手术减压时间对兔颈脊髓急性损伤并压迫模型的疗效影响

Influence of Timing of Decompression on Neurologic Recovery after Spinal Cord Injury in a Rabbit Model

目的制造颈脊髓损伤动物模型,观察颈脊髓损伤后减压时间对脊髓损伤后神经功能恢复的影响。方法选择新西兰大白兔65只,随机分对照组与实验组,实验组进一步分为6个亚组(A、B、C、D、E、F组)。C3椎体前路钻孔开窗,用改良Allen’s法40.0gcm力撞击脊髓,然后从骨窗处置入小螺钉造成脊髓压迫。并在术后18h、24h、2d、3d、5d、7d减压(去除小螺钉)。在术后28d内对改良Tarlov评分,体感诱发电位,细胞凋亡及病理等监测指标进行观察。结果运动学评分和体感诱发电位显示A、B组的神经恢复情况优于其他组,C、D组优于E、F组。而E、F、G组之间无明显差别。组织学显示脊髓受压时间越长,脊髓结构损害越严重。结论本实验显示脊髓损伤后确实存在一个减压的时间窗,该窗口为损伤后3d内,而术后18h内减压可以获得最佳的神经功能恢复。

Objective To evaluate the effect of the timing of decompression after spinal cord injury on neurologic recovery.Methods Sixty-five New Zealand rabbits were divided randomly into the .control group and experimental group.The experimental group was divided further into 6 subgroups （A ,B,C,D ,E and F）. The rabbits were made into models of ventral acute spinal cord injury according to the method of advanced Allen＇s. Then screw was used through cervical anterior approach for compression to spinal cord 3. At different time （18h,24h,2d,3d,5d and 7d after injury ）the vertebral canal was decompressed （remove the serew ）. Meanwhile the rabbits were evaluated the motor function as the advanced Tarlov method. Somatosensory evoked potential was used to assess neurologic recovery for 6 weeks until the animals were killed for histologie evaluation.Results The motor behavior seoresmotor behavior scores and somatosensory evoked potential all illustrate that the neurologic recovery of and B group were better than the other groups. And the C and D group were better than the E and F group. Histologie analysis showed more severe spinal cord damage as the time until decompression increased.Conclusion ＆nb sp;There is a time window for decompression in acute cervical spinal eord injury animal model. Early decompression in which can acquire best neurological functional reeovery,espeeially within 18 h.