选择性脊神经后根切断刺激对大鼠脊髓腰膨大以及脑干网状结构抑制区和易化区c-Fos表达的影响

目的:将选择性脊神经后根切断作为刺激源,观察刺激后不同时间点大鼠脊髓腰膨大以及脑干网状结构抑制区和易化区兴奋神经元细胞核中c-Fos蛋白表达的差异,探讨其对神经元活性和功能的影响。方法:实验于2004-02/06在郑州大学人体解剖学教研室完成。将成年Wistar大鼠64只随机分为脊神经后根切断组(n=24),假手术组(n=24)和正常对照组(n=16)。①模型制作:取背部正中切口,在×10手术显微镜下咬除腰1和腰2椎板,分离左侧腰3～6脊神经后根,并切断2mm。假手术组只暴露脊髓,不进行脊神经后根切断。②组织切片的制备:分别于术后1,2,6和12h相应的时间点,对各组动物进行心脏灌注后,取动物脊髓的腰膨大和脑干部,连续冠状切片,按Paxinos和Watson图谱进行组织核团定位。③免疫组织化学法染色后,在光镜下进行细胞计数和摄影。④细胞计数:光镜下对各切片的免疫阳性细胞进行计数,c-Fos蛋白阳性表达判定标准为细胞核染成深棕色,胞浆未染色,神经细胞无形态轮廓显示。每只大鼠观察腰膨大6张切片,分别计数左侧脊髓灰质板层Ⅰ～Ⅵ内c-Fos蛋白阳性表达细胞核的数量;观察网状结构抑制区和易化区切片6张,计数阳性标记细胞核数量。结果:脊神经后根切断组动物在手术后有2只死亡,随即进行了补充,纳入最后分析的动物为24只;假手术组动物24只,正常对照组动物16只,全部进入统计分析。①各组大鼠左侧腰髓3～6灰质板层Ⅰ～Ⅵc-Fos的表达:脊神经后根切断组脊髓损伤后1,2,6,12h时间点均有明显表达,主要集中在Ⅰ～Ⅲ板层;假手术组在1,2,6h有少量表达;对照组在各个时间点基本无表达。脊神经后根切断组在各个时间点的表达均高于与假手术组和对照组,差异有显著性(P<0.05)。②各组大鼠右侧脑干网状结构c-Fos的表达:在抑制区,各组各个时间点均无明显表达。在易化区,脊神经后根切断组可见大量c-Fos蛋白阳性细胞表达,假手术组有散在细胞表达,对照组基本无表达。脊神经后根切断组在各个时间点的表达均高于与假手术组和对照组,差异有显著性(P<0.05)。结论:本实验观察到选择性脊神经后根切断可引起大鼠同侧腰髓灰质后角和对侧脑干网状结构易化区c-Fos的大量表达,说明脊神经后根切断和网状结构易化区神经元功能的改变存在着密切的联系。结合易化区的功能,推测脊神经后根的切断改变了网状结构抑制区和易化区神经元的活性状态,从而通过网状结构的传出纤维影响各个运动核团,降低了相应核团的兴奋性,从而缓解了痉挛的过程。     

椎板切开复位选择性脊神经后根切断治疗痉挛性脑瘫

目的:探讨通过显微神经外科和电生理技术,进行椎板切开复位选择性脊神经后根切断术对痉挛性脑性瘫痪的治疗效果.方法:行T11～L1椎板切开复位,显微镜下在脊髓圆锥水平将L1～S2神经后根分离成神经小枝,观察电刺激神经后根小枝所诱发的肌肉收缩和肌电图反应,切断异常反应的神经后根小枝.神经后根小枝切断数目不超过60%.结果:所有病例术后肌痉挛程度立即出现明显下降,随访发现所有患者肢体运动功能均有改善,术后未出鲻现腰椎前凸、畸形及滑脱现象.结论:T11～L1椎板切开复位,脊髓圆锥入路选择性L1～S2神经后根切断,能够有效地控制脑瘫所引起的下肢肌痉挛,改善运动功能并减少术后并发症的发生.     

