中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Trauma
2015年
11期
1035-1040
,共6页
脊髓缺血%再灌注损伤%功能障碍
脊髓缺血%再灌註損傷%功能障礙
척수결혈%재관주손상%공능장애
Spinal cord ischemia%Reperfusion injury%Dysfunction
目的 探讨脊髓缺血/再灌注损伤后兔后肢功能障碍的特点. 方法 选择健康成年日本大耳白兔28只,按随机数字表法分为正常对照组(4只)和模型组(24只).采用选择性腰动脉阻断法,制备兔脊髓缺血/再灌注损伤模型,模型组又分缺血30 min/再灌注组(Ⅰ组)、缺血60 min/再灌注组(Ⅱ组)、缺血90min/再灌注组(Ⅲ组)3个亚组,每组各8只.于缺血/再灌注1,3,7d采用Jacobs评级、Reuters评分以及Rivlin斜板试验分别对各组动物后肢功能进行评价,并通过皮层体感诱发电位(CSEP)检测各组神经传导功能的变化. 结果 Ⅰ组缺血/再灌注1,3,7d截瘫率分别为50％、38％和38％,Ⅱ组分别为75％、88％和100％,Ⅲ组均为100％.缺血/再灌注1,3d时,三组截瘫率差异有统计学意义(P＜0.01),缺血/再灌注7d时,与Ⅰ组比较,Ⅱ、Ⅲ组差异均有统计学意义(P＜0.01),而Ⅱ组和Ⅲ组间差异无统计学意义.随着再灌注时间的延长,Ⅰ组Reuters评分降低,与对照组差异无统计学意义,而Ⅱ、Ⅲ组进一步升高,与Ⅰ组和对照组差异有统计学意义(P＜0.01),但Ⅱ组和Ⅲ组间差异无统计学意义.对照组Rivlin斜板临界角度为(68.4±3.0)°,斜板障碍率为0％;缺血/再灌注1d时,与对照组比较,Ⅰ、Ⅱ、Ⅲ组斜板临界角度[(58.8±4.1)°、(38.5±2.8)°、(29.8±1.8)°]、斜板障碍率[(14.5±0.9)％、(43.6±2.4)％、(56.0±2.9)％]差异均有统计学意义(P＜0.01);缺血/再灌注3,7d时,Ⅱ、Ⅲ组斜板临界角度较缺血/再灌注1d时有小幅度降低,斜板障碍率有轻微升高,与对照组差异均有统计学意义(P＜0.01);Ⅰ组斜板临界角度则较缺血/再灌注3d后上升,斜板障碍率则下降,与对照组差异无统计学意义.CSEP结果显示,缺血/再灌注7d时Ⅰ组N1波和P1波潜伏时分别为(26.2±0.7)ms和(50.2±4.2)ms,与对照组[(23.7±0.5)ms和(48.1±4.1)ms]比较差异无统计学意义(P＞0.05),Ⅱ组[(33.1±1.8)ms和(58.6 ±4.0) ms]较对照组、Ⅰ组均明显延长(P＜0.01),Ⅲ组波形消失.结论 脊髓缺血时间长短与再灌注造成损伤的严重程度呈正相关,且缺血/再灌注损伤造成的后肢功能障碍主要表现为痉挛性截瘫.
目的 探討脊髓缺血/再灌註損傷後兔後肢功能障礙的特點. 方法 選擇健康成年日本大耳白兔28隻,按隨機數字錶法分為正常對照組(4隻)和模型組(24隻).採用選擇性腰動脈阻斷法,製備兔脊髓缺血/再灌註損傷模型,模型組又分缺血30 min/再灌註組(Ⅰ組)、缺血60 min/再灌註組(Ⅱ組)、缺血90min/再灌註組(Ⅲ組)3箇亞組,每組各8隻.于缺血/再灌註1,3,7d採用Jacobs評級、Reuters評分以及Rivlin斜闆試驗分彆對各組動物後肢功能進行評價,併通過皮層體感誘髮電位(CSEP)檢測各組神經傳導功能的變化. 結果 Ⅰ組缺血/再灌註1,3,7d截癱率分彆為50％、38％和38％,Ⅱ組分彆為75％、88％和100％,Ⅲ組均為100％.缺血/再灌註1,3d時,三組截癱率差異有統計學意義(P＜0.01),缺血/再灌註7d時,與Ⅰ組比較,Ⅱ、Ⅲ組差異均有統計學意義(P＜0.01),而Ⅱ組和Ⅲ組間差異無統計學意義.隨著再灌註時間的延長,Ⅰ組Reuters評分降低,與對照組差異無統計學意義,而Ⅱ、Ⅲ組進一步升高,與Ⅰ組和對照組差異有統計學意義(P＜0.01),但Ⅱ組和Ⅲ組間差異無統計學意義.對照組Rivlin斜闆臨界角度為(68.4±3.0)°,斜闆障礙率為0％;缺血/再灌註1d時,與對照組比較,Ⅰ、Ⅱ、Ⅲ組斜闆臨界角度[(58.8±4.1)°、(38.5±2.8)°、(29.8±1.8)°]、斜闆障礙率[(14.5±0.9)％、(43.6±2.4)％、(56.0±2.9)％]差異均有統計學意義(P＜0.01);缺血/再灌註3,7d時,Ⅱ、Ⅲ組斜闆臨界角度較缺血/再灌註1d時有小幅度降低,斜闆障礙率有輕微升高,與對照組差異均有統計學意義(P＜0.01);Ⅰ組斜闆臨界角度則較缺血/再灌註3d後上升,斜闆障礙率則下降,與對照組差異無統計學意義.CSEP結果顯示,缺血/再灌註7d時Ⅰ組N1波和P1波潛伏時分彆為(26.2±0.7)ms和(50.2±4.2)ms,與對照組[(23.7±0.5)ms和(48.1±4.1)ms]比較差異無統計學意義(P＞0.05),Ⅱ組[(33.1±1.8)ms和(58.6 ±4.0) ms]較對照組、Ⅰ組均明顯延長(P＜0.01),Ⅲ組波形消失.結論 脊髓缺血時間長短與再灌註造成損傷的嚴重程度呈正相關,且缺血/再灌註損傷造成的後肢功能障礙主要錶現為痙攣性截癱.
