脊髓损伤后痉挛性膀胱的治疗与康复护理进展

脊髓损伤（SCI）后,膀胱或括约肌失去神经支配而产生排尿功能障碍,以至发生尿潴留,尿路感染等,病情严重者可导致死亡,因此做好患者膀胱功能的康复与护理,减低并发症,提高其生存质量成为治疗中极为重要的环节。本文就Th12以上SCI后痉挛性膀胱的治疗与康复护理的研究综述如下。     

大鼠脊髓损伤后植入人发角蛋白的实验研究

目的：研究人发角蛋白（HHK）在脊髓损伤（SCI）修复中诱导和促进神经元和神经纤维的再生以及HHK在脊髓中的降解机理。方法：选用12只成年雌性SD大鼠,采用改制的II型NYU装置,建立SCI组,SCI后植入HHK组,并设正常对照组,分别于术后14d取材,经HE,Mallory's－磷钨酸－苏木素,Loyer'sSterry Thionin等方法染色,观察其光镜结构的变化。结果：与损伤组相比较,植入HHK组损伤节段的萎缩程度明显,然质中部分神经元残存,有髓神经纤维脱髓鞘现象减轻,HHK周边集聚大量巨噬细胞和胶质细胞,植入的HHK毛小皮膨胀松弛,出现与皮质层分离,皮质层内出现皲裂,中央髓质腔增大,结论：植入HHK具有减轻脊髓损伤后的继发性损伤的作用,为进一步研究HHK在SCI修复过程中的作用及机理提供了形态学基础。     

胸椎管狭窄症椎板切除术后硬膜外血肿并发脊髓损伤的术后护理

目的 探讨胸椎管狭窄症（thoracic spinal stenosis,TSS）椎板切除脊髓减压术术后硬膜外血肿（postoperative spinal epidural hematoma,PSEH）并发脊髓损伤（spinal cord injury,SCI）的术后护理关键措施及其临床意义.方法 对4例胸椎管狭窄症椎板切除术PSEH形成并发SCI的临床诊疗和护理过程进行回顾性分析.结合相关文献,总结其术后护理经验和教训.结果 （1）脊髓功能恢复：PSEH并发SCI的脊髓功能评价,国际脊髓损伤评分标准（ASIA）分级由B级恢复至C级和D级各1例,恢复至E级2例;（2）并发症：均出现严重的贫血、低蛋白血症、电解质紊乱,未出现休克、感染、褥疮等;（3）1例第二次出现PSEH形成并发SCI;（4）心理变化：均出现不同程度的焦虑、恐惧和绝望心理,恢复良好.结论 正确的术后护理在胸椎管狭窄症椎板切除术硬膜外血肿形成并发脊髓损伤术后顺利康复和并发症防治中具有非常重要的作用,其术后护理要点包括采取合理的体位、保持引流管通畅、密切观察生命体征和脊髓功能的变化及加强心理护理.     

嗅鞘细胞移植治疗脊髓损伤的研究现状

脊髓损伤（spinal cord injury,SCI）是一种严重威胁人类健康的疾病,由于损伤后可导致损伤平面以下的感觉、运动及植物神经功能障碍,给患者、家庭和社会带来沉重的负担。目前对脊髓损伤的实验研究主要集中在改善SCI的生长环境、组织移植、细胞移植等。     

重复经颅磁刺激治疗脊髓损伤的临床疗效

目的：观察重复经颅磁刺激（rTMS）治疗对脊髓损伤（SCI）的临床疗效。方法：对26例SCI患者进行rTMS治疗,并与20例健康志愿者对照分析,观察治疗前后运动诱发电位（MEP）波幅及潜伏期的变化。结果：26例SCI患者治疗前MEP潜伏期延迟,波幅降低,治疗后均有明显变化,表现为MEP潜伏期明显缩短,波幅明显增高,治疗前后比较,差异有统计学意义。结论：rTMS治疗SCI具有一定疗效。     

脑电在脑卒中运动功能评估中的应用研究进展

脑电（EEG）作为一种非侵入式、低成本检测大脑皮层神经电位手段，能够反映大脑的神经功能活动，目前被广泛应用于脑卒中患者运动功能评估的研究中。通过EEG研究脑卒中患者的运动功能状态及其神经机制，有助于理解脑卒中的神经及康复机制，实现患者损伤严重程度和康复效果的个体化预测。本文首先概述了EEG的分析流程及方法，从皮质振荡活动、定量化EEG、脑功能连接等3个方面，总结EEG在脑卒中患者运动功能评估中的应用研究进展，并从EEG技术优势、康复效果评价、临床辅助决策等3个方面进行讨论，最后对未来的发展方向进行展望。     

