磷酸钙骨水泥填充椎体成形过程中椎体生物力学评价**★

背景：目前椎体成形中常用的充填剂聚甲基丙烯酸甲酯因其过高的强度会引起临近节段骨折，新型材料磷酸钙骨水泥具有骨传导性，但其在体内的生物力学情况尚不明确。 目的：模拟骨质疏松性骨折椎体的力学环境，观察磷酸钙骨水泥填充后椎体的力学变化情况，评价其在椎体成形中的适用性。 设计、时间及地点：随机对照，动物体内生物力学实验, 于2007-02/12在苏州大学实验动物中心完成。 材料：成年雌性山羊12只，双侧去卵巢法制备骨量减少动物模型。 方法：以直径4.0 mm钻头横向钻通模型山羊L2~5腰椎椎体双侧皮质，两两随机向骨缺损内注入磷酸钙骨水泥或聚甲基丙烯酸甲酯，以L1和L6椎体为对照组。 主要观察指标：生物力学测试仪测试术后2，6，12，24周各组椎体的强度和刚度。 结果：磷酸钙骨水泥组椎体强度从2周起逐渐增强，在24周时最强，各时间点与对照组相当，但均低于聚甲基丙烯酸甲酯组。磷酸钙骨水泥组椎体刚度从2周开始下降，12周达到最低，24周时上升，但各时间点间无统计学差异（P = 0.265）；聚甲基丙烯酸甲酯组刚度2~24周也无明显降低（P =0.815）；各时间点2组间比较无明显差异（P > 0.05），但都低于对照组。 结论：磷酸钙骨水泥填充后椎体具有更合适的生物力学强度，有望替代聚甲基丙烯酸甲酯在椎体成形中应用。     

脊髓硬脊膜外血肿

脊髓硬脊膜外血肿(SEH)临床较少见。主要因创伤、硬脊膜外血管疾病、抗凝治疗及原因不明的脊膜外出血所致。临床呈急性、亚急性、慢性经过。首发症状常为出血部位的疼痛及相应神经根区域疼痛,后继出现运动、感觉及小便障碍。椎管造影、脊椎CT和MRI可确定诊断。及时诊断和手术清除血肿是本病治疗的关键。本文就其病因、发病机理、诊断及治疗作一综述。     

骨质疏松性椎体压缩骨折患者经皮椎体成形注入黏丝期骨水泥后的再骨折

背景：目前经皮椎体成形术已成为治疗骨质疏松性椎体压缩骨折的首选方法,但其骨水泥注入后邻近椎体骨折并发症也在逐年增加,椎体成形过程中常采用黏丝期骨水泥注射,而骨水泥注射时状态可影响其在椎体内分布。 目的：回顾性分析骨质疏松性椎体压缩骨折经皮椎体成形注入黏丝期骨水泥后再骨折的原因。 方法：2006-07/2009-11对112例骨质疏松性椎体压缩骨折行经皮椎体成形术,术中DSA机透视引导下经单侧或双侧椎弓根入路,调配聚甲基丙烯酸甲酯骨水泥至黏丝期后经工作通道注入,并观察疗效。 结果与结论：每个椎体注入骨水泥2.4~6.0 mL,平均(3.40±1.02) mL。术中骨水泥渗漏至椎旁14例,椎间隙内15例。患者术后全部得到随访,随访时间6~15个月,平均(9.61±2.82)个月,未发现特殊的材料和宿主反应,29例患者疼痛再发,其中15例经MRI证实手术相邻椎体发生新鲜骨折,再次给予经皮椎体成形手术后疼痛症状缓解。结果提示经皮椎体成形注入黏丝期的骨水泥后应力集中、术中灌注剂渗漏椎间隙等综合因素增加了术后相邻椎体再次发生骨折的危险,寻找理想的骨水泥替代物将成为今后临床研究的方向。 关键词：骨水泥;骨质疏松性椎体压缩骨折;骨质疏松;经皮椎体成形术;生物材料 doi:10.3969/j.issn.1673-8225.2010.25.024     

