Objective To explore the feasibility and clinical results of circumferential decompression and three column reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment. Methods Tot...Objective To explore the feasibility and clinical results of circumferential decompression and three column reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment. Methods Totally, 24 patients with spinal tumor underwent tumor resection and spinal reconstruc tion through single-stage posterior transpedicular approach. Preoperatively, according to the Frankel classification, 12 patients were grade E, 9 grade D, and 3 grade C. Anterior column was reconstructed with non-expandable titanium cages. Posterior segmental instrumentation was used to maintain the stability of spine in all cases. Anterior and posterolateral fusion was performed with autograft and allogenic bone. The following data were followed up in these patients: deformity angle, local recurrence, neurological function, and spinal bony fusion. Results The average operating time and blood loss was 5.6 hours and 3 400 ml respectively. No intraoperative and postoperative complications were observed in this group. Postoperatively, 21 patients were Frankel grade E, 2 grade D, and 1 grade C. Four patients reported significant functional restoration and twenty patients reported complete resolution of pain. At follow-up (range, 6-42 months), implant failure or recurrent neurological symptoms was not found. Conclusions The tumor resection and spinal reconstruction through single-stage posterior transpedicular approach is a safe and effective technique for the treatment of spinal tumor. It can fully decompress the neurological structures, correct the kyphosis, and achieve early weight-bearing. This technique can improve life quality for the patients with spinal tumor.展开更多
BACKGROUND： Recently, three-dimensional （3D） reconstruction of the corticospinal tract has been attempted in treatment for corticospinal tract injury. However, results remain unsatisfactory. OBJECTIVE： This manusc...BACKGROUND： Recently, three-dimensional （3D） reconstruction of the corticospinal tract has been attempted in treatment for corticospinal tract injury. However, results remain unsatisfactory. OBJECTIVE： This manuscript reviews technique progress and problems in 3D reconstruction of rat spinal tracts, as well as 3D reconstruction of human spinal tracts. RETRIEVAL STRATEGY： Using the keywords ＂rat, spinal tracts, three-dimensional reconstruction＂, the PubMed database was searched for English articles pertaining to 3D reconstruction of the rat spinal tract that were published between January 1996 and January 2007. Meanwhile, the above-mentioned keywords in Chinese were also used to search the CNK1 database for articles that were published between January 1999 and January 2007. Inclusion criteria： manuscripts that addressed the study of 3D reconstruction of the rat spinal tract and review articles. Exclusion criteria： old and repetitive articles. All manuscripts were initially evaluated, followed by extensive review. LITERATURE EVALUATION： A total of 154 related manuscripts were collected; a total of 27 were evaluated and reviewed for the present review. One manuscript assessed rat behavioral functions, four were experimental reports addressing micro-3D reconstruction techniques, ten were experiment reports about image analysis of rat corticospinal tracts, and twelve were experiment articles related to image processing of serial spinal cord sections. DATA SYNTHESIS： Rat spinal cord sections were obtained through section staining or magnetic resonance imaging （MRI） techniques, specifically localizing the inner tracts. Software was used to construct 3D reconstruction from the serial sections to observe and analyze rat spinal cord structures. The rat spinal cord is small, with complicated inner tracts, which makes accurate 3D reconstruction difficult. CONCLUSION： The assembly of 3D reconstructions from rat spinal cord serial sections and the visualization of the inner tracts are imperative for studying rat spinal cord diseases.展开更多
Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although mic...Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1;simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2;and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.展开更多