选择性脊神经后根切断术前的医疗康复残疾测量初探

目的：探讨选择性脊神经后根切断术（ＳＰＲ）术前的医疗康复残疾测量和功能预后预测。方法：使用儿童功能独立检查（ＦｕｎｃｔｉｏｎａｌＩｎｄｅｐｅｎｄｅｎｔＭｅａｓｕｒｅｆｏｒＣｈｉｌｄｒｅｎ,简称ＷｅｅＦＩＭ）和临床神经肌肉系统障碍程度分级的方法评定２３例痉挛性脑瘫（ＳｐａｓｔｉｃＣｅｒｅｂｒａｌＰａｌｓｙ,ＳＣＰ）患者的功能状态。结果：各年龄组ＷｅｅＦＩＭ总分、行动和步行等与障碍程度的排序是一致的,结论：ＷｅｅＦＩＭ可作为基本的功能预后预测指标为ＳＰＲ手术及手术前后康复治疗方案的制定提供依据。     

选择性脊神经后根切断术的护理

总结手术室整体护理在选择性脊神经后根切断术治疗痉挛性脑瘫手术中的护理配合方法及注意事项,主要包括术前健康指导、心理护理、器械;位备、体位准备、术中配合要点。认为术前健康指导、心理护理、术中熟练配合有利于缩短手术时间,减少并发症的发生。     

应用显微技术行选择性脊神经后根切断手术的配合

探讨应用显微外科技术行选择性脊神经后根切断术的手术配合及手术过程的护理方法.回顾2005年2月-2008年1月行选择性脊神经后根切断术(SPR)的护理记录,认为充分的术前准备、娴熟的手术配合、细致的病情观察和密切的护理是手术顺利进行的重要保证.     

选择性脊神经后根切断术病人的护理

选择性脊神经后根切断术病人的护理王金玉关键词脑瘫，选择性脊神经后根切断术，护理Ｋｅｙｗｏｒｄｓ：ＣｅｒｅｂｒａｌｐａｌｓｙＳｅｌｅｃｔｉｖｅｐｏｓｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙＮｕｒｓｉｎｇｃａｒｅ选择性脊神经后根切断术，是一项新的神经显微外科技术。...     

选择性脊神经后根切断术前的医疗康复残疾测量初探

目的：探讨选择性脊神经后根切断术(SPR)术前的医疗康复残疾测量和功能预后预测。方法：使用儿童功能独立检查（Functional Independem Measure for Children．简称WeeFIM)和临床神经肌肉系统障碍程度分级的方法评定23例痉挛性脑瘫(Spastic Cerebral Palsy,SCP)患的功能状态。结果：各年龄组WeePIM总分、行动和步行等与障碍程度的排序是一致的．结论：WeeFIM可作为基本的功能预后预测指标为SPR手术及手术前后康复治疗方案的制定提供依据。     

脊髓圆锥部选择性脊神经前后根切断术早期并发症的护理

总结了28例选择性脊神经前后根切断术病人早期并发症如高热惊厥、伤口皮缘坏死、呕吐、脑脊液漏、神经根麻痹的观察及护理,认为术后积极的观察护理对于并发症性质的鉴别及其转归很有意义,早期发现,早期处理对于术后顺利康复起着重要的作用。     

脑瘫选择性脊神经后根切断术的运动疗法

采用选择性腰骶段脊神经后根切断术治疗脑癍患者的下肢痉挛,并且于手术前后配合运动疗法。选取研究对象60例,男45例,女15例;年龄范围4～33岁;其中传统手术方法15例,选择性脊神经后根切断术45例。通过对传统手术方法组与选择性脊神经后根切断术组的比较,以及手术前有无运动疗法的比较,证明了脑瘫选择性脊神经后根切断术配合术前术后运动疗法,疗效明显提高,并讨论了术后运动疗法的机理、方法及程序。     

Effects of cholinomimetic injection into the brain stem reticular formation on halothane anesthesia and antinociception in rats

The brain stem reticular formation plays an important role in determining consciousness and arousal. Modulation of cholinergic neurotransmission in this region alters the sleep-wake cycle. In the present study, we examined the effect of the direct application of cholinergic agents into the pontine reticular nucleus on anesthetic requirements and recovery and antinociception in rats. Sprague-Dawley rats were implanted with 24-gauge guide cannulas 1.0 mm above the oral portion of pontine reticular nucleus (PnO) while under pentobarbital anesthesia with the use of a stereotaxic apparatus. After recovery from surgery, animals were randomly assigned to one of the following protocols: minimum alveolar concentration (MAC), recovery time, tail-flick latency, or motor blockade. All measurements were performed after carbachol microinjection into the PnO after pretreatment with atropine or mecamylamine. Carbachol injection into the PnO significantly reduced MAC of halothane and prolonged recovery in a dose-dependent manner. Pretreatment with atropine reversed MAC reduction by carbachol, and both atropine and mecamylamine shortened recovery time under carbachol. In unanesthetized rats, carbachol produced antinociceptive effects as reflected by a change in tail-flick latency response. Atropine and mecamylamine inhibited antinociceptive effects of carbachol. These results suggest that cholinomimetic injection into the PnO modulates the anesthetic state produced by halothane, suggesting participation of this area in the mechanisms in the brain that generate the anesthetic state.     

