Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and...Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and its development remain largely unknown.The goal of the present study was to find differences,if any,in metabolites of the left precentral gyrus and basal ganglia of patients who have spinal cord injury with or without spasticity,and to explore the relationship between the brain metabolite concentrations and clinical status.Thirty-six participants were recruited for magnetic resonance spectroscopic examination:23 with spinal cord injury(12 with spasticity and 11 without spasticity)and 13 healthy controls.We acquired localized proton spectra from the precentral gyrus and basal ganglia via 10 mm^(3) voxels.Notably,univariate linear regression analysis demonstrated that the lower that the N-acetylaspartate concentration(a marker for neuronal loss)was in the precentral gyrus of the patients,the lower their ASIA(American Spinal Injury Association)light-touch scores,pinprick scores,and motor scores.Additionally,longer durations of injury were associated with higher N-acetylaspartate levels in the precentral gyrus.Compared with the healthy participants and patients without spasticity,N-acetylaspartate levels in the patients with spasticity were significantly lower in both the precentral gyrus and basal ganglia.Lower N-acetylaspartate levels also correlated with greater sensory and motor dysfunction in the patients who had spinal cord injury with spasticity.展开更多
Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and...Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal展开更多
目的:探讨胸腰段脊柱骨折合并急性创伤性脊髓损伤患者术后深静脉血栓的危险因素。方法:选取2018年7月~2020年9月于我院进行手术治疗的T11~L2骨折合并急性创伤性脊髓损伤(spinal cord injury,SCI)患者136例。收集患者的统计患者的年龄、...目的:探讨胸腰段脊柱骨折合并急性创伤性脊髓损伤患者术后深静脉血栓的危险因素。方法:选取2018年7月~2020年9月于我院进行手术治疗的T11~L2骨折合并急性创伤性脊髓损伤(spinal cord injury,SCI)患者136例。收集患者的统计患者的年龄、性别、体重指数、既往病史等一般资料,检测并收集患者总胆固醇(total cholesterol,TC)、甘油三酯(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白(high density lipoprotein cholesterol,HDL-C)等实验室指标。收集患者术前、术后6个月内的下肢静脉彩超,根据是否出现DVT分为DVT组(n=64)和非DVT组(n=72)。比较两组患者的一般资料,通过单因素分析及多因素Logistic回归分析确定急性创伤性SCI患者术后发生DVT的独立影响因素。通过Spearman法和Pearson法分析各影响因素间的相关性。根据独立影响因素建立并验证列线图模型。结果:单因素分析结果显示,DVT组和非DVT组的体重指数(27.03±2.12kg/m2和24.03±3.32kg/m2)、吸烟人数占比(39.06%和20.83%)、输血人数占比(45.31%和27.78%)、肿瘤病史人数占比(46.89%和23.61%)、出血量>600 mL人数占比(42.19%和22.22%)、ASIA分级A级人数占比(45.31%和18.06%)、肢体气压治疗及踝泵练习人数占比(18.75%和52.78%)、ASIA分级D级人数占比(14.06%和33.33%)、CRP(20.36±4.37和11.45±3.76)、FIB(6.49±1.31和4.51±1.26)以及D-二聚体(1.83±0.39和0.45±0.26)之间的差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,输血、ASIA分级A级、FIB>5g/L、D-二聚体>1.6mg/L以及未进行肢体气压治疗及踝泵练习是急性创伤性SCI患者术后DVT的独立危险因素(P<0.05),相关性分析显示,输血、ASIA分级A级、FIB、D-二聚体以及未进行肢体气压治疗及踝泵练习均呈明显的正相关关系(P<0.05)。根据独立影响因素构建列线图预测模型,模型的ROC曲线下面积(area under curve,AUC)为0.837(95%CI:0.791~0.864),具有较好的区分度,校准曲线评价结果提示模型具有较好的准确性。结论:输血、ASIA分级A级、FIB>5g/L、D-二聚体>1.6mg/L以及未进行肢体气压治疗及踝泵练习是急性创伤性SCI患者术后DVT形成的独立危险因素,各独立危险因素之间均存在密切联系。展开更多