脊髓半横断猕猴的护理

脊髓损伤（spinal cord injury，SCI）是脊柱骨折的严重并发症。有效的动物模型是脊髓损伤修复研究的基础。以往的研究都是建立在啮齿类动物上的，而人类神经系统生理结构及修复能力与啮齿类动物有很大不同。建立猴脊髓半横断（hemi-sected SCI，hSCI）和全横断（transected SCI，tSCI）脊髓损伤模型，更深入地研究脊髓损伤修复机理，为临床提供治疗脊髓损伤提供新的策略。动物模型建立之后，正确的护理是实验成功的必要环节，常常决定了实验的成败。为提高非人灵长类动物在脊髓损伤与修复研究中的成活率，本对实践中猴脊髓半横断损伤模型有效的护理经验进行了总结。     

脊髓损伤患者的婚姻恋爱

谈及脊髓损伤（SCI）患者的婚姻恋爱，许多人认为是荒诞可笑的，理由是生活重负，脊髓中枢损伤失去性功能。本文大量资料证明，SCI患者婚恋已成为现实。提示我们，截瘫患者的婚姻恋爱是SCI患者精神、心理康复的重要内容，也是其回归社会的重要标志之一。1资料本文所用资料，SCI患者都是由于1976年7月28日唐山大地震外伤造成的截瘫。所考察的对象在震时没有婚恋关系，或虽有这种关系但配偶在震中丧生，共127例。所说的婚恋关系，是指在震后形成的（伤后5年以上），不包括早已存在的家庭困地震致一方或双方脊髓损伤而婚姻关系未解体者。…     

脐带间充质干细胞治疗脊髓损伤临床分析

目的观察脐带间充质干细胞（UC-MSCs）鞘内注射治疗脊髓损伤（SCI）的临床效果及安全性。方法对2008年1月至2010年10月收治的22例SCI患者,给予UC—MSCs鞘内注射治疗,细胞数1×10^6个／（kg·次）,1次／周,4次为1个疗程,其中4例接受2个疗程,1例接受3个疗程,余均接受1个疗程。采用美国脊髓损伤协会制定的脊髓损伤神经功能评分标准（ASIA标准）对患者治疗前后神经功能进行评定,采用国际神经修复学会脊髓损伤功能评价量表（IANR—SCIRFS）对患者治疗前后日常生活活动能力进行评定。结果22例患者中13例有效,9例无效。不完全性SCI患者有效率达81．25％,完全性SCI的6例患者均无效。有5例有效的患者接受了2～3个疗程治疗,疗效均有进一步的提高。有效患者多表现为运动和／或感觉功能改善,大小便控制能力增强。22例患者治疗后1个月与治疗前比较,痛觉、触觉、运动、日常生活活动能力评分均有明显升高（P〈0．01）。治疗后常见的不良反应有头痛（1例）、腰痛（1例）,均在1～3d内消失。随访3个月至3年,无治疗相关不良事件发生。结论UC—MSCs鞘内注射治疗是安全的,可以改善大部分不完全性SCI患者的神经功能,提高这些患者的生活质量。     

重心移动式截瘫步行矫形器对胸腰段脊髓损伤患者的疗效分析

目的　观察胸腰段完全性脊髓损伤患者应用重心移动式截瘫步行矫形器（AGO）后对步行能力、日常生活活动能力和生存质量的临床疗效。 方法　胸腰段完全性脊髓损伤患者60例,随机分为AGO组和对照组,各30例。所有患者均进行SCI常规康复训练和处理,AGO组在常规治疗的基础上,装配AGO及进行步行训练。两组分别在入院时、装配AGO前、装配AGO后8周进行步行能力评定、ADL评定和生存质量评定。 结果 经4个月的治疗前后,进行组间比较,AGO及训练后,均可借助肘拐或步行器步行,患者10 m步行时间平均87.27s,6 min步行距离平均46.35 m;ADL能力在装配后比较治疗组明显优于对照组（P<0.01）;生存质量评分中的生理和心理方面改善具有统计学意义（P<0.05）。 结论 AGO配合系统的康复治疗对改善胸腰完全性脊髓损伤患者日常生活活动能力、步行能力及生存质量有一定效果, 值得临床进一步应用。     