As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra （C2） surgery had been described pr...As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra （C2） surgery had been described previously in diverse approaches and reconstruction forms, each has its own limita- tions and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior （retropharyngeal） cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight con- secutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mor- tality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids （one of them experienced dysphonia） and 1 developed cerebrospinal fluid leakage （CSFL） that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale （VAS） and Japanese orthopedic association （JOA） score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixa- tion failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior re- construction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.展开更多
The purpose of this present work is to provide a tool to better understand mechanically related pathologies of the lumbar unit and the spinal structure by providing spinal cord deformations in different loading cases....The purpose of this present work is to provide a tool to better understand mechanically related pathologies of the lumbar unit and the spinal structure by providing spinal cord deformations in different loading cases. In fact, spinal cord injury (SCI) resulting from a traumatic movement leades to a deformation of the neural and vascular structure of the spinal cord. And since the magnitude of the spinal cord stress is correlated with the pressure of the vertebral elements, stresses will be computed on all theses components. Physical properties of the vertebrae, various ligaments, the discs, and the spinal cord are described under simple loading as compression, and combined loading, flexion and lateral bending to evaluate the pressure undergone by different components of the lumbar unit. A nonlinear three-dimensional finite element method is used as a numerical tool to perform all the computations. This study provides accurate results for the localisation and the magnitude of maximum equivalent stress and shear stress on the lumbar unit and especially for the spinal cord. These results showed that stresses are more important when a compression of 500 N is combined with a flexion and a lateral bending. In particular, shear stresses are maximum for the spinal cord and the four intervertebral discs for the case of a flexion of 3.8 N.m and a lateral bending of 6.5 N.m.展开更多
AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by im...AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.展开更多
Spinal cord injury is linked to the interruption of neural pathways,which results in irreversible neural dysfunction.Neural repair and neuroregeneration are critical goals and issues for rehabilitation in spinal cord ...Spinal cord injury is linked to the interruption of neural pathways,which results in irreversible neural dysfunction.Neural repair and neuroregeneration are critical goals and issues for rehabilitation in spinal cord injury,which require neural stem cell repair and multimodal neuromodulation techniques involving personalized rehabilitation strategies.Besides the involvement of endogenous stem cells in neurogenesis and neural repair,exogenous neural stem cell transplantation is an emerging effective method for repairing and replacing damaged tissues in central nervous system diseases.However,to ensure that endogenous or exogenous neural stem cells truly participate in neural repair following spinal cord injury,appropriate interventional measures(e.g.,neuromodulation)should be adopted.Neuromodulation techniques,such as noninvasive magnetic stimulation and electrical stimulation,have been safely applied in many neuropsychiatric diseases.There is increasing evidence to suggest that neuromagnetic/electrical modulation promotes neuroregeneration and neural repair by affecting signaling in the nervous system;namely,by exciting,inhibiting,or regulating neuronal and neural network activities to improve motor function and motor learning following spinal cord injury.Several studies have indicated that fine motor skill rehabilitation training makes use of residual nerve fibers for collateral growth,encourages the formation of new synaptic connections to promote neural plasticity,and improves motor function recovery in patients with spinal cord injury.With the development of biomaterial technology and biomechanical engineering,several emerging treatments have been developed,such as robots,brain-computer interfaces,and nanomaterials.These treatments have the potential to help millions of patients suffering from motor dysfunction caused by spinal cord injury.However,large-scale clinical trials need to be conducted to validate their efficacy.This review evaluated the efficacy of neural stem cells and magnetic or electrical stimulation combined with rehabilitation training and intelligent therapies for spinal cord injury according to existing evidence,to build up a multimodal treatment strategy of spinal cord injury to enhance nerve repair and regeneration.展开更多
