康复干预对脊髓损伤后神经功能恢复的临床与实验研究

发布时间：2018-04-15 05:11

  本文选题：脊髓损伤 + 康复　； 参考：《南京医科大学》2017年博士论文

【摘要】：第一部分:康复治疗对脊髓损伤患者功能恢复的影响背景:既往研究表明,运动康复治疗可以促进脊髓损伤(spinal cord injury,SCI)运动功能恢复。但有关运动康复治疗是否会促通SCI后上行和/或下行两条传导通路,以及运动效应与神经传导通道的关系尚不清楚。目的:观察康复治疗对不同程度胸腰段脊髓损伤患者体感诱发电位(SEPs)和修订的Barthel指数(MBI)的影响,并探讨体感诱发电位和修订的Barthel指数的应用价值。方法:取脊髓损伤患者19例,按照美国脊髓损伤学会脊髓损伤程度的分级(ASIA)对患者进行分类。所有的患者都进行为期1个月的运动治疗、作业治疗、神经肌肉电刺激和心理治疗。康复治疗前后分别对患者进行SEPs检查和修订的Barthel指数评分。结果:A、B、C、D级脊髓损伤患者MBI评分和SEPs相关指标,康复前后比较均有明显的统计学意义(P0.05),不同病程康复前后比较均有明显的统计学意义(P0.05),而且SEPs和MBI之间存在直线相关性。结论:康复治疗能改善脊髓损伤患者功能,不同类型脊髓损伤的康复价值不一,体感诱发电位结合修订的Barthel指数评分法,能够准确评估康复效果。第二部分:三种高频电疗对急性脊髓损伤大鼠神经功能恢复的对比研究背景:短波、超短波和微波已被证实对外周神经损伤具有营养、再生及功能恢复作用,但短波、超短波和微波对脊髓损伤后的神经修复效果尚不清楚。目的:观察无热量短波、超短波和微波对急性脊髓损伤大鼠神经功能恢复和BDNF-TrkB表达的影响,并探讨其可能作用机制。方法:成年雌性SD大鼠120只,随机分为Sham组(24只)、SCI组(24只)、SW组(24只)、USW组(24只)和MW组(24只)。应用改良Allen' s法制备大鼠脊髓损伤模型。Sham组仅行椎板切除术暴露硬脊膜,不予打击。SW组、USW组和MW组在脊髓损伤造模后24小时分别给予受损部位无热量短波、超短波和微波治疗,10 min/次,1次/d,至取材前。SCI组不给予任何治疗。在造模后1d、7d、14d和21d用BBB评分、体感诱发电位(SEPs)和运动诱发电位(MEPs)评定脊髓损伤后后肢功能恢复情况并获取损伤段脊髓标本,用免疫组织化学方法检测SCI组、SW组、USW组和MW组脊髓在损伤后不同时段BDNF-TrkB的表达。应用方差分析法比较三种治疗效果,对BBB评分、SEPs、MEPs和BDNF-TrkB进行相关分析。结果:BBB评分结果提示,SW组和USW组大鼠7d、14d、21d时的BBB评分均较SCI组和MW组明显提高(P0.01);SCI组和MW组BBB评分7d时变化不明显(P0.05),14d后MW组优于SCI组(P0.05)。SEPs和MEPs结果显示,SW组和USW组大鼠7d、14d、21d时的神经功能较SCI组和MW组明显改善(P0.01);MW组与SCI组相比,在7d时潜伏期和波幅无差异(P0.05),在14d和21d时潜伏期和波幅明显改善(P0.01)。免疫组织化学方法提示,与SCI组相比,SW组、USW组和MW组在一定时间段能上调损伤脊髓区BDNF-TrkB 的表达(P0.05)。7d 和 14d 时SW 组和USW 组的BDNF-TrkB 表达较SCI组和MW组高(P0.01),各时间点MW组的BDNF-TrkB表达较SCI组差异无统计学意义(P0.05)。在术后7d、14d和21d,BBB评分与SEPs、MEPs和BDNF-TrkB表达呈线性相关,BDNF与TrkB正相关,SEPs和MEPs正相关。结论:无热量短波、超短波和微波均能促进损伤脊髓的神经传导功能恢复,其机制可能与短波、超短波和微波上调损伤区脊髓BDNF-TrkB的表达有关,其中超短波的效果优于短波,而短波的效果要优于微波,且微波不宜过早使用。
[Abstract]:The first part: the effect of rehabilitation therapy on the background of the functional recovery of patients with spinal cord injury: Previous studies have shown that exercise rehabilitation therapy can promote spinal cord injury (spinal cord, injury, SCI). But the recovery of motor function rehabilitation training will promote through SCI uplink and / or two pathways, and the relationship between exercise and effect nerve conduction channel is unclear. Objective: To observe the effect of rehabilitation therapy on different degree of patients with thoracolumbar spinal cord injury somatosensory evoked potential (SEPs) and modified Barthel index (MBI) effect, and to explore the application value of somatosensory evoked potential and revised Barthel index. Methods: 19 cases of patients with spinal cord injury, according to classification of American Spinal Injury Association Degree of spinal cord injury (ASIA) to classify the patients. All patients were treated for 1 months exercise, operation therapy, neuromuscular electrical stimulation and rehabilitation therapy. The complex respectively before and after treatment in patients were examined by SEPs and modified Barthel index score. Results: A, B, C, SEPs and MBI score in patients with spinal cord injury related indicators of D, before and after rehabilitation were statistically significant (P0.05), obvious statistical significance before and after different duration of rehabilitation were significant (P0.05), and there was a linear correlation between SEPs and MBI. Conclusion: rehabilitation therapy can improve the function of patients with spinal cord injury, spinal cord injury rehabilitation value of different types of a somatosensory evoked potentials and the revised Barthel score method, able to accurately assess the effect of rehabilitation. The second part: three high frequency electrotherapy on acute spinal cord injury recovery of nerve in rats background: the function of shortwave, ultrashort wave and microwave has been confirmed with nutrition on peripheral nerve injury, regeneration and functional recovery, but the shortwave, ultrashort wave and micro wave on the nerve after spinal cord injury 淇�澶嶆晥鏋滃皻涓嶆竻妤�.鐩�鐨�:瑙傚療鏃犵儹閲忕煭娉，

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