even in areas with dilute metrizamide. However, excessive vertebral movement and bulging ligamenta flava with their effects on cord deformity, so easily visualised in myelograms, are completely or partially missed. In the assessment of CSM, metrizamide myelography (MM) followed by CAM should be performed, particularly when the myelographic images are unsatisfactory due to contrast dilution or blockage, when cord compression cannot be ascertained with MM and when cord atrophy is suspected. In CSR, the diagnostic information from MM and CAM is comparable. The diagnostic criteria in CAM are, however, less direct and since MM is adequate in uncomplicated cases, CAM is generally not necessary. The APD, APD/TD ratio, area and circularity are sensitive indices of cord deformity and the first two should be used more often to assist visual assessment of cord deformity. The relation between cord parameters and treatment response is better reflected in CSM cases managed conservatively and the results suggest that the degree of cord deformity is helpful in determining the outcome and hence the choice between surgical and conservative treatment. In plain CT, the osteophytes and calcified discs are adequately visualised and canal dimensions measured with accuracy, but the cervical cord and roots cannot be properly assessed and the diagnosis of CSM or CSR cannot be ascertained. At present, its role in cervical spondylosis is therefore limited.     

颈髓横断致大鼠胃粘膜损伤机制

为了研究颈髓横断大鼠急性胃粘膜损伤的机制，我们在不同的时间点（３、５和７小时）测定大鼠胃粘膜非蛋白巯基（ＮＰＳＨ）、蛋白巯基（ＰＳＨ）和丙二醛（ＭＤＡ）含量。实验结果和对照组相比：ＮＰＳＨ分别减少１９．３２％（３小时）、２８．５０％（５小时）和４２．４９％（５小时）；ＰＳＨ分别下降２７．３３％（３小时）、２４．０９％（５小时）和２４．８９％（７小时）；ＭＤＡ含量增加１０２．００％（５小时）和１１１．４４％（７小时）。提示，颈髓横断后胃粘膜巯基含量减少引起胃粘膜清除自由基的能力下降而脂质过氧化加强，另外，ＰＳＨ的减少导致蛋白质结构和功能的改变。这些可能与急性胃粘膜损伤的发生有关。     

Spinal cord abnormalities in sports

Many types of spinal abnormalities can have an impact on an athlete’s ability to participate in sports. One of the challenges in the current era is distinguishing the clinically relevant lesions from the incidental. Almost without exception, a Chiarimal formation, significant syringomyelia or other cyst compressing the spinal cord or nerve roots, tethered spinal cord, or spinal tumor should prompt referral to a neurosurgeon. However, tonsillar ectopia (descent of the cerebellum less than 5 mm beyond the foramen magnum) and small dilatations of the central canal, are very commonly seen and appear to represent normal anatomic variants that place athletes at no increased risk of spinal injury, and should not be considered a contraindication to play. The recommendations made in this article are largely based on consensus and experience, but as we gain more clinical experience to correlate with the increasingly sophisticated imaging findings, we hope that these recommendations can be refined further.     

急性无骨折脱位型颈髓损伤的MRI诊断价值探讨

目的:探讨MRI对急性无骨折脱位型颈髓损伤的诊断价值.方法:回顾108例经X线和CT证实无骨折脱位型颈髓损伤的MRI表现,分析其影像特征.结果:无骨折脱位型颈髓损伤可累及颈髓任一平面,而以C<,4>、C<,5>椎体对应平面最多见(63.3%),其中广泛水肿型51例,出血水肿型19例,局限型38例.此外,24例共计38个椎体骨挫伤;85例183个椎间盘髓核突出,相应平面硬膜囊及脊髓受压,以C<,4/5>、C<,5/6>椎间盘突出多见(85.2%);17例可见前纵韧带增厚及水肿信号;32例可见颈后部软组织水肿信号.结论:MRI不但能够早期发现急性无骨折脱位型颈髓损伤,并且能够对脊髓损伤进行分类,同时能够发现韧带及肌肉损伤,在诊断、治疗及预后判断中均具有重要价值.     