Facilitation of immune function, healing of pressure ulcers, and nutritional status in spinal cord injury patients

Multiple communicative pathways among nervous, endocrine, and immune systems facilitate physiological immunoregulation. Spinal cord injury (SCI) patients had strikingly decreased natural and adaptive immune responses by 2 weeks post injury. While NK-cell function was decreased, plasma ACTH and urine-free cortisol levels were increased. T cell function and activation were both diminished. With rehabilitation therapy, NK and T function increased; without rehabilitation, NK levels remained depressed. When rehabilitation ceased, NK function decreased. Cervical SCI patients had less NK and T function than thoracic injury patients. SCI patients also had reduced levels of cellular adhesion molecules (CAMs) that participate in immune function and wound healing. SCI patients with pressure ulcers were compared to those without pressure ulcers. LFA-1, VLA-4, and other surface markers were decreased on the lymphocytes of all SCI patients. SCI patients with pressure ulcers had lower CAM levels than did patients without pressure ulcers. Nutritional status was determined by zinc, albumin, and prealbumin levels. SCI patients had decreased albumin levels. Those with pressure ulcers had decreased prealbumin levels and zinc levels.     

神经肌肉电刺激对躯干稳定肌影响的研究进展

该文从神经肌肉电刺激作用于躯干稳定肌的效果与参数及对不同人群的应用效能等角度,阐述了躯干稳定肌的组成与功能,以及神经肌肉电刺激招募躯干稳定肌的作用机制与参数,并分析探讨了其临床效果。未来的临床研究可能集中在健康人群的长期随访队列研究和运动损伤人群躯干稳定肌萎缩的机制与临床研究方面,同时神经肌肉电刺激联合运动康复的研究也是发展趋势。该文预判相关便携式NMES设备的研发与应用具有较大的临床意义。     

Rigid and remodelled: cerebrovascular structure and function after experimental high‐thoracic spinal cord transection

Key Points

• Spinal cord injury (SCI) is associated with a 3–4 fold increased risk of stroke, and impaired cerebral blood flow regulation, although the effect of SCI on the structure and function of the cerebral arteries is unclear.
• Using pressure myography to assess isolated vessels distended at physiological pressures, we provide novel evidence that experimental SCI leads to inward cerebrovascular remodelling, increased stiffness and impaired reactivity of the largest cerebral artery.
• Histochemical analyses revealed that a profibrotic environment within the largest cerebral artery occurs after SCI, which was characterized by greater collagen and less elastin. This may be due to increased transforming growth factor β, a well‐known profibrotic signalling protein.
• Further analysis revealed that profibrotic alterations were not due to disruption of descending sympathetic pathways to the cerebrovasculature.
• Experimental SCI exerts a deleterious influence on the structure and function of cerebral arteries, which may underlie the increased risk of stroke and impaired cerebral blood flow regulation.

Abstract

High‐thoracic or cervical spinal cord injury (SCI) is associated with several critical clinical conditions related to impaired cerebrovascular health, including: 300–400% increased risk of stroke, cognitive decline and diminished cerebral blood flow regulation. The purpose of this study was to examine the influence of high‐thoracic (T3 spinal segment) SCI on cerebrovascular structure and function, as well as molecular markers of profibrosis. Seven weeks after complete T3 spinal cord transection (T3‐SCI, n = 15) or sham injury (Sham, n = 10), rats were sacrificed for either middle cerebral artery (MCA) structure and function assessments via ex vivo pressure myography, or immunohistochemical analyses. Myogenic tone was unchanged, but over a range of transmural pressures, inward remodelling occurred after T3‐SCI with a 40% reduction in distensibility (both P < 0.05), and a 33% reduction in vasoconstrictive reactivity to 5‐HT trending toward significance (P = 0.09). After T3‐SCI, the MCA had more collagen I (42%), collagen III (24%), transforming growth factor β (47%) and angiotensin II receptor type 2 (132%), 27% less elastin as well as concurrent increased wall thickness and reduced lumen diameter (all P < 0.05). Sympathetic innervation (tyrosine hydroxylase‐positive axon density) and endothelium‐dependent dilatation (carbachol) of the MCA were not different between groups. This study demonstrates profibrosis and hypertrophic inward remodelling within the largest cerebral artery after high‐thoracic SCI, leading to increased stiffness and possibly impaired reactivity. These deleterious adaptations would substantially undermine the capacity for regulation of cerebral blood flow and probably underlie several cerebrovascular clinical conditions in the SCI population.     