自发性脊髓硬脊膜外血肿

自发性脊髓硬脊膜外血肿指原因不明的脊髓硬脊膜外腔出血Piotrowski收集文献中124例脊髓硬脊膜外血肿,其中47例属自发性。自从1869年Jakson首次报告以来陆续有报道,截止1969年100年间文献中共50例,1978年达60例左右。本病虽然发病率不高,但临床病象凶险,进展迅速,如不及时确诊并手术减压可导危及生命。为提高对本病认识,本文就其病因、临床表现、治疗和预后等作一综述。     

经皮椎体成形过程中骨水泥注入及其并发症

经皮椎体成形以其创伤小、操作方式简单、疗效快且确切、安全性高、适应证广等优点,很快受到广泛关注和接受,尤其是在治疗椎体压缩性骨折方面取得了明显的疗效。聚甲基丙烯酸甲酯是目前最常用的填充物;单侧注射和双侧注射疗效没有明显差别;应用对比剂及掌握合适的骨水泥黏稠度可以减少骨水泥的渗漏率;成形前腰部垫枕自身复位可以恢复椎体的高度,避免采用操作复杂及价格昂贵的球囊后凸成形及骨膨胀椎体后凸成形;进行经皮椎体成形时应该配合应用抗骨质疏松药物,以减少椎体再骨折的发生。     

多椎体病变一次性经皮穿刺注入骨水泥椎体成形31例

背景：老年性骨质疏松、骨髓瘤和转移性肿瘤时往往发生多个椎体的病变和压缩,但文献对多发性椎体病变的成型治疗报道较少。 目的：探讨多椎体胸腰椎病变一次性经皮穿刺注入骨水泥椎体成形的治疗效果和相关材料与宿主反应的注意事项。 设计、时间及地点：观察性试验,病例来自2004-11/2008-10十堰市太和医院脊柱外科、康复科和肿瘤科等。 对象：选择十堰市太和医院脊柱外科、康复科、肿瘤科等收治的老年性骨质疏松合并压缩性骨折、多发性骨髓瘤和溶骨性转移性肿瘤患者31例,男14例,女17例;年龄56~82岁。 方法：对31例2个以上椎体异常的患者进行一次性经皮穿刺椎体成形术。局麻下先后采用椎弓根入路穿刺病变椎体,在严密监测下依次向各病变椎体内加压注射骨水泥,术后观察椎体内骨水泥注入情况和患者的反应,术后1周评价治疗效果。 主要观察指标：一次性椎体成形的数目,椎体穿刺成功率,骨水泥注射量、椎体内骨水泥分布情况,骨水泥向椎旁软组织和静脉泄漏情况,疼痛缓解及有无并发症发生。 结果：共进行33次75个椎体的成型治疗,最少1次2个椎体,最多1次5个椎体,平均1次进行2.27个椎体成型;各椎体内骨水泥注射剂量4~12 mL,平均7.5 mL,椎体内骨水泥均匀充填49个,部分充填椎体者26个;注入骨水泥中未发生明显并发症,所有患者术后局部疼痛缓解,其中明显缓解或消失者20例,部分缓解者11例。 结论：经皮穿刺注入骨水泥椎体成形是治疗椎体病变有效而安全的方法,多椎体一次性成形治疗要求合理的骨水泥注射方法和剂量以及严密的治疗过程中的监测。     

聚甲基丙烯酸甲酯骨水泥结合椎体成形重建非感染性缺血坏死的椎体

摘要 背景：非感染性椎体缺血性坏死是一种较少见的椎体缺血坏死,表现为椎体压缩骨折,国内的报道较少。可能与该病的发病率低对该病认识不足有关。 目的：分析非感染性椎体缺血坏死的特点,观察经皮椎体成形术治疗该病的效果。 方法：回顾分析近5年来经皮椎体成形注入聚甲基丙烯酸甲酯骨水泥治疗12例非感染性椎体缺血坏死的疗效。经皮椎体成形手术均在透视监测下经椎弓根注入聚甲基丙烯酸甲酯骨水泥。采用目测类比评分法评估治疗前后疼痛状况,通过侧位片测量经皮椎体成形术前后椎体前缘和中央的高度。 结果与结论：采用经皮椎体成形术治疗12个非感染性椎体缺血坏死,骨水泥注入量平均为(6.0±1.5) mL,术后疼痛完全或显著缓解10例(83%),部分缓解2例(17%)。目测类比评分法评分从术前的9.08±0.76降为后2.33±1.43和术后6个月1.08±0.95 (P < 0.01)。经皮椎体成形3 d后椎体高度恢复平均为前缘2.2 mm,中央3.2 mm。结果提示,经皮椎体成形注入聚甲基丙烯酸甲酯骨水泥是一种治疗非感染性椎体缺血坏死的有效方法,具有良好的止痛效果,并能部分恢复椎体高度。     