Magnetic resonance imaging of the normal and chronically injured adult rat spinal cord in vivo

We assessed the capacity of MRI to show and characterise the spinal cord (SC) in vivo in normal and chronically injured adult rats. In the chronically injured animals the SC was studied by MRI and histological examination. MRI was performed at 1.5 T, using gradient-echo and spin-echo (SE) sequences, the latter with and without gadolinium-DTPA (Gd-DTPA). Several positions were tried for good alignment and to diminish interference by respiratory movements. Images of the SC were obtained in sagittal, coronal, and axial planes. Normal SC was observed as a continuous intensity in both sequences, although contrast resolution was better using SE; it was not possible to differentiate the grey and white matter. Low signal was seen in the damaged area in chronically injured rats, which corresponded to cysts, trabeculae, mononuclear infiltrate, and fibroglial wall on histological examination. Gd-DTPA failed to enhance the SC in normal or chronically injured rats. It did, however, cause enhancement of the lesion after acute SC injury.     

脊髓腹侧压迫损伤后运动功能恢复的变化规律

目的 观察脊髓侧压迫致伤后脊髓功能变化的规律。方法 先制作脊髓腹侧压迫损伤模型、造成脊髓不完全损伤,应用后肢功能评分、神经电生理检查等手段,观察受试动物双后肢的功能变化。结果 脊髓受压致脊髓不完全损伤后,随着观察时间的延长,受试动物后肢功能呈不同程度的恢复,但以伤后2周功能恢复最快。脊髓完全损伤后受试动物后肢功能无明显变化。结论 脊髓损伤后其功能恢复机制目前尚不完全清楚,如果脊髓功能在伤后2周内有明显恢复,将预示着脊髓功能最终有较好的恢复。     

不同剂量的神经节苷酯钠对急性脊髓损伤的疗效比较

目的通过对急性脊髓损伤患者使用不同剂量的单唾液酸四己糖神经节苷酯钠（GM-1）的疗效进行比较,观察GM—l的剂量对急性脊髓损伤的疗效的影响。方法回顾性分析我院2006年12月～2012年12月82例急性脊髓损伤病例,按照使用的药物剂量分3个小组：0剂量组（未使用）、低剂量组（20—40mg／d）、高剂量组（100mg／d）;再按照美国脊髓损伤学会（ASIA）92损伤分级分为A、B、C、D级。对伤后24h、2周、1个月、2个月时患者的浅感觉、运动及小便功能等方面进行对比来评价不同剂量的GM-1对急性脊髓损伤严重程度的疗效影响。结果3组患者的用药前后浅感觉和运动功能的恢复评分各进行q检验,浅感觉和运动功能的恢复疗效均存在着显著性的差异（P〈0．05）,具有统计学意义。3组患者用药前后的小便功能分级结果进行X。检验,小便功能恢复疗效有显著性差异（P〈0．05）,具有统计学意义。结论GM-1对脊髓损伤患者的神经功能的恢复有促进作用,同时具有浓度依赖效应。大剂量的GM．1对脊髓损伤后的神经功能的恢复促进作用更加明显,尤其是在损伤的急性期。     

持续性压迫对损伤脊髓组织学变化的影响

目的观察急性脊髓损伤后所存在的压迫物对损伤脊髓的血流量及病理变化的影响。方法对急性脊髓损伤伴压迫组动物和非压迫组动物伤部脊髓行血流量测定及光镜、电镜观察。结果（１）压迫对急性损伤脊髓血流量下降幅度影响不大，却影响了伤部脊髓血流量恢复。（２）长时间的压迫使伤部脊髓病理改变呈进行性加重。结论脊髓损伤后持续性压迫使损伤脊髓血流量恢复减慢，病理损害加重。     