目的建立椎板回植椎管重建的有限元模型,并分析椎板回植椎管重建对L_(2~3)和L_(3~4)节段的生物力学效应。方法选择1名作者医院骨科就诊的健康成年男性志愿者,采集影像学资料,建立正常人体腰椎L2~4的有限元模型,并与对照组(Panjabi等[6]...目的建立椎板回植椎管重建的有限元模型,并分析椎板回植椎管重建对L_(2~3)和L_(3~4)节段的生物力学效应。方法选择1名作者医院骨科就诊的健康成年男性志愿者,采集影像学资料,建立正常人体腰椎L2~4的有限元模型,并与对照组(Panjabi等[6]体外实验数据结果)进行比较,以验证该模型的有效性。根据处理方式分为正常赋值模型组、单纯椎板切除组和椎管重建组。在相同边界固定和生理载荷的条件下,进行前屈、后伸、左弯、右弯、左旋和右旋6种活动,计算各模型在6种加载工况处理下L_(2~3)和L_(3~4)节段关节活动度(range of motion,ROM)的变化情况,并进行比较分析。结果本实验所建立的正常赋值模型组L_(2~4)的有限元模型各个节段的ROM与对照组比较,差异均无统计学意义(P>0.05),验证了该模型的有效性,可用于实验研究。6种加载工况下,椎管重建组L_(2~3)和L_(3~4)的ROM低于单纯椎板切除组,差异均有统计学意义(P均<0.05);单纯椎板切除组L_(2~3)和L_(3~4)的ROM高于正常赋值模型组和对照组,组间比较差异均有统计学意义(P均<0.05)。椎管重建组与正常赋值模型组和对照组L_(3~4)的ROM比较,组间比较差异均无统计学意义(P>0.05)。前屈时,椎管重建组L_(2~3)的ROM高于正常赋值模型组和对照组,组间比较差异均有统计学意义(P均<0.05);后伸、左弯、右弯、左旋和右旋时,椎管重建组L_(2~3)的ROM与正常赋值模型组和对照组相比,差异均无统计学意义(P均>0.05)。结论本实验所建立的椎板回植椎管重建三维有限元模型可用于正常和手术模型的生物力学模拟和分析。单纯椎板切除严重影响脊柱生物力学的稳定性,而应用椎板回植椎管重建的方式可有效减少脊柱节段的ROM位移并维持其生物力学稳定性。展开更多
文摘Objective To explore the feasibility and clinical results of circumferential decompression and three column reconstruction through single-stage posterior transpedicular approach for spinal tumor treatment. Methods Totally, 24 patients with spinal tumor underwent tumor resection and spinal reconstruc tion through single-stage posterior transpedicular approach. Preoperatively, according to the Frankel classification, 12 patients were grade E, 9 grade D, and 3 grade C. Anterior column was reconstructed with non-expandable titanium cages. Posterior segmental instrumentation was used to maintain the stability of spine in all cases. Anterior and posterolateral fusion was performed with autograft and allogenic bone. The following data were followed up in these patients: deformity angle, local recurrence, neurological function, and spinal bony fusion. Results The average operating time and blood loss was 5.6 hours and 3 400 ml respectively. No intraoperative and postoperative complications were observed in this group. Postoperatively, 21 patients were Frankel grade E, 2 grade D, and 1 grade C. Four patients reported significant functional restoration and twenty patients reported complete resolution of pain. At follow-up (range, 6-42 months), implant failure or recurrent neurological symptoms was not found. Conclusions The tumor resection and spinal reconstruction through single-stage posterior transpedicular approach is a safe and effective technique for the treatment of spinal tumor. It can fully decompress the neurological structures, correct the kyphosis, and achieve early weight-bearing. This technique can improve life quality for the patients with spinal tumor.
基金Natural Science Research Plan for Jiangsu Colleges, No.05KJB180105Postgraduate Innovation Cultivating Project in Jiangsuprovince, No. CX07s_035z
文摘BACKGROUND： Recently, three-dimensional （3D） reconstruction of the corticospinal tract has been attempted in treatment for corticospinal tract injury. However, results remain unsatisfactory. OBJECTIVE： This manuscript reviews technique progress and problems in 3D reconstruction of rat spinal tracts, as well as 3D reconstruction of human spinal tracts. RETRIEVAL STRATEGY： Using the keywords ＂rat, spinal tracts, three-dimensional reconstruction＂, the PubMed database was searched for English articles pertaining to 3D reconstruction of the rat spinal tract that were published between January 1996 and January 2007. Meanwhile, the above-mentioned keywords in Chinese were also used to search the CNK1 database for articles that were published between January 1999 and January 2007. Inclusion criteria： manuscripts that addressed the study of 3D reconstruction of the rat spinal tract and review articles. Exclusion criteria： old and repetitive articles. All manuscripts were initially evaluated, followed by extensive review. LITERATURE EVALUATION： A total of 154 related manuscripts were collected; a total of 27 were evaluated and reviewed for the present review. One manuscript assessed rat behavioral functions, four were experimental reports addressing micro-3D reconstruction techniques, ten were experiment reports about image analysis of rat corticospinal tracts, and twelve were experiment articles related to image processing of serial spinal cord sections. DATA SYNTHESIS： Rat spinal cord sections were obtained through section staining or magnetic resonance imaging （MRI） techniques, specifically localizing the inner tracts. Software was used to construct 3D reconstruction from the serial sections to observe and analyze rat spinal cord structures. The rat spinal cord is small, with complicated inner tracts, which makes accurate 3D reconstruction difficult. CONCLUSION： The assembly of 3D reconstructions from rat spinal cord serial sections and the visualization of the inner tracts are imperative for studying rat spinal cord diseases.
