艾盒热敷促进非脊髓损伤骨科下肢术后尿潴留患者排尿功能恢复的护理研究

目的探讨艾盒热敷刺激骶尾部骶丛神经促进非脊髓损伤骨科下肢手术后患者排尿功能恢复的临床护理效果。方法选取2017年6月~2018年6月于本院接受非脊髓损伤骨科下肢手术后出现尿潴留患者100例,根据随机数字表法将患者分为对照组(n=50)与研究组(n=50)。对照组给予常规的基础护理,研究组在对照组的基础上每次给予艾盒热敷,直至患者恢复自行排尿,比较两组患者恢复自主排尿的时间、重置尿管率、术后住院天数。结果研究组患者恢复自行排尿时间短于对照组(P<0.05),重置尿管率低于对照组(P<0.05),术后住院天数短于对照组(P<0.05)。研究组干预后社会领域,心理领域、生理领域、环境领域及生活质量总评分均高于对照组(P<0.05)。结论艾盒热敷刺激骶尾部骶丛神经能缩短患者恢复自主排尿的时间,促进术后排尿,降低了重置尿管率,减少了术后住院天数,从而减轻了患者的痛苦与经济负担,提高患者生活质量。

非创伤性脊髓损伤的临床特点

目的：探讨非创伤性脊髓损伤患者的人口学特征、病因学分布以及神经功能预后。方法对44例非创伤性因素造成的脊髓损伤患者的临床资料进行回顾性分析。结果患者均获得3个月以上随访，平均随访时间13.3个月（3~23个月）。其中男性27例（61.3%），女性17例（38.7%）；平均年龄39.85岁（3.5~78岁）。病因包括脊髓炎16例（36%），脊柱肿瘤8例（18.1%），椎管内肿瘤7例（15.9%），脊髓血管畸形6例（13.6%），非创伤性椎间盘突出3例（6.8%，包括颈椎间盘突出致四肢瘫1例，腰椎间盘突出致马尾综合征2例），非脊柱手术造成的医源性脊髓缺血2例（4.5%），肝性脊髓病2例（4.5%）。入院时神经损伤情况：颈段脊髓损伤9例（20.4%），胸段损伤30例（68.1%），圆锥综合征2例（4.5%），马尾综合征3例（6.8%）。AISA残损分级：A级14例（31.8%），B级6例（13.6%），C级13例（29.5%），D级11例（25%）。最终随访时，34%患者出现至少1个等级的神经功能恢复。结论非创伤性脊髓损伤是造成脊髓损伤的重要原因。因具有特殊的病因学特点，此组病例在人口学特征以及临床特点上与创伤性脊髓损伤患者有较大区别。

小儿非脊柱骨折脱位型脊髓损伤康复治疗的临床效果

目的:观察小儿非脊柱骨折脱位型脊髓损伤(SCI-WORA)综合康复治疗后的临床效果。方法:3例SCI-WORA患者均使用辅助器、功能性电刺激及超短波等综合康复治疗。结果:治疗6个月后,3例患者ASIA损伤分级提高,Ashworth痉挛分级降低,Barthel指数以及Lindmark评分与治疗前比较均明显提高。结论:综合康复治疗明显促进SCI-WORA患者功能康复,有助其回归家庭和社会。

国际脊髓损伤数据集：非外伤性脊髓损伤数据集(1.0版)

[志谢]在制定该数据集的过程中，很多人都参与其中。通过参与电子邮件讨论和参加2008年在南非德班举办的国际脊髓损伤会议的研讨会，共有超过120位专家提供建议和反馈意见，在此我们表示感谢。

小儿非脊柱骨折脱位型脊髓损伤康复治疗的临床效果

目的:探讨小儿非脊柱骨折脱位型脊髓损伤康复治疗的临床疗效。方法:收治非脊柱骨折脱位型脊髓损伤患儿3例,给予综合康复治疗,观察临床治疗效果。结果:治疗后,3例患者Barthel指数、Ashoworth痉挛分级及Lindmark评分均优于治疗前,差异具有统计学意义(P<0.05)。结论:综合康复治疗可促进非脊柱骨折脱位型脊髓损伤患儿的功能恢复。

非外伤性脊髓损伤患者康复效果及影响因素分析

目的探讨非外伤性脊髓损伤（NTSCI）患者的康复效果，并分析其影响因素。方法回顾性分析2014年12月至2016年11月进行康复治疗的49例NTSCI患者，康复效果评定的主要指标为患者出院时日常生活自理能力即改良Barthel指数（MBI），按照患者出院时MBI是否达到入院时制订的目标，将患者分为有效组31例和无效组18例。记录患者的社会人口学资料（性别、年龄）、疾病相关因素（损伤原因、损伤平面、损伤等级、损伤程度、瘫痪类型、住院时间、患病时间、并发症数）、功能状态（入院和出院时MBI）、治疗相关因素（是否手术、是否进行早期康复）。通过单因素分析和Logistic回归分析NTSCI患者康复效果的影响因素。结果经过系统的康复训练，患者MBI有明显的提高，入院时（38．98±24．90）分，出院时（56．35±22．69）分，差异有统计学意义（Z=-4．95，P=0．00。回归分析显示，患者入院时MBI（OR=I．044，P=0.010）、住院时间（OR=1．044，P=0.039）是影响NTSCI患者康复效果的主要因素，而年龄、性别、损伤等级、损伤平面、损伤程度、并发症数等对NTSCI患者的康复效果没有确切影响。结论应对NTSCI患者开展积极的康复训练，系统评估患者入院时的MBI，结合患者损伤情况等制订严格的康复训练目标和训练程序，提高康复效率，缩短住院时间，提高患者生命质量。