球囊扩张椎体后注入丙烯酸树脂骨水泥重建脊柱稳定性

目的：评估丙烯酸树脂骨水泥经皮球囊后凸椎体成形治疗脊柱转移瘤重建脊柱稳定性的特点。 方法：选择2006-10/2008-01暨南大学医学院附属第二医院深圳市人民医院脊柱外科33例椎体转移瘤患者行球囊后凸椎体成形术治疗。所有病椎伴有不同程度骨质破坏并压缩骨折，经皮球囊后凸椎体成形在C臂X射线机的监视下完成，行双侧椎弓根穿刺，分别置入球囊，扩张椎体后注射丙烯酸树脂骨水泥，胸椎注射骨水泥平均量3.6 mL、腰椎4.8 mL。随访6个月，评估材料与宿主生物相容性、病椎高度的变化及手术前后疼痛程度及活动能力。 结果: 33例49个椎体中有43个椎体经皮球囊后凸椎体成形均一次成功。5例因肿瘤全身转移死亡。43个锥体进入结果分析。①病椎高度比较：手术前后椎体前缘[（2.2±0.6）cm，(2.6±0.6) cm]和后缘高度[(2.6±0.6) cm, (2.9±0.7) cm]，经配对t检验，差异均有显著性意义(P < 0.05)，术后椎体高度较术前增高。②术前目测类比评分为(8.1±0.5) 分，术后24 h、1周和6个月分别为(2.1±1.4) 分、(1.3±1.6) 分和(0.9±1.5) 分， 4个时间点比较差异有显著性意义（P﹤0.01）；术前活动能力评分为(3.4±0.5) 分，术后24 h、1周和6个月分别为(1.6±0.8) 分、(1.3±0.6) 分和(1.3±0.6) 分，4个时间点比较差异有显著性意义（P < 0.01）。经重复测量设计的方差分析，时间效应有统计学意义，呈线性趋势。③术前3例有神经根受损症状者术后缓解不明显；术中1例发生骨水泥椎管内渗漏及时改为开放手术，未发生神经受损症状；2例发生椎旁静脉内渗漏，未出现临床症状。除死亡者其余椎体未进一步压缩。 结论：丙烯酸树脂骨水泥能有效增高压缩椎体高度，改善后凸畸形，增强病椎强度和稳定性，与宿主生物相容性好，经皮球囊后凸椎体成形微创手术能迅速缓解椎体转移瘤引起的疼痛。     

脊髓动静脉畸形、硬脊膜动静脉瘘、硬脊膜外动静脉瘘与脊髓周围动静脉瘘的鉴别

正脊髓血管病比较少见,但是脊髓动静脉畸形(spinal cord arteriovenous marformation,SAVM)、硬脊膜动静脉瘘(spinal dural arteriovenous fistula,SDAVF)、硬脊膜外动静脉瘘(spinal epidural arteriovenous fistula,SEDAVF)、脊髓周围动静脉瘘(spinal perimedullary arteriovenous fistula,SPAVF)四种类型,诊断容易混淆,也容易误诊。这四种脊髓血     