文摘Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1;simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2;and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.
文摘目的:构建椎管重建内固定术的有限元模型,并分析椎管重建内固定术对脊柱稳定性的影响,验证椎管重建内固定术在椎管内手术中的有效性和可靠性。方法:筛选1名30岁男性,身高172 cm,体重75 kg的健康志愿者并采集其腰椎CT资料,建立正常腰椎L3-L5的有限元模型,并与体外实体结果和已发表的有限元分析结果进行比较,以验证该模型的有效性。根据处理方式不同分为正常组、椎板切除组和椎管重建组。在相同边界固定和生理载荷条件下,实施前屈、后伸、左弯、右弯、左旋和右旋6种工况活动,分析6种工况活动下L3-L4和L4-L5观察节段的活动度(range of motion,ROM)和L3-L5整体最大ROM的变化情况。结果:构建的L3-L5有限元模型各节段ROM位移与体外实体结果和既往文献数据结果吻合,确认了该模型的有效性。在L3-L4中,椎管重建组仅在后伸时较正常组增加,ROM变化百分比>5%;其他工况下的ROM与正常组相近,变化百分比<5%;而椎板切除组在前屈、后伸、左旋和右旋时的ROM较正常组和椎管重建组增加,变化百分比>5%。在L4-L5中,椎管重建组,在各工况下的ROM与正常组相近,变化百分比<5%,而椎板切除组在6种工况下的ROM均大于正常组和椎管重建组,变化百分比>5%。在L3-L5的整体最大ROM中,椎管重建组仅在后伸时超过正常组,变化百分比>5%;而椎板切除在前屈、后伸、左旋和右旋时大于正常组和椎管重建组,变化百分比>5%。L3-L5各节段ROM及总体ROM的变化趋势为:椎板切除组>椎管重建组>正常组。结论:椎板切除会严重影响脊柱生物力学的稳定性,而应用椎管重建内固定的方式可有效减少脊柱责任节段的ROM位移并维持其生物力学稳定性。
文摘As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra （C2） surgery had been described previously in diverse approaches and reconstruction forms, each has its own limita- tions and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior （retropharyngeal） cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight con- secutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mor- tality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids （one of them experienced dysphonia） and 1 developed cerebrospinal fluid leakage （CSFL） that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale （VAS） and Japanese orthopedic association （JOA） score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixa- tion failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior re- construction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.
文摘The purpose of this present work is to provide a tool to better understand mechanically related pathologies of the lumbar unit and the spinal structure by providing spinal cord deformations in different loading cases. In fact, spinal cord injury (SCI) resulting from a traumatic movement leades to a deformation of the neural and vascular structure of the spinal cord. And since the magnitude of the spinal cord stress is correlated with the pressure of the vertebral elements, stresses will be computed on all theses components. Physical properties of the vertebrae, various ligaments, the discs, and the spinal cord are described under simple loading as compression, and combined loading, flexion and lateral bending to evaluate the pressure undergone by different components of the lumbar unit. A nonlinear three-dimensional finite element method is used as a numerical tool to perform all the computations. This study provides accurate results for the localisation and the magnitude of maximum equivalent stress and shear stress on the lumbar unit and especially for the spinal cord. These results showed that stresses are more important when a compression of 500 N is combined with a flexion and a lateral bending. In particular, shear stresses are maximum for the spinal cord and the four intervertebral discs for the case of a flexion of 3.8 N.m and a lateral bending of 6.5 N.m.
文摘AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.
