陈旧性脊髓损伤的修复与神经功能重建

Repair of obsolete spinal cord injury and reconstruction of nerve function

背景:脊髓损伤尤其是陈旧性脊髓损伤所致的瘫痪是一种较为严重的伤残,如何对脊髓损伤患者采取有效的修复治疗方法进行功能重建一直是临床上的难点。目的:探讨陈旧性脊髓损伤的修复与神经功能重建的有效方法,总结陈旧性脊髓损伤修复治疗与神经功能重建的临床经验。方法:应用计算机检索CNKI期刊全文数据库(1996-10/2009-12)和PubMed数据库(1999-10/2009-10)与陈旧性脊髓损伤的治疗和神经功能重建有关的文章,检索词分别为"陈旧性脊髓损伤;神经功能重建;细胞移植;手术治疗;痉挛疼痛"和"obsolete spinal cord injury;surgery;transplants;spasmpain;nerve functional reconstruction"。纳入所述内容与陈旧性脊髓损伤、细胞移植或神经功能重建等方式修复脊髓损伤相关的文章。排除重复研究或Meta分析类文章。结果与结论:收集到107篇相关文献,排除61篇不符合标准的文献,共纳入46篇符合标准的文献。经分析得出以下结论:对于陈旧性非完全性损伤患者,采取细胞移植治疗和显微外科手术治疗可刺激神经细胞再生和解除脊髓、神经根压迫,从而促进神经功能的恢复或再生;对完全性脊髓损伤患者采用截瘫平面以上的正常周围神经旁路转位于平面以下的神经相嫁接,可重建膈肌呼吸功能、部分上肢和手功能、迈步、尿便和足底感觉等关键神经功能,是一种可行的治疗策略。

BACKGROUND： Spinal cord injury, especially obsolete spinal cord injury-induced paralysis, is a more serious disability. How to treat spinal cord injury with effective therapy then doing functional reconstruction are difficulties in the clinic. OBJECTIVE： To explore effective methods for repair of obsolete spinal cord injury and reconstruction of nerve function, and to summarize the clinical experiences. METHODS： Papers related to therapy for obsolete spinal cord injury and nerve functional reconstruction published between October 1996 and December 2009 in CNKI and between October 1999 and October 2009 in PUBMED database were searched with Keywords of ＂obsolete spinal cord injury; nerve functional reconstruction, cell transplantation, surgery, spasm pain＂ in Chinese and English. The articles regarding obsolete spinal cord injury, cell transplantation or nerve functional reconstruction were selected, and the duplicated study or Meta analysis was excluded. RESULTS AND CONCLUSION： Totally 107 literatures were collected, and 61 of them were excluded, thus, 46 documents were included. Analysis results showed that for obsolete incomplete injury, cell transplantation and microsurgery can stimulate nerve cells regeneration, remove compressions on spinal cord and nerve root, and thus, promote the recovery or regeneration. For complete injury, the normal peripheral nerve bypass on the paraplegia plane can be connected to the nerve on the plane, which can reconstruct diaphragmatic respiratory function, partial upper limb and hand function, walking, defecation and plantar sensory, therefore, this method is a feasible treatment strategy.