102例经皮椎体成形术22例骨水泥渗漏原因分析及防治

老年人骨质疏松所致的椎体压缩性骨折（VCF）可致伤椎椎体塌陷,脊柱稳定性下降,疼痛和神经功能丧失。传统的治疗方法采用长期卧床休养等治疗,患者生活质量严重下降,且易出现坠积性肺炎、下肢深静脉血栓,褥疮等并发症,尤其对高龄,基础疾病较多者;有的学者尝试使用开放手术,然而对于老年VCF患者特别是高龄患者,骨质对内固定物的把持力不够,容易出现内固定在椎体内的切割,松动现象,导致内固定物松动,拔出致治疗失败。1984年首次应用经皮椎体成形术治疗椎体血管瘤,1997年开始采用经皮椎体成形术(Percutancousvertebroplasty,PVP)成功治疗老年VCF。该方法为微创性手术,早期止痛效果好,术后患者可早期下地活动,避免了患者长期卧床引起的各种并发症,目前在国内外得到了广泛的应用,但不可忽视的是PVP术由于骨水泥自身具有一定流动性性状所致的渗漏比例较高,大量临床资料显示这种渗漏多不至造成严重神经血管症状,如致死性大出血,不可逆性脊髓,外周神经损伤,但由于骨水泥在凝固过程中于局部释放大量热量,最高可达80C°-90C°,且渗漏后的固体骨水泥块位移及定位位置具有一定随机性,不可控性,如占位于关键点部位,如椎管内,神经根孔等处,仍有一定机率出现严重,不可逆性后果,如截瘫等,如何在临床工作中尽量减少骨水泥渗漏机率,减轻骨水泥渗漏后造成的影响,有必要从PVP术手术适应症,具体操作细节等方面做深入探讨。目的：探讨经皮椎体成形术(Percutaneous vertebroplasty,PVP)骨水泥渗漏的防治措施。方法：经皮椎体成形术治疗VCF102例131个椎体,方法再完善一些患者俯卧位或侧卧位,在X线机透视下定位伤椎,选定穿刺点,经单侧椎弓根至椎体前中1／3处,透视下注入并观察骨水泥PMMA填充、弥散情况,至填充、弥散满意后3～5 min,拔出穿刺针,24 h后鼓励患者下地活动。观察术后疼痛缓解情况及术后1月一般健康状况,手术疗效及骨水泥渗漏情况,。。结果与结论：所有患者术后疼痛即明显缓解,术前术后VAS疼痛评分分别为(8.78±0.58)分、(1.13±0.34)分,术前术后VAS分值具有明显差异(P<0.05),术后半年和术后一年VAS疼痛评分分别为(1.12±0.32)分、(1.55±0.50)分,VAS分值差异无统计学意义(P>0.05)。术前术后SF-36生活质量积分比较(mean±SD),PVP术后患者疼痛改善状况,总体健康,活力完成社会职能方面与术前比较有差异有统计学意义,术后优于术前。骨水泥渗漏22例：渗漏至椎管1例,改行开放手术后患者恢复良好;渗漏至神经根管3例,经保守治疗后缓解;渗漏至椎间隙内10例,椎旁8例,无明显临床症状。聚甲基丙烯酸骨水泥（PMMA）与成人骨成分一致,组织相容性好,即使长期留置体内也不会有排斥反应,PVP治疗VCF效果良好,但是骨水泥渗漏发生率较高,需严格掌握手术适应证,减少骨水泥渗漏的发生。     

Neuroprotective Effects of Sacral Epidural Neuromodulation Following Spinal Cord Injury : An Experimental Study in Rats

Objective

The purpose of this study is to evaluate neuroprotective effect of sacral neuromodulation in rat spinal cord injury (SCI) model in the histological and functional aspects.

Methods

Twenty-one female Sprague Dawley rats were randomly divided into 3 groups : the normal control group (CTL, n=7), the SCI with sham stimulation group (SCI, n=7), and the SCI with electrical stimulation (SCI+ES, n=7). Spinal cord was injured by dropping an impactor from 25 mm height. Sacral nerve electrical stimulation was performed by the following protocol : pulse duration, 0.1 ms; frequency, 20 Hz; stimulation time, 30 minutes; and stimulation duration, 4 weeks. Both locomotor function and histological examination were evaluated as scheduled.

Results

The number of anterior horn cell was 12.3±5.7 cells/high power field (HPF) in the CTL group, 7.8±4.9 cells/HPF in the SCI group, and 6.9±5.5 cells/HPF in the SCI+ES group, respectively. Both the SCI and the SCI+ES groups showed severe loss of anterior horn cells and myelin fibers compared with the CTL group. Cavitation and demyelinization of the nerve fibers has no significant difference between the SCI group and the SCI+ES group. Cavitation of dorsal column was more evident in only two rats of SCI group than the SCI+ES group. The locomotor function of all rats improved over time but there was no significant difference at any point in time between the SCI and the SCI+ES group.