目的:目前脊髓损伤仍缺乏十分有效的治疗手段,细胞治疗可能是一种很有前景的治疗手段,其中人脐带间充质干细胞由于其具有易获取、低成本、伦理争议少和免疫原性低等优点受到广泛关注。但目前临床上并没有大范围使用人脐带间充质干细胞,...目的:目前脊髓损伤仍缺乏十分有效的治疗手段,细胞治疗可能是一种很有前景的治疗手段,其中人脐带间充质干细胞由于其具有易获取、低成本、伦理争议少和免疫原性低等优点受到广泛关注。但目前临床上并没有大范围使用人脐带间充质干细胞,对其有效性和安全性还有争议。文章使用Meta分析来评价人脐带间充质干细胞治疗脊髓损伤的有效性和安全性。方法:应用计算机检索英文数据库(PubMed、Web of Science、Cochrane、EMbase)和中文数据库(中国知网、万方医学网和维普数据库),搜集人脐带间充质干细胞治疗脊髓损伤的临床研究文献,检索时间为各数据库建库至2021年4月。由2位研究人员独立阅读纳入文献、提取资料和评价质量,随机对照试验使用改良Jadad评分量表对纳入文献进行评分,并使用Cochrane风险偏倚评估工具进行偏倚风险评估,队列研究采用NOS量表进行评价,使用RevMan 5.3软件进行Meta分析。结果:共纳入10篇文献,370例患者,包括6篇随机对照试验,4篇队列研究,文献总体质量较高。Meta分析结果显示:①人脐带间充质干细胞移植组的ASIA感觉功能评分(MD=5.20,95%CI:3.50-6.90,P<0.00001)、AIS分级改善率(RR=2.26,95%CI:1.40-3.65,P=0.0008)、日常生活能力评分(Barthel指数)(MD=5.12,95%CI:1.04-9.20,P=0.01)均高于对照组;②人脐带间充质干细胞移植组在ASIA运动功能评分(MD=3.48,95%CI:-0.14-7.10,P=0.06)、ASIA感觉功能评分中细化的针刺觉(MD=7.58,95%CI:-0.44-15.59,P=0.06)、轻触觉(MD=7.67,95%CI:-0.42-15.77,P=0.06)评分方面,与对照组相比差异无显著性意义;③敏感性分析结果显示,在人脐带间充质干细胞移植组ASIA运动功能评分高于对照组(MD=6.14,95%CI:4.46-7.81,P<0.00001),在日常生活能力评分方面,结论与之前保持一致。纳入的10篇文献中,均报道未有严重不良反应发生,但是个别病例存在轻微的不良反应,经对症治疗后均消失。结论:现有的临床证据表明,人脐带间充质干细胞治疗脊髓损伤安全有效,患者的感觉和运动功能以及日常生活能力可得到显著改善。展开更多
Background:This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome.Surgical technique a...Background:This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome.Surgical technique and postoperative management is discussed.Case presentation:A 34-year-old fit and well healthy man was admitted with a history of stab injury to the thoracic spine at thoracic T2/3 level with ASIA impairment score(AIS)score D with an incomplete spinal cord affecting his left lower limb with complete paralysis and right lower limb paresis with impaired sensation below T6 level to L5.Neuroimaging confirmed a penetrating knife injury traversing the T2/3 level causing hemi-section of the spinal cord confirmed intraoperatively.He underwent an urgent exploratory surgery of his spine and a T2/3 laminectomy was performed to aid removal of the knife.The dura was noted to be contused and severed spinal cord was noted to be severed with associated cord oedema.A microsurgical repair of the severed cord was performed with duroplasty followed by intense neuro-rehabilitation.On a 3 month follow up his AIS score is E with lower limb power is 5/5 bilaterally and he is able to mobilise independently up to 8-10 steps without any supportive aid and with crutches he is independently functional and mobile.Conclusion:This is the first documented case of microsurgical repair of severed thoracic spinal cord secondary to traumatic knife injury.In the management of such scenario,apart from the removal of foreign body,repair of the cord with duroplasty should be carefully considered.The role of spinal neuroplasticity in healing following timely repair of the spinal cord along with intense rehabilitation remains the key.This had resulted in a good clinical and functional outcome with in a 18-month follow up.展开更多
