脊髓损伤与修复研究进展及展望

Spinal cord injuries and repairs: research progress and prospects

脊髓损伤的治疗和康复一直是基础和临床医学领域的重大难题之一。脊髓损伤的具体病理过程主要包括脊髓损伤发生时的原发性机械损伤,以及随后由于微循环障碍和过度炎症反应等导致的继发性损伤。脊髓损伤的神经生物学机制是由于脊髓损伤不同程度地破环了来自高级中枢的下行输入支配和来自外周的感觉信息的传入,阻碍了高级中枢和感受器通过前馈、反馈等机制对运动协调功能进行的规划和调整,同时也在一定程度上影响到具有相对自主性和可塑性的局部神经环路正常功能的进行。动物脊髓损伤模型主要有切断损伤模型、砸击损伤模型、压迫损伤模型、缺血损伤模型和化学损伤模型等。目前,脊髓损伤在基础和临床治疗研究方面取得明显进展,包括神经再生的分子机制和基因调控、细胞移植、生物材料的修复、药物神经保护、神经信号刺激及康复训练、人工智能和脑机接口的应用等。加强多学科交叉合作的基础研究、积极推广有效的临床康复新技术及促进共享数据库和数据标准等将是今后脊髓损伤机制和治疗研究领域的发展趋势。

Therapeutic intervention and rehabilitation after spinal cord injury（SCI） are currently confronted with tremendous challenges in basic and clinical medicine. The pathological process of SCI starts with the primary injury process directly caused by a mechanical force and follows the secondary injury process caused by microcirculation disorders and inflammatory responses. In this review, we interpret the neurobiological mechanisms underlying SCI. Damage to descending motor pathways and ascending sensory pathways interrupt their feedback and/or feedforward control of movement planning and modulation. To some extent, it also affetcs the normal function of local neural circuits with partial plasticity and independence. The animal models for SCI include transection models, contusion and compression models, ischemia-reperfusion injury and chemical injury models. Basic and translational studies in SCI have achieved remarkable progress in various aspects, including the gene network regulation of axonal regeneration, cell implantation, biomaterials applications, neuronal protection, neurostimulation and functional rehabilitation training, applications of artificial intelligence and brain computer interface. Obviously, future trends in basic and translational studies in SCI research will be enhancement of interdisciplinary research, cutting-edge technology application for clinical rehabilitation, database sharing and data standardization.