Conclusion

In a rat thoracic spinal cord contusion model, we observed that sacral neuromodulation did not prevent SCI-induced myelin loss and apoptosis.     

Safety and Efficacy of Bone Cement (Spinofill®) for Vertebroplasty in Patients with Osteoporotic Compression Fracture : A Preliminary Prospective Study

ObjectiveAlthough several commercialized bone cements are used during percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fracture (OVCF), there are no reports using domestic products from South Korea. In this study, we investigated the safety and efficacy of Spinofill^® (Injecta Inc., Gunpo, Korea), a new polymethyl methacrylate product. MethodsA prospective, single-center, and single-arm clinical trial of 30 participants who underwent PVP using Spinofill^® for painful thoracolumbar OVCF was performed with 6-months follow-up. Clinical and surgical outcomes included the Visual analog scale (VAS), Korean-Oswestry disability index (K-ODI), and Odom’s criteria, complication rate, and recurrence rate. Radiological outcomes were evaluated by measuring the findings of postoperative computed tomography and simple radiograph. ResultsThe pain of VAS (from 8.95±1.05 to 4.65±2.06, p<0.001) and the life quality based on K-ODI (from 33.95±5.84 to 25.65±4.79, p<0.001) improved significantly, and successful patient satisfaction were achieved in 20 patients (66.7%) 1 day after surgery. These immediate improvements were maintained or more improved during the follow-up. There was no surgery- or product-related complications, but OVCF recurred in two patients (6.7%). Favorable cement interdigitation was reported in 24 patients (80.0%), and extra-vertebral cement leakage was reported in 13 patients (43.0%). The mean vertebral height ratio (from 60.49%±21.97% to 80.07%±13.16%, p<0.001) and segmental kyphotic angle (from 11.46°±8.50° to 7.79°±6.08°, p=0.002) improved one day after surgery. However, these short-term radiological findings somewhat regressed at the end. ConclusionThe overall outcomes of PVP using Spinofill^® were as favorable as those of other conventionally used products.     

Neuroprotective Effect of Anthocyanin on Experimental Traumatic Spinal Cord Injury

Objective

We investigated the neuroprotective effect of anthocyanin, oxygen radical scavenger extracted from raspberries, after traumatic spinal cord injury (SCI) in rats.

Methods

The animals were divided into two groups : the vehicle-treated group (control group, n=20) received an oral administration of normal saline via stomach intubation immediately after SCI, and the anthocyanin-treated group (AT group, n=20) received 400 mg/kg of cyanidin 3-O-β-glucoside (C3G) in the same way. We compared the neurological functions, superoxide expressions and lesion volumes in two groups.

Results

At 14 days after SCI, the AT group showed significant improvement of the BBB score by 16.7±3.4%, platform hang by 40.0±9.1% and hind foot bar grab by 30.8±8.4% (p<0.05 in all outcomes). The degree of superoxide expression, represented by the ratio of red fluorescence intensity, was significantly lower in the AT group (0.98±0.38) than the control group (1.34±0.24) (p<0.05). The lesion volume in lesion periphery was 32.1±2.4 µL in the control and 24.5±2.3 µL in the AT group, respectively (p<0.05), and the motor neuron cell number of the anterior horn in lesion periphery was 8.3±5.1 cells/HPF in the control and 13.4±6.3 cells/HPF in the AT group, respectively (p<0.05).

Conclusion

Anthocyanin seemed to reduce lesion volume and neuronal loss by its antioxidant effect and these resulted in improved functional recovery.     

Effects of Tumor Necrosis Factor Alpha Blocker Adalimumab in Experimental Spinal Cord Injury

Objective

Tumor necrosis factor alpha (TNF-α) have proven effects in pathogenesis of neuroinflammation after spinal cord injury (SCI). Current study is designed to evaluate the effects of an anti-TNF-α agent, adalimumab, on spinal cord clip compression injury in rats.

