脊髓损伤研究进展2012年-9-6(关骅).pptVIP

脊髓损伤研究进展 中国康复研究中心北京博爱医院 脊柱脊髓外科 关 骅 脊髓损伤是可导致患者终生致残的灾难性损伤，完全性损伤至今尚无有效的治愈方法。长期以来，世界各国学者对此进行了大量基础与临床研究，在脊髓继发性损伤的预防、脊髓损伤功能康复、脊髓神经结构与功能的重建等方面取得了一定进展。 脊髓继发性损伤的预防 脊髓二次损伤的预防 伤后制动与固定 手术固定与减压 脊髓损伤-外科治疗 长期以来认为早期减压有利于脊髓损伤的治疗效果，但缺乏临床证据支持。近来，STASCIS的多中心研究结果支持早期（伤后24小时内）减压治疗。 Early decompression has long been believed to be beneficial for the treatment of SCI,although clinical evidence to support this belief has been lacking. STASCIS,a multicenter,randomized clinical trial,is addressing this issue. 继发性损伤的药物治疗 临床与试验研究一直在探索减少脊髓继发性损伤的方法。现有许多关于脊髓损伤药物治疗的高价值的研究。 Clinical and experimental studies have been conducted to determine mathods to reduce secondary SCI,and to search for effective treatment.There is a long list of high value research manuscripts in many different aspects of spinal cord medicine.（2011，Spinal Cord Vol 49：321） 试验药物治疗 alter neuroinflammation (immunomodulator drugs such as minocycline or antibodies against leukocyte adhesion molecules) reduce free radical damage (glucocorticoids, iron chelators, and glutathione promoters) reduce excitotoxic damage to neurons (N-methyl-D-aspartate (NMDA) receptor antagonists) improve blood flow (opioid antagonists or calcium channel blockers) seal damaged membranes (surfactants) counter the effects of local ionic imbalances (sodium and calcium channel blocker) So far, none of these treatments have been useful for treating spinal cord injury. Marsh等证明Reparixin在脊髓损伤动物模型急性期治疗中减轻了急性炎症，改善了运动功能。 Marsh and Flemming demonstrated in an animal SCI model that acute treatment with Reparixin reduces acute inflammation and is associated with minor improvements in motor function and a significant reduction in the severity of autonomic dysreflexia. 临床药物治疗 对于甲基强的松龙的临床应用仍存在争论，且出现否定应用的证据。最近，动物试验结果显示，甲强龙联合放射疗法，可减少神经胶质增生，利于神经轴突再生，对脊髓损伤后神经功能恢复产生协同效应。 The clinical use of MP continue to be controversial,with emerging evidence arguing against its use.Recently,the result of combined therapy of irradiation and MP in animal model,suggesting it has