小儿非脊柱骨折脱位型脊髓损伤（SCI－WORA）综合康复效果观察

目的：观察康复疗法治疗小儿非脊柱型骨折脱位型脊髓损伤的临床效果。方法：研究对象来院于我院2000年8月～2014年8月接诊的36例非脊柱骨折脱位型脊髓损伤患儿，全体患儿均给予佩戴辅助器、电刺激等综合康复治疗。统计患者治疗前后ASIA评分、JOA评分以及Barthel指数。结果：治疗后ASIA评分59．97±24．88分，显著高于治疗后34．22±16．37分，JOA评分10．28±0．83分显著高于治疗前6．14±0．51分，Barthel指数82．31±5．42分显著高于治疗后53．31±4．83分，治疗前后上述指标对比差异均有统计学意义（P＜0．05）。结论：综合康复治疗小儿非脊柱骨折脱位型脊髓损伤疗效显著，适合于临床推广。

Ex vivo non-viral vector-mediated neurotrophin-3 gene transfer to olfactory ensheathing glia: effects on axonal regeneration and functional recovery after implantation in rats with spinal cord injury

Objective Combine olfactory ensheathing glia （OEG） implantation with ex vivo non-viral vector-based neurotrophin- 3 （NT-3） gene therapy in attempting to enhance regeneration after thoracic spinal cord injury （SCI）. Methods Primary OEG were transfected with cationic liposome-mediated recombinant plasmid pcDNA3.1 （＋）-NT3 and subsequently implanted into adult Wistar rats directly after the thoracic spinal cord （T9） contusion by the New York University impactor. The animals in 3 different groups received 4x 1050EG transfected with pcDNA3.1 （＋）-NT3 or pcDNA3.1 （＋） plasmids, or the OEGs without any plasmid transfection, respectively; the fourth group was untreated group, in which no OEG was implanted. Results NT-3 production was seen increased both ex vivo and in vivo in pcDNA3.1 （＋）-NT3 transfected OEGs. Three months after implantation of NT-3-transfected OEGs, behavioral analysis revealed that the hindlimb function of SCI rats was improved. All spinal cords were filled with regenerated neurofilament-positive axons. Retrograde tracing revealed enhanced regenerative axonal sprouting. Conclusion Non-viral vector-mediated genetic engineering of OEG was safe and more effective in producing NT- 3 and promoting axonal outgrowth followed by enhancing SCI recovery in rats.

Recording of spared motor evoked potentials and its augmentation by 4-aminopyridine in chronic spinal cord-injured rats

Objective To research the direct electrophysiological evidence of discomplete spinal cord injury (SCI) and the effect of 4-aminopyridine on it.Methods Motor evoked potentials (MEPs), both spinal cord recorded MEPs (scMEPs) and extracellularly recorded MEPs (exMEPs) were recorded and characterized on a T13 epidural electrode (scMEPs) and an extracellular microelectrode (exMEPs) for 10 normal rats and 40 rats with lesions of various severity (sham, 35?g*cm force (gcf), 70?gcf, 100?gcf impact injury) at the T8-T9 cord using the Allen's drop model. The incline plane and Tarlov techniques were used to assess clinical neurological function. Results MEPs in the normal rats were elicited by applying transcortical suprathreshold stimulation consisting of 3-4 early negative peaks (N1, N2, N3 and N4) followed by several late waves. The N1 and N2 peaks were largest in the anterior and ventrolateral funiculus, respectively, which was indicative of extrapyramidal pathways. The 100?gcf impact injuries and the cord transection abolished the MEP distal to the lesion, whereas the 35?gcf injuries resulted in a latency shift and amplitude decrement of the MEP peaks. Eighteen of the 20 rats with 70?gcf injuries showed clinical paraplegia. Among them, 7 rats had neurophysiological evidence of residual conduction pathways through the lesioned cord segment, such as the presence of N1 and N2 peaks in the scMEPs or exMEPs. After 4-aminopyridine (4-AP) administrations (1?mg/kg), the amplitude of the spared exMEP increased significantly and spread more widely. Conclusions MEPs evoked by transcortical stimulation travel mostly in the extrapyramidal tract. MEP monitoring could provide an excellent method of detecting the functional integrity of the motor tracts after SCI, and could even detect spared motor fibers after discomplete SCI. Furthermore, the use of 4-AP or other K+ channel blocking agents may be a potential treatment for patients with chronic moderate to severe SCI.