人参皂甙Rb1减轻大鼠脊髓缺血再灌注损伤的实验研究

目的在整体水平探讨人参皂甙Rb1对脊髓缺血再灌注损伤(spinal cord ischemiareperfusion injury,SCII)的治疗作用。方法 Sprague-Dawley(SD)大鼠72只,随机分为假手术组、对照组(SCII+安慰剂)和实验组(SCII+人参皂甙Rb1),采用腹主动脉夹闭法建立SCII模型。应用Basso-Beattie-Bresnahan(BBB)评分系统评价神经功能,HE染色观察病理组织结构和细胞形态改变,原位末端脱氧核苷酸转移酶标记(the in situ terminal deoxynucleotidyl transferase-mediateddUTP nick end-labeling technique,TUNEL)方法检测细胞凋亡情况。结果人参皂甙Rb1干预可以减轻脊髓缺血再灌注损伤导致的后肢功能障碍。HE染色显示人参皂甙Rb1干预可减轻神经元受损程度。TUNEL检测显示假手术组很少有细胞凋亡,对照组的神经细胞凋亡率最高,实验组与对照组比较可显著减少细胞凋亡率,差异有统计学意义(P<0.05)。结论人参皂甙Rb1可改善大鼠神经功能,减轻SCII导致的神经元受损,减少脊髓细胞凋亡。     

五种不同的手术方式治疗胸腰椎结核的比较研究

目的 探讨颈椎布鲁杆菌病的早期诊断与鉴别诊断及手术治疗的疗效。 方法 回顾性分析2000年1月～2012年6月本院收治的15例颈椎布鲁杆菌病性脊椎炎患者,男11例,女4例;年龄48～78岁,平均54岁。病程6～21个月,平均10个月。其中3例合并腰椎病变;6例合并不同程度神经功能损伤,采用一期颈前路病灶清除及植骨融合内固定术。行手术治疗的患者比较手术前后日本骨科学会（Japanese Orthopaedic Association, JOA） 评分,评价预后及植骨融合情况。 结果 所有患者均获得随访,患者术后JOA评分较术前提高,差异有统计学意义（P＜0.05） 。无复发及严重并发症发生,内固定可靠,植骨融合良好。 结论 颈椎布鲁杆菌病需早期发现早期治疗,如有骨质破坏、神经功能损害应手术治疗。     

三种创面处理方法治疗胫腓骨骨折合并骨筋膜室综合征临床疗效分析

目的探讨切开复位内固定结合传统敞开引流无菌敷料敷盖、DR脱细胞异种(猪)皮和持续负压封闭引流技术(VSD)3种创面处理技术治疗胫腓骨骨折合并骨筋膜室综合征的疗效。方法 67例胫腓骨骨折合并骨筋膜室综合征,早期均行切开减张术和内固定术,分别以传统敞开引流无菌敷料覆盖(A组,n=35)、DR脱细胞异种(猪)皮覆盖(B组,n=13)、VSD持续吸引(C组,n=19)处理至创面肉芽组织生长良好后,二期行游离植皮术。结果 C组创面修复及骨折愈合良好,且骨筋膜室综合征得到控制;在换药次数、术后3 d伤口渗出量、减轻小腿肿胀程度、疼痛、伤口感染率、住院时间、二期创面修复时间方面,B、C组均优于A组,差异有统计学意义(P<0.05)。结论切开复位内固定结合VSD技术治疗胫腓骨骨折合并骨筋膜室综合征可缩短治疗时间,降低感染率和渗出量,减轻肿胀和疼痛。尽管DR脱细胞异种(猪)皮不及VSD技术优势明显,但是其价格低廉,适用于基层医院的推广。     

脐带间充质干细胞在遗传性痉挛性截瘫中的应用

目的观察脐带间充质干细胞（UC-MSC）治疗遗传性痉挛性截瘫（HSP）的临床疗效及安全性。方法2010年9月及2011年4月,分别给予一HSP家系父子2人行UC-MSC鞘内注射治疗,两个疗程,每次1×106 cells/Kg,每周1次,4次为1个疗程。采用改良的Ashworth肌张力分级标准（MAS）、国际合作共济失调评分量表（ICARS）及日常生活量表（ADL）,对患者治疗前后神经功能、日常生活能力进行评定。结果第一疗程结束1个月与治疗前比较,2人MAS分级、ICARS及ADL评分均降低,两人行走站立稳定性及言语流利程度较治疗前改善;第二疗程结束后1个月与该疗程治疗前比较,2人ICARS及ADL评分降低,儿子肌张力进一步降低,父亲双上肢共济失调减轻。2人治疗后均未见明显不良反应发生。末次治疗结束后随访20个月,父、子俩分别于第二疗程治疗结束7个月及8个月后,症状继续加重。结论 UC-MSC鞘内注射治疗是安全的,可在一定时间内一定程度上减轻患者临床症状,提高患者生活质量,延缓疾病进展,但疗效不能持久。     

Prevention and Treatment Of Heterotopic Ossification After Spinal Cord Injury

Abstract

Background/Objectives: Heterotopic ossification (HO) is a frequent, irreversible complication afterspinal cord injury (SCI). The objective of this article is to explain the etiology of HO; present new advances in prevention, diagnosis, and management of this complication; and provide a suggested algorithm for clinical management.

Etiology: Although still hypothetical, trauma and overexpression of bone morphogenic protein(s) in traumatized soft tissue appear to play important roles as initiating factors of HO.

Prevention: Preventive use of nonsteroidal antiinflammatory agents (NSAIDs) reduces the incidence of HO by a magnitude of 2 to 3.