基金supported by the Major International(Regional)Joint Research Project of the National Natural Science Foundation of China,No.81820108013(to LMC)the General Research Project of the National Natural Science Foundation of China,No.81772453(to DSX)the National Key Research and Development Program of China,No.2016YFA0100800(to LMC)
文摘Spinal cord injury is linked to the interruption of neural pathways,which results in irreversible neural dysfunction.Neural repair and neuroregeneration are critical goals and issues for rehabilitation in spinal cord injury,which require neural stem cell repair and multimodal neuromodulation techniques involving personalized rehabilitation strategies.Besides the involvement of endogenous stem cells in neurogenesis and neural repair,exogenous neural stem cell transplantation is an emerging effective method for repairing and replacing damaged tissues in central nervous system diseases.However,to ensure that endogenous or exogenous neural stem cells truly participate in neural repair following spinal cord injury,appropriate interventional measures(e.g.,neuromodulation)should be adopted.Neuromodulation techniques,such as noninvasive magnetic stimulation and electrical stimulation,have been safely applied in many neuropsychiatric diseases.There is increasing evidence to suggest that neuromagnetic/electrical modulation promotes neuroregeneration and neural repair by affecting signaling in the nervous system;namely,by exciting,inhibiting,or regulating neuronal and neural network activities to improve motor function and motor learning following spinal cord injury.Several studies have indicated that fine motor skill rehabilitation training makes use of residual nerve fibers for collateral growth,encourages the formation of new synaptic connections to promote neural plasticity,and improves motor function recovery in patients with spinal cord injury.With the development of biomaterial technology and biomechanical engineering,several emerging treatments have been developed,such as robots,brain-computer interfaces,and nanomaterials.These treatments have the potential to help millions of patients suffering from motor dysfunction caused by spinal cord injury.However,large-scale clinical trials need to be conducted to validate their efficacy.This review evaluated the efficacy of neural stem cells and magnetic or electrical stimulation combined with rehabilitation training and intelligent therapies for spinal cord injury according to existing evidence,to build up a multimodal treatment strategy of spinal cord injury to enhance nerve repair and regeneration.
文摘目的建立椎板回植椎管重建的有限元模型,并分析椎板回植椎管重建对L_(2~3)和L_(3~4)节段的生物力学效应。方法选择1名作者医院骨科就诊的健康成年男性志愿者,采集影像学资料,建立正常人体腰椎L2~4的有限元模型,并与对照组(Panjabi等[6]体外实验数据结果)进行比较,以验证该模型的有效性。根据处理方式分为正常赋值模型组、单纯椎板切除组和椎管重建组。在相同边界固定和生理载荷的条件下,进行前屈、后伸、左弯、右弯、左旋和右旋6种活动,计算各模型在6种加载工况处理下L_(2~3)和L_(3~4)节段关节活动度(range of motion,ROM)的变化情况,并进行比较分析。结果本实验所建立的正常赋值模型组L_(2~4)的有限元模型各个节段的ROM与对照组比较,差异均无统计学意义(P>0.05),验证了该模型的有效性,可用于实验研究。6种加载工况下,椎管重建组L_(2~3)和L_(3~4)的ROM低于单纯椎板切除组,差异均有统计学意义(P均<0.05);单纯椎板切除组L_(2~3)和L_(3~4)的ROM高于正常赋值模型组和对照组,组间比较差异均有统计学意义(P均<0.05)。椎管重建组与正常赋值模型组和对照组L_(3~4)的ROM比较,组间比较差异均无统计学意义(P>0.05)。前屈时,椎管重建组L_(2~3)的ROM高于正常赋值模型组和对照组,组间比较差异均有统计学意义(P均<0.05);后伸、左弯、右弯、左旋和右旋时,椎管重建组L_(2~3)的ROM与正常赋值模型组和对照组相比,差异均无统计学意义(P均>0.05)。结论本实验所建立的椎板回植椎管重建三维有限元模型可用于正常和手术模型的生物力学模拟和分析。单纯椎板切除严重影响脊柱生物力学的稳定性,而应用椎板回植椎管重建的方式可有效减少脊柱节段的ROM位移并维持其生物力学稳定性。
