直肠电刺激治疗脊髓损伤痉挛的研究现状

Rectal Probe Eectrostimulation for Spasticity after Spinal Cord Injury(review)

目的通过查阅文献,总结出直肠电刺激(RPES)治疗脊髓损伤的作用机制及其效果,并为进一步的实验提供可能的研究方向。方法采用文献检索法,分别从直肠电刺激治疗脊髓损伤的研究背景、直肠神经解剖基础、脊髓损伤后痉挛产生的机理、直肠电刺激治疗脊髓损伤痉挛的研究4个方面,归纳和总结出目前研究的成果、存在的问题和今后的研究方向。结果RPES治疗脊髓损伤后痉挛的机制还需要进一步研究。直肠内接收和传递RPES信号的神经与受体没有明确,还未找到直肠与躯体肌肉间的神经传导通路,高位神经中枢是否参加调节还未有定论。结论直肠、交感和副交感神经干、大脑皮层感觉区、脊髓的后连合体(DCN)和肢体肌肉可能存在某些复杂的神经传导通路,其中大脑皮层感觉区、脊髓的DCN是这些神经传导通路中重要的整合区。这些神经传导通路是否存在以及RPES是否通过这些神经传导通路发挥治疗脊髓损伤后痉挛的作用,将是研究的重要课题。

Objective Through literature review, we summarized the mechanism on the treatment of spinal cord injury（SCI）using rectal probe electrostimulation （RPES）and its effects, which provided possible directions for further experimental re search. Methods Using literature retrieval method, we respectively summarized the results of the present study, problems and future research directions from the research background on the treatment of spasticity after SCI using RPES, the basis of rectal nerve anato my, the mechanism on spasticity after SCI and the research on the treatment of spasticity after SCI using RPES. Results The mecha- nism on the treatment of spasticity after SCI using RPES need further study. Nerves and receptors used in receiving and transmitting RPES signals in rectum are not clear, the nerve pathway among rectum and muscle have not been found, and the superior nerve cen ter whether to participate in modulation has not been final conclusion. Conclusion There are some complex neural pathways between rectum, sympathetic and parasympathetic nerve stem, sensory area of cerebral cortex, the dorsal commissural nucleus （DCN） in spinal cord and muscles of limbs, in which sensory area of cerebral cortex and the DCN in spinal cord are two important integration areas in these pathways. It would be important for our research whether the existence of neural pathways and RPES treating spasticity after SCI through these pathways.