基金supported by the National Natural Science Foundation of China,Nos.82071400,81870979the Scientific Research Foundation of China Rehabilitation Research Center,No.2020cz-01the Special Capital Health Research and Development of China,No.2018-1-6011(all to JJL)。
文摘Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and its development remain largely unknown.The goal of the present study was to find differences,if any,in metabolites of the left precentral gyrus and basal ganglia of patients who have spinal cord injury with or without spasticity,and to explore the relationship between the brain metabolite concentrations and clinical status.Thirty-six participants were recruited for magnetic resonance spectroscopic examination:23 with spinal cord injury(12 with spasticity and 11 without spasticity)and 13 healthy controls.We acquired localized proton spectra from the precentral gyrus and basal ganglia via 10 mm^(3) voxels.Notably,univariate linear regression analysis demonstrated that the lower that the N-acetylaspartate concentration(a marker for neuronal loss)was in the precentral gyrus of the patients,the lower their ASIA(American Spinal Injury Association)light-touch scores,pinprick scores,and motor scores.Additionally,longer durations of injury were associated with higher N-acetylaspartate levels in the precentral gyrus.Compared with the healthy participants and patients without spasticity,N-acetylaspartate levels in the patients with spasticity were significantly lower in both the precentral gyrus and basal ganglia.Lower N-acetylaspartate levels also correlated with greater sensory and motor dysfunction in the patients who had spinal cord injury with spasticity.
文摘Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal
文摘目的:探讨胸腰段脊柱骨折合并急性创伤性脊髓损伤患者术后深静脉血栓的危险因素。方法:选取2018年7月~2020年9月于我院进行手术治疗的T11~L2骨折合并急性创伤性脊髓损伤(spinal cord injury,SCI)患者136例。收集患者的统计患者的年龄、性别、体重指数、既往病史等一般资料,检测并收集患者总胆固醇(total cholesterol,TC)、甘油三酯(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白(high density lipoprotein cholesterol,HDL-C)等实验室指标。收集患者术前、术后6个月内的下肢静脉彩超,根据是否出现DVT分为DVT组(n=64)和非DVT组(n=72)。比较两组患者的一般资料,通过单因素分析及多因素Logistic回归分析确定急性创伤性SCI患者术后发生DVT的独立影响因素。通过Spearman法和Pearson法分析各影响因素间的相关性。根据独立影响因素建立并验证列线图模型。结果:单因素分析结果显示,DVT组和非DVT组的体重指数(27.03±2.12kg/m2和24.03±3.32kg/m2)、吸烟人数占比(39.06%和20.83%)、输血人数占比(45.31%和27.78%)、肿瘤病史人数占比(46.89%和23.61%)、出血量>600 mL人数占比(42.19%和22.22%)、ASIA分级A级人数占比(45.31%和18.06%)、肢体气压治疗及踝泵练习人数占比(18.75%和52.78%)、ASIA分级D级人数占比(14.06%和33.33%)、CRP(20.36±4.37和11.45±3.76)、FIB(6.49±1.31和4.51±1.26)以及D-二聚体(1.83±0.39和0.45±0.26)之间的差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,输血、ASIA分级A级、FIB>5g/L、D-二聚体>1.6mg/L以及未进行肢体气压治疗及踝泵练习是急性创伤性SCI患者术后DVT的独立危险因素(P<0.05),相关性分析显示,输血、ASIA分级A级、FIB、D-二聚体以及未进行肢体气压治疗及踝泵练习均呈明显的正相关关系(P<0.05)。根据独立影响因素构建列线图预测模型,模型的ROC曲线下面积(area under curve,AUC)为0.837(95%CI:0.791~0.864),具有较好的区分度,校准曲线评价结果提示模型具有较好的准确性。结论:输血、ASIA分级A级、FIB>5g/L、D-二聚体>1.6mg/L以及未进行肢体气压治疗及踝泵练习是急性创伤性SCI患者术后DVT形成的独立危险因素,各独立危险因素之间均存在密切联系。