选择性脊神经后根切断术治疗小儿痉挛型脑瘫

目的：观察选择性脊神经后根切断术治疗小儿痉挛型脑瘫的疗效。方法：对517例痉挛型脑瘫患儿施行选择性脊神经后根切断术。术后随访24个月，观察痉挛解除情况并进行功能评定。结果：术后疗效优298例、良187例，优良率达93．8％。结论：选择性脊神经后根切断术治疗小儿痉挛型脑瘫疗效显著。     

电针对士的宁诱发大鼠脊髓背角c-fos基因表达的影响

背景大鼠皮下注射士的宁后电针解溪或昆仑穴,是否可诱发出脊髓跨节段的c-fos表达.目的通过电针对士的宁诱发大鼠脊髓背角c-fos基因表达情况,探讨针刺信息传递中脊髓兴奋性的作用.设计完全随机对照研究.单位南京中医药大学江苏省针灸学重点实验室.对象采用健康雄性Wistar大鼠,体质量200～230 g.随机分为空白对照组,假电针组,士的宁组,电针解溪组,士的宁解溪组,电针昆仑组和士的宁昆仑组等7组,每组8只.干预空白对照组不做任何处理;假电针组臀部皮下注射生理盐水(与士的宁等容量,下同)30 min后解溪穴插针不给电刺激;士的宁组臀部皮下注射士的宁(1.0 mg/kg,下同)30 min后解溪穴插针不给电刺激;电针解溪组注射生理盐水30 min后电针解溪穴;士的宁解溪组注射士的宁30 min后电针解溪穴;电针昆仑组注射生理盐水30 min后电针昆仑穴;士的宁昆仑组注射士的宁30 min后电针昆仑穴.主要观察指标各组大鼠不同脊髓节段背角的c-fos表达.结果皮下注射士的宁可在大鼠脊髓L5诱发中等量的c-fos表达,而皮下注射士的宁后电针解溪或昆仑穴,不仅可使脊髓L5的c-fos表达增强,同时在T12和C8节段也可诱发c-fos表达;其标记最密集的区域主要在背角的Ⅱ,Ⅲ,Ⅳ层亦有少量分布.结论在脊髓兴奋性提高的条件下,针刺信息可能沿脊髓进行跨节段传递.提示脊髓兴奋性的改变可能是影响针刺信息传递的重要基础之一.     

高压氧对鼠损伤脊髓内神经生长相关蛋白表达的影响

目的研究高压氧(HBO)治疗对脊髓损伤(SCI)组织中神经生长相关蛋白(GAP-43)表达水平的影响。方法用Allen氏WD法制作鼠脊髓损伤模型。55只成年Wistar鼠随机分为正常组、SCI对照组和HBO治疗组。治疗组于术后每天HBO治疗1次，对照组无特殊治疗：各组分别于术后1d、4d、7d、10d、14d各随机取鼠5只，取损伤脊髓组织，Western blot法检测GAP-43表达水平。结果GAP-43在正常成年鼠脊髓中少量表达，SCI后表达增加且HBO治疗组较对照组表达更为显著：术后1周时SCI对照组GAP-43表达达到高峰，2周时降至接近初始水平，但HBO治疗组GAP-43表达仍维持高水平。结论HBO可增强损伤脊髓组织GAP-43表达。     

选择性脊神经后根切断术联合生物反馈综合治疗对痉挛性脑瘫患儿脑功能及肌张力的影响

目的探讨选择性脊神经后根切断术联合生物反馈综合治疗对痉挛性脑瘫患儿脑功能及肌张力的影响。方法80例痉挛性脑瘫患儿随机分为对照组(选择性脊神经后根切断术)和观察组(选择性脊神经后根切断术联合生物反馈综合治疗),每组40例。比较治疗前后2组患者脑电功率水平、粗大运动功能、肌张力及关节活动度的变化情况。结果与对照组相比,观察组治疗后脑θ波值及θ/β波值均显著降低,β波值显著增高(P0.05);与对照组相比,观察组治疗后粗大运动功能量表(GMFM)66项评分显著增高(P0.05);与对照组相比,观察组治疗后腓肠肌肌张力及足背屈角均显著降低(P0.05)。结论选择性脊神经后根切断术联合生物反馈综合治疗能够明显改善痉挛性脑瘫患儿的脑功能,降低患儿肌张力。     