Differential skeletal muscle gene expression after upper or lower motor neuron transection

Causes of disuse atrophy include loss of upper motor neurons, which occurs in spinal cord injury (SCI) or lower motor neurons (denervation). Whereas denervation quickly results in muscle fibrillations, SCI causes delayed onset of muscle spasticity. To compare the influence of denervation or SCI on muscle atrophy and atrophy-related gene expression, male rats had transection of either the spinal cord or sciatic nerve and were sacrificed 3, 7, or 14 days later. Rates of atrophy increased gradually over the first week after denervation and then were constant. In contrast, atrophy after SCI peaked at 1 week, then declined sharply. The greater atrophy after SCI compared to denervation was preceded by high levels of ubiquitin ligase genes, MAFbx and MuRF1, which then also markedly declined. After denervation, however, expression of these genes remained elevated at lower levels throughout the 2-week time course. Interestingly, expression of the muscle growth factor, IGF-1 was increased at 3 days after denervation when fibrillation also peaks compared to SCI. Expression of IGF-1R, GADD45, myogenin, and Runx1 were also initially increased after denervation or SCI, with later declines in expression levels which correlated less well with rates of atrophy. Thus, there were significant time-dependent differences in muscle atrophy and MAFbx, MuRF1, and IGF-1 expression following SCI or denervation which may result from distinct temporal patterns of spontaneous muscle contractile activity due to injury to upper versus lower motor neurons.     

Anoxic encephalopathy: neuroradiological and neuropsychological findings.

The effects of anoxic brain injury are examined in 12 patients. Neuroradiological as well as neuropsychological findings are discussed and clinical guidelines offered. The most common neuropsychological profile associated with anoxic brain injury is one in which there is generalized cognitive impairment but with particular deficits in memory function. The common neuropathological findings are manifested by a pattern of diffuse cerebral atrophy as identified by neuroimaging techniques. A detailed case study is presented.     

被动运动对脊髓损伤大鼠后肢运动功能及骨骼肌的影响

目的　观察被动运动促进脊髓损伤（Spinal cord injury, SCI）大鼠后肢运动功能恢复和改善骨骼肌萎缩的影响;探讨脑源性神经营养因子（BDNF）对被动运动促进功能恢复和延缓肌萎缩的作用。 方法　将36只健康成年雌性SD大鼠随机分假手术组、对照组（未行运动）,被动运动组（损伤1周后开始被动运动,共4 周）。采用改良的Allen’s法制备SCI模型。术后1 d和1、2、3、4 周通过大鼠Basso-Beattie-Bresnahan(BBB)行为学评分检测各组大鼠的运动功能;术后5周,采用HE染色比较各组大鼠脊髓组织病理变化,观察大鼠后肢腓肠肌的横断面积、直径和形态变化。测量腓肠肌湿重、体重和肌湿重/体重,评价肌萎缩情况;采用Western blots检测腓肠肌中BDNF的表达变化。 结果　被动运动组运动功能明显高于对照组（P<0.05）。损伤5周后,对照组和被动运动组的脊髓组织失去正常形态,神经元数量减少,损伤区大量空洞形成,而被动运动组的变化较对照组轻。对照组腓肠肌湿重、肌湿重/体重、横断面积和直径下降,被动运动组改善上述肌萎缩情况（P<0.05）。与假手术组相比,对照组和被动运动组BDNF表达量增加（P<0.05）,其中被动运动组高于对照组（P<0.05）。 结论　被动运动可能是通过增加SCI后BDNF表达促进损伤后运动功能的恢复,并能有效改善失神经性肌萎缩。     

Treatment of chronic thoracic spinal cord injury patients with autologous Schwann cell transplantation: an interim report on safety considerations and possible outcomes

