痉瘫丹治疗创伤性痉挛型截瘫临床疗效分析

目的观察痉瘫丹治疗创伤性痉挛型截瘫的临床疗效,并探讨其作用机制。方法将56例痉挛型截瘫患者分为治疗组(28例)和对照组(28例),对照组采用西药常规治疗,治疗组在常规治疗基础上加用中药痉瘫丹,于治疗前后观察临床疗效。结果两组总有效率,治疗组为89.3%,对照组为53.5%,差异有显著性(P<0.05)。治疗组痉挛消失率为57.2%,明显高于对照组的21.4%,差异有显著性(P<0.01)。结论中药痉瘫丹对痉挛型截瘫临床症状有明显改善作用,与常规治疗合用疗效更显著。     

外伤性截瘫的中医治疗及研究概况

通过对近年的国内有关外伤性截瘫的中医药研究及治疗资料整理概述,发现外伤性截瘫的中医药治疗及研究仍然以针灸为主,研究的水平已深入到分子水平,治疗上也显示了较好的疗效,但一些损伤严重的截瘫仍然得不到明显的恢复,此病仍然达不到根治。这种状况不仅需要从医学的角度去不断的创新和探索,还有待于其他科学领域的突破,为根治本病获得更多有效的手段。     

The Vienna functional electrical stimulation system for restoration of walking functions in spastic paraplegia

An eight-channel stimulation system, currently intended for stimulation of lower extremities, was developed and is introduced. The major development goals were easy handling, modularity to make the system easily adaptable for other functional electrical stimulation (FES) applications, and a wide stimulation parameter range for application-specific parameter optimization. For paraplegic stepping, the system worn by the patient consists of 2 four-channel stimulation modules, a central unit holding the battery and circuitry for power management and communication control, a wireless remote control unit, and a palmtop computer as the main control and input device. A software package for Microsoft Windows supports the design and optimization of stimulation sequences in the rehabilitation center. First tests with patients familiar with FES showed smoother movements during stepping and acceptable good handling. In combination with the PC software, the required stimulation sequences could be created in a very short time.     

Selective block of urethral sphincter contraction using a modified Brindley electrode in sacral anterior root stimulation of the dog

AIMS: Patients with spinal cord injury often present with dysfunction of urinary bladder and urethral sphincter. One treatment option is sacral rhizotomy and sacral anterior root stimulation with the Finetech Brindley stimulator. However, a major disadvantage is the lack of selective stimulation, resulting in simultaneous contraction of sphincter and bladder followed by unphysiological micturition. This study investigated the possibility of selective bladder stimulation by using a Brindley electrode. METHODS: In 11 male anaesthetized foxhounds, a complete posterior rhizotomy was perormed. The anterior S2 roots were stimulated with different quasi-trapezoidal (QT) pulses (pulse length range, 600-1,400 microsec; stimulation current, 0.1-2.0 mA; frequency, 20 Hz) by using a tripolar Brindley electrode. Sphincter and bladder pressures were measured urodynamically. RESULTS: All 11 animals showed a maximal reduction of the highest sphincter pressure over 80%, and in 6 of 11 trials, the sphincter pressure was inhibited completely (100%). With stimulations at maximal sphincter blockade, the average achievable bladder pressure was 33.48 cm H(2)O higher than the average sphincter pressure, and in three cases, a strong micturition was observed. Selective blockade of the sphincter was possible by applying QT pulses. The bladders remained uninfluenced by this blockade and kept their excitability at any time. CONCLUSIONS: This study shows that selective bladder stimulation with little or no coactivation of the sphincter is possible. A physiological micturition can be achieved by using a tripolar Brindley electrode. Introduction of this stimulation technique into clinical practice should not face major difficulties, considering that the device is an established electrode.     

A large family with pure autosomal dominant hereditary spastic paraplegia from southern Italy mapping to chromosome 14q11.2-q24.3

A large Italian pedigree from southern Italy with autosomal dominant uncomplicated spastic paraplegia is reported. The clinical picture was uniform and characterized by insidiously progressive lower extremity weakness and spasticity. The mean age at onset of symptoms was 8.3 years. Significant linkage to the SPG3 locus on chromosome 14 was detected. The authors also report their search for mutations in a gene located in the region and its exclusion as a candidate for SPG3. Received: 14 November 2001, Received in revised form: 8 April 2002, Accepted: 23 April 2002 Correspondence to A. Quattrone, MD     

Missense and splice site mutations in SPG4 suggest loss-of-function in dominant spastic paraplegia