Effect of selective posterior rhizotomy on transverse myelitis in a patient with systemic lupus erythematosus

This report describes the case of a 26-yr-old man experiencing transverse myelitis, a rare but serious complication of systemic lupus erythematosus occurring in less than 1% of patients with systemic lupus erythematosus, 4 yr after the onset of systemic lupus erythematosus. Significant neurologic deficits, including spastic paraplegia, dysthetic pain, and impaired bladder control, which made him completely bedridden and dependent in activities of daily living, continued, despite his immediate diagnosis and treatment. The patient received bilateral L1 to S1 selective posterior rhizotomy 1 yr after the onset of transverse myelitis, and 10 mo after selective posterior rhizotomy, he was completely independent in ambulation and self-care, demonstrating that selective posterior rhizotomy can be safely performed and its goals achieved under different medical conditions, as long as thorough preoperative evaluation and every possible precaution have been taken.     

Effect of intrathecal octreotide on thermal hyperalgesia and evoked spinal c-Fos expression in rats with sciatic constriction injury

This study was designed to determine whether intrathecal octreotide (sandostatin), a synthetic octapeptide derivative of somatostatin, relieved thermal hyperalgesia and reduced the evoked spinal c-Fos expression in rats with chronic constriction injury (CCI) of the sciatic nerve. Intrathecal catheters were implanted in rats 7 days before CCI of the sciatic nerve over the left hind limb. After confirmation of the development of thermal hyperalgesia by decreased paw withdrawal latencies (PWL) to heat stimulation 7 days after CCI, intrathecal sandostatin at 20, 40, and 80 microg was administered, respectively. Rats in the control group received saline injections intrathecally. PWLs were evaluated at 30, 60, 120, 180, and 240 min after drug administration. Detection of Fos-like immunoreactivity (Fos-LI) neurons in the dorsal horn of the spinal cord following drug administration was performed after mechanical stimulation (stroking of the hind paws) on the 14th day after CCI. The reduction of PWL was attenuated significantly in the groups that received intrathecal sandostatin at 20, 40, and 80 g when compared with the saline group. However, PWL did not return to pre-CCI values in all groups. In the 40 microg group, PWL returned up to 76% of pre-CCI values 120 min after drug administration. Stroking of the hind paw in CCI-treated (ipsilateral) limbs induced a significantly greater expression of spinal Fos-LI neurons than that of non-CCI treated (contralateral) limbs in each group. The number of Fos-LI neurons in animals receiving intrathecal sandostatin was dose-dependently reduced. Expression of Fos-LI neurons in the 80 microg group was nearly completely inhibited. These data suggest that intrathecal sandostatin significantly relieved thermal hyperalgesia behaviorally but with limited effects and dose-dependently reduced spinal Fos-LI neurons expression evoked by stroking stimulation, which may reflect mechanical allodynia in rats with sciatic constriction injury. This implies that intrathecal sandostatin was effective in the treatment of neuropathic pain.     

选择性脊神经后根切断术对脑瘫患者肢体功能改善的作用

目的:对选择性脊神经后根切断术(SPR)对于痉挛解除、术后患者肢体功能状态,以及手术后并发症进行分析观察。方法:对1990年—2000年收治的825例随访时间超过2年的脑瘫患者,对比观察手术前后的痉挛状态、肢体功能状态,并进行统计分析。结果:肌张力由术前平均3.44级下降至术后1.23级;术前能够独立行走的129例患者中,107例步态有明显改善;借助行走的418例患者中,263例术后可独立行走。爬行278例患者中,91例可以独立行走,52例可以借助站立和行走;癫痫发作减少31例;流涎患者术后49例减轻,21例消失。斜视患者中132例术后减轻。语言功能障碍456例中72例发音改善吐字转变为较清晰。328例伴有上肢痉挛的患者术后67例上肢肌张力有不同程度的减轻。术后痉挛复发2例、腰痛16例、腰部无力41例、下肢无力24例、小腿及足底麻木50例。尿潴留8例。脊柱侧弯15例、腰椎后凸2例。术后发现4例腰椎峡部裂和1例Ⅰ°腰椎滑脱。结论:SPR可以在有效地解除肢体痉挛的同时,达到改善肢体功能的目的且手术并发症少。