Several experimental studies have introduced Schwann cell transplantation as a means of recovery in animal models of spinal cord injury (SCI). The reported promising results together with the availability of autologous sources for Schwann cells indicate Schwann cell transplantation as a possible treatment for SCI. To address the safety and feasibility concerns we report 1-year follow-up of four patients aged between 22 and 43 years who had stable chronic (28-80 months) spinal cord injury at mid-thoracic level and treated with autologous Schwann cell transplantation. Purified Schwann cells used for transplantation were acquired from autologous sural nerve and cultured without the use of any specific mitogenic or growth factors. The patients were evaluated by means of American Spinal Injury Association (ASIA) criteria, sphincter, sexual function and Magnetic Resonance Imaging assessments for 1 year after transplantation. None of the patients were found to have any adverse effects indicating transfer of infection, neurological deterioration or other related clinical problems. Of the four patients, only one patient with incomplete SCI showed motor and sensory improvement 1 year after transplantation with extensive and continuous rehabilitation. All the four patients experienced transient paresthesia or increased muscle spasm after transplantation. Magnetic Resonance (MR) images of the patients did not show any visible changes or pathological findings after 1 year. This preliminary report shows that autologous Schwann cell transplantation is generally safe for the selected number of SCI patients but it does not prove beneficial effects. Further safety and outcome studies are recommended.     

The linear-ordered collagen scaffold-BDNF complex significantly promotes functional recovery after completely transected spinal cord injury in canine

Spinal cord injury (SCI) is still a worldwide clinical challenge for which there is no viable therapeutic method. We focused on developing combinatorial methods targeting the complex pathological process of SCI. In this study, we implanted linear-ordered collagen scaffold (LOCS) fibers with collagen binding brain-derived neurotrophic factor (BDNF) by tagging a collagen-binding domain (CBD) (LOCS + CBD-BDNF) in completely transected canine SCI with multisystem rehabilitation to validate its potential therapeutic effect through a long-term (38 weeks) observation. We found that LOCS + CBD-BDNF implants strikingly promoted locomotion and functional sensory recovery, with some dogs standing unassisted and transiently moving. Further histological analysis showed that administration of LOCS + CBD-BDNF reduced lesion volume, decreased collagen deposits, promoted axon regeneration and improved myelination, leading to functional recovery. Collectively, LOCS + CBD-BDNF showed striking therapeutic effect on completely transected canine SCI model and it is the first time to report such breakthrough in the war with SCI. Undoubtedly, it is a potentially promising therapeutic method for SCI paralysis or other movement disorders caused by neurological diseases in the future.     

Acupuncture and physical therapy for spinal cord injury: Case report

BackgroundSpinal cord injury (SCI) is a major problem worldwide, which can result in partial or complete loss of sensory function and motor control. Injured people are 2–5 times more likely to suffer premature death than their uninjured counterparts.Case InformationThis case reports the injuries sustained by a 41-year-old woman who jumped from a building being bombed in Kyiv, Ukraine, and her subsequent treatment and recovery.The patient suffered a complete spinal cord injury (SCI), lower distal paraplegia, and dysfunction of pelvic organs, with orthopedist reporting she would likely never walk again. She substantially recuperated after the integration of acupuncture and physical therapy (PT) in her rehabilitation. Utilizing electrical, manual, and scalp acupuncture along with PT, the patient regained full bowel control, improved bladder function, and gained ability to support orthostatic position.ConclusionsAcupuncture is cost effective and easy to perform in hospital settings. It has an important role to play in the rehabilitation of injuries. The integration of acupuncture and PT may significantly improve motor and neurological functions for SCI patients.     

Cortical thickness and voxel-based morphometry in posterior cortical atrophy and typical Alzheimer's disease

A significant minority of Alzheimer's disease patients present with posterior cortical atrophy (PCA). PCA is characterized by visuospatial and visuoperceptual deficits, and relatively preserved memory, whereas patients with typical Alzheimer's disease (tAD) mostly present with early episodic memory deficits. We used two unbiased image analysis techniques to assess atrophy patterns in 48 PCA, 30 tAD, and 50 healthy controls. FreeSurfer was used to measure cortical thickness, and volumetric grey matter differences were assessed using voxel-based morphometry (VBM). Both PCA and tAD showed widespread reductions compared with controls using both techniques. Direct comparison of PCA and tAD revealed thinner cortex predominantly in the right superior parietal lobe in the PCA group compared with tAD, whereas the tAD group showed thinning in the left entorhinal cortex compared with PCA. Similar results were obtained in the VBM analysis. These distinct patterns of atrophy may have diagnostic utility. In a clinical context, a relatively spared medial temporal lobe in the presence of posterior parietal atrophy may imply PCA, and should not discount AD.