大鼠坐骨神经损伤急性期缓激肽在相应脊髓前角的变化规律

应用免疫细胞化学方法,结合图像分析仪,研究了缓激肽在脊髓腰骶段及L_(4～6)背根节的分布,以及坐骨神经切断后,它在相应前角运动神经元的相对含量的变化规律。结果:缓激肽分布于L_(4～6)背根节及腰骶髓灰质的第Ⅱ、Ⅲ、Ⅳ、Ⅸ层神经元及脊髓白质的神经胶质细胞和神经纤维。在神经损伤的研究中,相应脊髓前角运动神经元的缓激肽含量,损伤后第15h是减少的,以后逐渐增多,至第72h仍维持在高位水平。     

颈脊髓过伸伤患者退变性因素的分布节段及原因分析

目的研究过伸性颈椎损伤退变程度的相关因素。方法对45例急性过伸性颈椎损伤患者进行回顾分析。所有患者根据影像学和临床查体情况后行改良Frankel分级。根据神经损伤平面结合颈髓髓内高信号征象判定脊髓损伤节段,凡神经平面下整个节段或节段内大部分呈高信号改变者是主要受损脊髓节段,节段内呈现斑片状高信号改变者为一般受损脊髓节段。设计头面部受创、高速运动受创或头面部挫裂较重为重伤力,创伤较轻者为轻伤力。据MRI T2加权椎间盘信号强度判定颈椎间盘退变程度,并进行退变最严重椎间盘分级代表整体颈椎退变分级,轻重程度由0~4级分析外伤力、颈椎退变与受损脊髓节段的关系。结果轻伤者12例,重伤者33例,轻伤组较重伤组脊髓损伤轻、年龄大,组间比较差异具有统计学意义（P〈0.05）。主要受损节段38例共45节,其中C4、5最多;一般受损脊髓节段21例39节。所有患者的颈椎均有明显退变,其中22例发生3级退变,退变严重节段为C5、6。椎间盘处发生退变的受损脊髓节段数为0级无,1级9节,2级20节,3级14节,4级2节。结论外力大小、颈椎节段性退变在颈脊髓过伸性损伤中具有重要作用。     

多种神经组织修复成鼠脊髓损伤的实验研究

目的 探讨 不同神经组织移植修复成鼠急性脊髓损伤（SCI）的能力。方法 成鼠脊髓损伤后，分别移植游离正中神经（EPN组）、带血管蒂正中神经（VPN组）、孕、14天胚胎脊髓（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周行神经解剖及电生理检查。结果 V＋F组再生轴突和存活雪旺氏细胞数目、胚胎脊髓体积增长速度和神经元密度显著高于对照组（P＜0．01），细胞分化较好，突触较成熟。体感诱发电位（SEP）的P1、N1波潜伏期显著缩短（P＜0．01）。结论 带血管蒂周围神经与胚胎脊髓联合移植，在解剖和电生理上均优于其他组织，对FSC的生长发育和损伤神经元的再生能力均有一定的促进作用。     

内源性NSPCs与脊髓损伤治疗的研究进展

脊髓损伤治疗是当今研究的热点和难点。目前脊髓损伤治疗主要包括移植外源性神经干/祖细胞(neural stem/progenitor cells,NSPCs)和激活内源性NSPCs。移植外源性NSPCs治疗脊髓损伤面临细胞来源受限、伦理道德、移植细胞的存活等问题。内源性NSPCs治疗脊髓损伤,面临如何促使内源性NSPCs的激活、增殖、迁移、分化、转归等问题。本文就内源性NSPCs及脊髓损伤治疗的研究进展进行综述。     

Magnetisation transfer ratio measurement in the cervical spinal cord: a preliminary study in multiple sclerosis