文摘目的:目前脊髓损伤仍缺乏十分有效的治疗手段,细胞治疗可能是一种很有前景的治疗手段,其中人脐带间充质干细胞由于其具有易获取、低成本、伦理争议少和免疫原性低等优点受到广泛关注。但目前临床上并没有大范围使用人脐带间充质干细胞,对其有效性和安全性还有争议。文章使用Meta分析来评价人脐带间充质干细胞治疗脊髓损伤的有效性和安全性。方法:应用计算机检索英文数据库(PubMed、Web of Science、Cochrane、EMbase)和中文数据库(中国知网、万方医学网和维普数据库),搜集人脐带间充质干细胞治疗脊髓损伤的临床研究文献,检索时间为各数据库建库至2021年4月。由2位研究人员独立阅读纳入文献、提取资料和评价质量,随机对照试验使用改良Jadad评分量表对纳入文献进行评分,并使用Cochrane风险偏倚评估工具进行偏倚风险评估,队列研究采用NOS量表进行评价,使用RevMan 5.3软件进行Meta分析。结果:共纳入10篇文献,370例患者,包括6篇随机对照试验,4篇队列研究,文献总体质量较高。Meta分析结果显示:①人脐带间充质干细胞移植组的ASIA感觉功能评分(MD=5.20,95%CI:3.50-6.90,P<0.00001)、AIS分级改善率(RR=2.26,95%CI:1.40-3.65,P=0.0008)、日常生活能力评分(Barthel指数)(MD=5.12,95%CI:1.04-9.20,P=0.01)均高于对照组;②人脐带间充质干细胞移植组在ASIA运动功能评分(MD=3.48,95%CI:-0.14-7.10,P=0.06)、ASIA感觉功能评分中细化的针刺觉(MD=7.58,95%CI:-0.44-15.59,P=0.06)、轻触觉(MD=7.67,95%CI:-0.42-15.77,P=0.06)评分方面,与对照组相比差异无显著性意义;③敏感性分析结果显示,在人脐带间充质干细胞移植组ASIA运动功能评分高于对照组(MD=6.14,95%CI:4.46-7.81,P<0.00001),在日常生活能力评分方面,结论与之前保持一致。纳入的10篇文献中,均报道未有严重不良反应发生,但是个别病例存在轻微的不良反应,经对症治疗后均消失。结论:现有的临床证据表明,人脐带间充质干细胞治疗脊髓损伤安全有效,患者的感觉和运动功能以及日常生活能力可得到显著改善。
文摘Background:This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome.Surgical technique and postoperative management is discussed.Case presentation:A 34-year-old fit and well healthy man was admitted with a history of stab injury to the thoracic spine at thoracic T2/3 level with ASIA impairment score(AIS)score D with an incomplete spinal cord affecting his left lower limb with complete paralysis and right lower limb paresis with impaired sensation below T6 level to L5.Neuroimaging confirmed a penetrating knife injury traversing the T2/3 level causing hemi-section of the spinal cord confirmed intraoperatively.He underwent an urgent exploratory surgery of his spine and a T2/3 laminectomy was performed to aid removal of the knife.The dura was noted to be contused and severed spinal cord was noted to be severed with associated cord oedema.A microsurgical repair of the severed cord was performed with duroplasty followed by intense neuro-rehabilitation.On a 3 month follow up his AIS score is E with lower limb power is 5/5 bilaterally and he is able to mobilise independently up to 8-10 steps without any supportive aid and with crutches he is independently functional and mobile.Conclusion:This is the first documented case of microsurgical repair of severed thoracic spinal cord secondary to traumatic knife injury.In the management of such scenario,apart from the removal of foreign body,repair of the cord with duroplasty should be carefully considered.The role of spinal neuroplasticity in healing following timely repair of the spinal cord along with intense rehabilitation remains the key.This had resulted in a good clinical and functional outcome with in a 18-month follow up.