Methods

Thirty two male adult Wistar rats were divided into four groups (sham, trauma, infliximab, and adalimumab groups) and SCI was introduced using an aneurysm clip. Animals in treatment groups received 5 mg/kg subcutaneous adalimumab and infliximab right after the trauma. Malondialdehyde (MDA) levels were studied in traumatized spinal cord tissues 72 hours after the injury as a marker of lipid peroxidation.

Results

Animals that received anti-TNF-α agents are found to have significantly decreased MDA levels. MDA levels were significantly different between the trauma and infliximab groups (p<0.01) and trauma and adalimumab groups (p=0.022). There was no significant difference in neurological evaluation of the rats using Tarlov scale.

Conclusion

These results suggest that, like infliximab, adalimumab has favorable effects on lipid peroxidation induced by spinal cord trauma in rats.     

Bone Cement Dislodgement: One of Complications Following Bone Cement Augmentation Procedures for Osteoporotic Spinal Fracture

Bone cement augmentation procedures have been getting more position as a minimally invasive surgical option for osteoporotic spinal fractures. However, complications related to these procedures have been increasingly reported. We describe a case of bone cement dislodgement following cement augmentation procedure for osteoporotic spinal fracture by reviewing the patient''s medical records, imaging results and related literatures. A 73-year-old woman suffering back and buttock pain following a fall from level ground was diagnosed as an osteoporotic fracture of the 11th thoracic spine. Percutaneous kyphoplasty was performed for this lesion. Six weeks later, the patient complained of a recurrence of back and buttock pain. Radiologic images revealed superior dislodgement of bone cement through the 11th thoracic superior endplate with destruction of the lower part of the 10th thoracic spine. Staged anterior and posterior fusion was performed. Two years postoperatively, the patient carries on with her daily living without any significant disability. Delayed bone cement dislodgement can occur as one of complications following bone cement augmentation procedure for osteoporotic spinal fracture. It might be related to the presence of intravertebral cleft, lack of interdigitation of bone cement with the surrounding trabeculae, and possible damage of endplate during ballooning procedure.     

犬实验性脊髓损伤后病理学改变与MRI对比研究

目的研究脊髓损伤(SCI)后MRI特点与病理改变的时间关系。方法采用Allen法制成犬SCI模型,分别在损伤后1d、1周、2周、4周、16周观察MRI与病理改变,并测定其行为学与后肢诱发电位变化。结果SCI后1d,动物双后肢肌力均为0级,记录不到明显的诱发电位。此后动物双下肢肌力逐渐恢复;伤后1周诱发电位开始出现,但潜伏期明显延长,随后潜伏期逐渐缩短;SCI后4周,行为学与诱发电位测定恢复均进入平台期,脊髓中央出现空腔,MRI能准确反映SCI后脊髓中央囊腔的形状与位置,T2WI表现边界清楚的高信号影。结论SCI后4周作为慢性SCI的时间定位界限,MRI检查结果尤其是T2WI能够准确反映囊腔的形态,为治疗慢性SCI处理囊腔的定位与范围判断提供实验依据。     

The Neuroprotective Effect of Kefir on Spinal Cord Ischemia/Reperfusion Injury in Rats

Objective

The main causes of spinal cord ischemia are a variety of vascular pathologies causing acute arterial occlusions. We investigated neuroprotective effects of kefir on spinal cord ischemia injury in rats.

Methods

Rats were divided into three groups : 1) sham operated control rats; 2) spinal cord ischemia group fed on a standard diet without kefir pretreatment; and 3) spinal cord ischemia group fed on a standard diet plus kefir. Spinal cord ischemia was performed by the infrarenal aorta cross-clamping model. The spinal cord was removed after the procedure. The biochemical and histopathological changes were observed within the samples. Functional assessment was performed for neurological deficit scores.

Results

The kefir group was compared with the ischemia group, a significant decrease in malondialdehyde levels was observed (p<0.05). Catalase and superoxide dismutase levels of the kefir group were significantly higher than ischemia group (p<0.05). In histopathological samples, the kefir group is compared with ischemia group, there was a significant decrease in numbers of dead and degenerated neurons (p<0.05). In immunohistochemical staining, hipoxia-inducible factor-1α and caspase 3 immunopositive neurons were significantly decreased in kefir group compared with ischemia group (p<0.05). The neurological deficit scores of kefir group were significantly higher than ischemia group at 24 h (p<0.05).