Management: Early determination of serum creatine phosphokinase may have a diagnostic value in predicting the onset and severity of HO, and an NSAID may be added to etidronate therapy in the initial inflammatory phase of HO formation until C-reactive protein Ieveis return to normal range. Surgery is indicated in a subset of patients, and a regimenthat includes radiation therapy may prevent postoperative recurrence.

Conclusion: Significant progress has been made in the early prevention and management of HO. Further studies are needed to elucidate the etiology.     

Efficacy and Safety of Tol Terodine in People With Neurogenic Detrusor Overactivity

Abstract

Objective: To compare tolterodine with oxybutynin and placebo in people with neuragenie detrusor overactivity.

Design: Prospective, randomized, double-blind, crossover trial plus open-label comparative stage.

Participants: Ten participants with neuragenie detrusor overactivity due to spinal cord injury or multiple sclerosis who usedintermittent catheterization.

Methods: Bladder capacity on cystometrogram, a 10-day record of catheterization volumes, number of incontinent episodes perday, and perceived dry mouth using a visual analog scale (VAS) were measured for the following: (a) a blinded comparison:tolterodine, 2 mg twice daily, vs placebo, twice daily; and (b) an unblinded comparison: oxybutynin vs tolterodine, each atself-selected doses (SSDs).

Results: Tolterodine, 2 mg twice daily, was superior to placebo in enhancing catheterization volumes (P<0.0005) and reducingincontinence (P<0.001 ), but was comparable with placebo in cystometric bladder capacity. Efficacy of tolterodine SSD wascomparable with oxybutynin SSD with regard to catheterization volumes, degree of incontinence, and cystometric bladder capacity.The side effect profile (dry mouth) was comparable between tolterodine, 2 mg twice daily, and placebo, but differed significantlywhen comparing tolterodine SSD with oxybutynin SSD (P<0.05).

Conclusion: T olterodine, when used at SSDs, is comparable with oxybutynin at SSDs in enhancing bladder volume and improvingcontinence, but with less dry mouth. T olterodine at the recommended dosage of 2 mg twice daily improves incontinence and bladdervolumes compared with placebo, and without significant dry mouth. Larger doses of tolterodine may be needed to achieve best effectin this population, but further studies are required.     

Evidence for an Exaggerated Postprandial Lipemia in Chronic Paraplegia

Abstract

Background/Objective: Excessive delay in triglyceride (TG) metabolism after ingestion of dietary fatrepresents a significant cardiovascular disease (CVD) risk. The objective of this study was to compare thepostprandial lipemic responses of individuals with paraplegia with those of healthy nondisabled individuals.

Methods: The ability of 3 recreationally active individuals with paraplegia having normal fasting TG(mean= 103 mg/dl) to metabolize TG after ingestion of a high-fat test meal was compared with apreviously published cohort of 21 recreationally active individuals without paraplegia (TG mean= 86 mg/dl)who underwent identical testing. The subjects with paraplegia had venous blood taken under fastingconditions, and then ingested a milkshake containing premium ice cream blended with heavy whippingcream(~ 92% of calories from fat). Additional blood samples were obtained at 2, 4, and 6 hours afteringestion. The area under the curve (AUC) for TG clearance for both subject groups was measured with anarea planimeter.

Results: TG uptake for both groups was almost identical for the first 2 hours after ingestion. At 4 and 6 hoursafter ingestion, the TG levels were 50 and 35 mg/dl higher, respectively, in subjects with paraplegia than innondisabled subjects. When corrected for small baseline differences in TG concentrations (16 mg/dl), theAUC was 46.5% greater for the group with paraplegia than in the nondisabled group. A near mirrorassociation across time was observed between postprandial serum high-density lipoprotein cholesterol(HDL-C) and TG levels in subjects with paraplegia.

Conclusion: This case series finds an exaggerated postprandial lipemia (PPL) in persons with paraplegiawith normal fasting TGs. This finding is the first evidence, in a small population, of an unreported potentialCVD risk in persons with paraplegia.     

Hydronephrosis Due to Improper Condom Catheter Use

ABSTRACT

This report concerns a patient with bilateral hydronephrosis due to a tight external condom catheter retention strap. Urodynamics with fluoroscopy and cystoscopy failed to demonstrate bladder outlet obstruction, urethral stricture, uretero-vesicle junction abnormality, or other explanations for the bilateral hydronephrosis. The hydronephrosis resolved when the external condom catheter retention strap was eliminated. The authors emphasize the importance of patient education to prevent this problem and encourage alertness by clinicians to assess appropriateness of external condom catheter use. (J Am Paraplegia Soc; 17: 168–170)     

Transcranial Magnetic Stimulation: Use of Motor Evoked Potentials in the Evaluation of Surgically Induced Spinal Cord Ischemia

Abstract

We evaluated transcranial magnetic stimulation producing motor evoked potentials (TMS MEP) as a method to detect spinal cord ischemia during surgery for thoracoabdominal aneurysms. Four groups of swine were subjected to different types of surgically-induced ischemia. TMS MEP and neurological function were assessed at baseline, immediately after the ischemic insult and after four hours of reperfusion/post-ligation. Cross-clamping of the aorta in groups A & B resulted in the disappearance and subsequent reappearance of TMS MEP with significantly prolonged latencies in most animals and variable neurological function. Ligation of intercostal arteries produced no changes in TMS MEP or neurological function (group C). However, after ligation of intercostal and lumbar arteries, group D demonstrated no reappearance of TMS MEP and severe neurological deficits. TMS MEP can provide rapid detection of global spinal cord ischemia and can also predict local devascularization injury. (J Spinal Cord Med 1997; 20:395-401)