MRI readily detects the lesions of multiple sclerosis (MS) in the brain and spinal cord. Conventional MRI sequences do not, however, permit distinction between the various pathological characteristics (oedema, demyelination, axonal loss and gliosis) of lesions in MS. Magnetisation transfer (MT) imaging may be more specific in distinguishing the pathologies responsible for disability in MS, namely demyelination and axonal loss, and therefore may have a potential role in monitoring treatment. We have applied MT imaging to the cervical spinal cord to see if it is feasible to measure MT ratios (MTR) in this region where pathological changes may result in considerable disability. We studied 12 patients with MS and 12 age- and sex-matched normal controls using a sagittal T2-weighted fast spin-echo sequence with and without an MT pulse. The median value for cervical cord mean MTR measurement in normal controls was 19.30 % units (interquartile range 19.05–19.55), whereas values were significantly lower in MS patients (median = 17.95 % units, interquartile range 17.25–19.00, P = 0.0004). There was a low intrarater variability for repeated mean MTR measurements. We conclude that it is possible to measure MTR in the cervical spinal cord, that a significant reduction occurs in patients with MS, and that there may be a role for this measure in future MS treatment trials. Received: 11 May 1996 Accepted: 24 July 1996     

Morphology and measurements of the cervical spinal cord in computer-assisted myelography

Summary Thirty-six control subjects had computer assisted myelography (CAM) using the EMI CT 5005 scanner. The normal cervical cord is elliptical, more circular at the upper and lower ends and flatter in the mid-segments. Asymptomatic cord deformities, usually mild, were present in nine subjects (25%). Four measurements, namely, sagittal diameter (APD), transverse diameter (TD), area (a) and circumference (c) were made and two more parameters calcultted i.e. APD/TD ratio and circularity (=4 a/c²). These control values form the basis of qualitative and quantitative assessment of cord deformity. When cord measurements are to be used, control values should be obtained for each scanner and procedures should be standardized     

胚胎脊髓不同移植方法促进成鼠损伤脊髓功能恢复的研究

目的研究提供血运的胚胎脊髓移植对成鼠损伤脊髓功能恢复的作用。方法将胚胎脊髓组织、胚胎十大网膜组织、胚胎＋椎旁肌组织移植到成鼠半切洞损伤的脊髓中,手术后进行联合行为评分,感觉诱发电位,运动诱发电位检查。结果联合行为评分,单纯移植组和胚胎＋大网膜组织优于单纯损伤组,感觉诱发电位,运动诱发电位潜峰时的恢复,移植各组均优于单损伤组。胚胎＋大网膜组效果最好,单纯胚胎脊髓移植组优于胚胎＋椎旁肌移植组。结论通过各种功能检查表明提供血运的胚胎脊髓移植对成鼠损伤脊髓功能恢复有较好的促进作用。     

创伤早期免疫炎性反应与脊髓继发性损伤

脊髓损伤（Spinal cord injury,SCI)是致残的主要原因，治疗措施非常有限，近来研究表明免疫炎性反应在脊髓损伤早期异常活跃，并在继发性脊髓损伤中扮演着重要的角色，调节免疫炎性反应可能是脊髓损伤早期救治的一条新途径。     

脊髓损伤后胶质瘢痕形成中补体的作用

由于外伤性脊髓损伤(SCI)发生率不断增高,后果严重,其致残率与耗费高,常遗留瘫痪等后遗症,给家庭及社会造成严重的负担,因此,加强SCI再生修复研究具有重要的现实意义.大量证据表明,胶质瘢痕是中枢神经再生修复的主要障碍之一,补体与胶质瘢痕的形成关系密切.本文就SCI后补体在胶质瘢痕形成中的作用作一综述.     

脊髓损伤后胃肠功能障碍的机制

脊髓损伤(SCI)后的患者常出现肠梗阻、便秘、大便失禁、腹胀等胃肠功能障碍的症状,严重影响患者的生活质量。但是相比而言,人们大多数关注患者的运动功能,对于脊髓损伤后胃肠功能障碍的发生机制研究报道并不多见,笔者就目前国内外有关脊髓损伤急性期后胃肠功能障碍发生机制的研究进展作一综述。