Conclusion

Our study revealed that kefir pretreatment in spinal cord ischemia/reperfusion reduced oxidative stress and neuronal degeneration as a neuroprotective agent. Ultrastructural studies are required in order for kefir to be developed as a promising therapeutic agent to be utilized for human spinal cord ischemia in the future.     

Outcome Evaluation with Signal Activation of Functional MRI in Spinal Cord Injury

Objective

The authors investigated the changes of cortical sensorimotor activity in functional MRI (fMRI) and functional recovery in spinal cord injury (SCI) patients who had been treated by bone marrow cell transplantation.

Methods

Nineteen patients with SCI were included in this study; ten patients with clinical improvement and nine without. The cortical sensorimotor activations were studied using the proprioceptive stimulation during the fMRI.

Results

Diagnostic accuracy of fMRI with neurological improvement was 70.0% and 44.4% for sensitivity and specificity, respectively. Signal activation in the ipsilateral motor cortex in fMRI was commonly observed in the clinically neurological improved group (p-value=0.002). Signal activation in the contralateral temporal lobe and basal ganglia was more commonly found in the neurological unimproved group (p-value<0.001). Signal activation in other locations was not statistically different.

Conclusion

In patients with SCI, activation patterns of fMRI between patients with neurologic recovery and those without varied. Such plasticity should be considered in evaluating SCI interventions based on behavioral and neurological measurements.     

The Effect of Minocycline on Motor Neuron Recovery and Neuropathic Pain in a Rat Model of Spinal Cord Injury

Objective

Minocycline, a second-generation tetracycline-class antibiotic, has been well established to exert a neuroprotective effect in animal models and neurodegenerative disease through the inhibition of microglia. Here, we investigated the effects of minocycline on motor recovery and neuropathic pain in a rat model of spinal cord injury.

Methods

To simulate spinal cord injury, the rats'' spinal cords were hemisected at the 10th thoracic level (T10). Minocycline was injected intraperitoneally, and was administered 30 minutes prior surgery and every second postoperative day until sacrifice 28 days after surgery. Motor recovery was assessed via the Basso-Beattie-Bresnahan test. Mechanical hyperalgesia was measured throughout the 28-day post-operative course via the von Frey test. Microglial and astrocyte activation was assessed by immunohistochemical staining for ionized calcium binding adaptor molecule 1 (Iba1) and glial fibrillary acidic protein (GFAP) at two sites: at the level of hemisection and at the 5th lumbar level (L5).

Results

In rats, spinal cord hemisection reduced locomotor function and induced a mechanical hyperalgesia of the ipsilateral hind limb. The expression of Iba1 and GFAP was also increased in the dorsal and ventral horns of the spinal cord at the site of hemisection and at the L5 level. Intraperitoneal injection of minocycline facilitated overall motor recovery and attenuated mechanical hyperalgesia. The expression of Iba1 and GFAP in the spinal cord was also reduced in rats treated with minocycline.

Conclusion

By inhibiting microglia and astrocyte activation, minocycline may facilitate motor recovery and attenuate mechanical hyperalgesia in individuals with spinal cord injuries.     

经支气管动脉内治疗肺癌时预防脊髓损伤的研究

目的：为了总结经支气管动脉内治疗肺癌时,预防脊髓损伤的经验,方法：根据血流动力学的特点,在经支气管动脉内治疗肺癌时,将导管未端置于支气管动脉开口前一血液自然灌注小区内,间断地推注药物,从而避免了药液返流。结果：全组302例肺癌患中26例采用将导管插进支气管动脉中的常规方法治疗,术后4例发生脊髓损伤,发生率为1．3％,其中3例高位截瘫,1例右下肢单瘫,而采用根据血流动力学特点改进的方法治疗的276例病人,术后无1例发生脊髓损伤,结论：根据血流动力学特点改进的血管内治疗肺癌的方法,从根本上改变和替代了常规将导管直接插进支气管动脉内的方法,临床实践证明,该方法是一个全新的可避免脊髓损伤的有效方法。