We studied nine Italian families with a pure form of autosomal dominant spastic paraplegia (ADHSP) to assess the frequency of mutations in the SPG4 gene. We observed marked intrafamilial variability in both age-at-onset and clinical severity, ranging from severe congenital presentation to mild involvement after age 55 years to healthy carriers of the mutation after age 70. Four of nine probands harboured SPG4 mutations, We identified three new SPG4 mutations, all predicting a loss-of-function with apparently important consequences for spastin function. RT-PCR studies predict loss-of-function as a possible mechanism leading to spastin-related HSP. The current study expands the spectrum of allelic variants in SPG4, confirming their pathological significance in pure AD-HSP and suggesting implications for the presumed function of spastin. Received: 15 December 2000, Received in revised form: 29 May 2001, Accepted: 18 June 2001     

The respective contribution of lumbar segments to the generation of locomotion in the isolated spinal cord of newborn rat

Various studies on isolated neonatal rat spinal cord have pointed to the predominant role played by the rostral lumbar area in the generation of locomotor activity. In the present study, the role of the various regions of the lumbar spinal cord in locomotor genesis was further examined using compartmentalization and transections of the cord. We report that the synaptic drive received by caudal motoneurons following N-methyl-d-l-aspartate (NMA)/5-HT superfusion on the entire lumbar cord is different from that triggered by the same compounds specifically applied on the rostral segments. These differences appear to be due to the direct action of NMA/5-HT on motoneuron membrane potential, rather than on premotoneuronal input activation. In order to assess the possible participation of the caudal lumbar segments in locomotor rhythm generation, the segments were over-stimulated with high concentrations of NMA or K+. We find that significant variations in motor cycle period occurred during the over-activation of the rostral segments. Over-activation of caudal segments only si+gnificantly increased the caudal ventral roots burst amplitude. We find that low 5-HT concentrations were unable to induce fictive locomotion under our experimental conditions. When a hemi-transection of the cord was performed between the L2-L3 segments, rhythmic bursting in the ipsilateral L5 disappeared while rhythmicity persisted on the contralateral side. Sectioning of the remaining L2-L3 side totally suppressed rhythmic activity in both L5 ventral roots. These results show that the thoracolumbar part of the cord constitutes the key area for locomotor pattern generation.     

侧前路减压固定治疗胸腰椎骨折伴不完全性瘫痪疗效分析

目的 探讨侧前路减压固定治疗胸腰椎骨折伴不完全性瘫痪的临床疗效。方法 对36例胸腰椎骨折伴不完全性瘫痪患者行侧前路减压，椎间植骨融合固定。结果 36例均获得随访，平均随访18个月（5～48个月）。随访结果：手术后胸腰椎生理曲度恢复满意，平均Cobb’S角及平均椎管狭窄指数得到明显改善（P〈0．05），神经功能恢复（Frankel分级）提高1～3级。术中损伤胸膜3例，未发生大血管损伤、内脏损伤、伤口感染、生殖股神经损伤、交感神经损伤、术后深静脉血栓形成．术后未发生断棒脱钉等并发症。结论 侧前路减压固定具有减乐直接彻底、能很好重建脊柱序列及脊髓神经功能恢复满意等特点，是治疗椎管占位明显或脊柱严重后凸畸形的胸腰椎骨折伴不完全性瘫痪的理想方法。     

Spastic paraplegia,epilepsy, and mental retardation in several members of a family: A novel genetic disorder

We report on a family in which an association between spastic paraplegia and epilepsy has been observed. This disorder is an autosomal dominant trait with incomplete penetrance and variable expressivity. The onset was limited to the first four decades of life; the symptoms were typically those of progressive weakness and spasticity of lower limbs. Epilepsy was present in members of three of the four generations on whom we have information. The concomitance of spastic paraplegia and epilepsy in several members of the same family is unlikely to be fortuitous and probably represents the pleiotropic effect of a single mutant gene. © 1993 Wiley-Liss, Inc.     

Aortic occlusion by a balloon catheter: A method to induce hind limb rigidity in rats

Post-ischaemic spinal extensor or flexor rigidity can be induced in different species by clamping or ligature of the descending aorta after thoracotomy or laparotomy. A similar motor deficit can also be induced by an intraluminal aortic occlusion produced by inflation of a balloon attached to the tip of a catheter inserted via the femoral artery. This method is easy to perform and avoids all the possible complications of thoracotomy or laparotomy. In rats the occlusion time for obtaining the maximum percentage of animals exhibiting a permanent hind limb extensor (62.5%) or flexor (12.5%) rigidity was 15–16 minutes. A marked depression of hind limb sensory perception accompanied this rigidity but there were no urinary, bowel or skin disturbances. The unilateral femoral ligation following the catheterization did not induce a difference in muscle tone between both hind limbs. The present procedure which is simpler than other published procedures might thus serve as a useful animal model for spastic paraplegia.