목적 탐토척수결혈/재관주손상후토후지공능장애적특점. 방법 선택건강성년일본대이백토28지,안수궤수자표법분위정상대조조(4지)화모형조(24지).채용선택성요동맥조단법,제비토척수결혈/재관주손상모형,모형조우분결혈30 min/재관주조(Ⅰ조)、결혈60 min/재관주조(Ⅱ조)、결혈90min/재관주조(Ⅲ조)3개아조,매조각8지.우결혈/재관주1,3,7d채용Jacobs평급、Reuters평분이급Rivlin사판시험분별대각조동물후지공능진행평개,병통과피층체감유발전위(CSEP)검측각조신경전도공능적변화. 결과 Ⅰ조결혈/재관주1,3,7d절탄솔분별위50％、38％화38％,Ⅱ조분별위75％、88％화100％,Ⅲ조균위100％.결혈/재관주1,3d시,삼조절탄솔차이유통계학의의(P＜0.01),결혈/재관주7d시,여Ⅰ조비교,Ⅱ、Ⅲ조차이균유통계학의의(P＜0.01),이Ⅱ조화Ⅲ조간차이무통계학의의.수착재관주시간적연장,Ⅰ조Reuters평분강저,여대조조차이무통계학의의,이Ⅱ、Ⅲ조진일보승고,여Ⅰ조화대조조차이유통계학의의(P＜0.01),단Ⅱ조화Ⅲ조간차이무통계학의의.대조조Rivlin사판림계각도위(68.4±3.0)°,사판장애솔위0％;결혈/재관주1d시,여대조조비교,Ⅰ、Ⅱ、Ⅲ조사판림계각도[(58.8±4.1)°、(38.5±2.8)°、(29.8±1.8)°]、사판장애솔[(14.5±0.9)％、(43.6±2.4)％、(56.0±2.9)％]차이균유통계학의의(P＜0.01);결혈/재관주3,7d시,Ⅱ、Ⅲ조사판림계각도교결혈/재관주1d시유소폭도강저,사판장애솔유경미승고,여대조조차이균유통계학의의(P＜0.01);Ⅰ조사판림계각도칙교결혈/재관주3d후상승,사판장애솔칙하강,여대조조차이무통계학의의.CSEP결과현시,결혈/재관주7d시Ⅰ조N1파화P1파잠복시분별위(26.2±0.7)ms화(50.2±4.2)ms,여대조조[(23.7±0.5)ms화(48.1±4.1)ms]비교차이무통계학의의(P＞0.05),Ⅱ조[(33.1±1.8)ms화(58.6 ±4.0) ms]교대조조、Ⅰ조균명현연장(P＜0.01),Ⅲ조파형소실.결론 척수결혈시간장단여재관주조성손상적엄중정도정정상관,차결혈/재관주손상조성적후지공능장애주요표현위경련성절탄.
Objective To investigate the effect of spinal cord ischemia/reperfusion injury on hindlimb dysfunction in rabbits.Methods Twenty-eight health adult rabbits were distributed into normal control group (n =4) and model group (n =24) according to the random number table.The modelof spinal cord ischemia/reperfusion injury was established by selective occlusion of lumbar arteries.The model group were submitted to ischemia for 30 min (Group Ⅰ),60 min (Group Ⅱ) and 90 min (Group Ⅲ) before the reperfusion with 8 rabbits each.Jacobs score,Reuters score and Rivlin inclined plane test were used to evaluate the hindlimb function in each Group at days 1,3 and 7 after reperfusion.Changes in nerve conduction function in each group were observed using the cortical somatosensory evoked potential (CSEP).Results At days 1,3 and 7,the paraplegia rates in group Ⅰ were 50％,38％ and 38％ respectively,in Group Ⅱ were 75％,88％ and 100％,and in Group Ⅲ were all 100％.Paraplegia rate differed significantly among the three groups at 1 d and 3 d (P ＜ 0.01).Paraplegia rate differed significantly in Groups Ⅱ and Ⅲ when compared to that in Group Ⅰ at 7 d (P ＜ 0.01),but there was no significant difference between Groups Ⅱ and Ⅲ (P ＞ 0.05).With the prolongation of reperfusion,the Reuters score in Group Ⅰ dropped but not differed from that in control group (P ＞ 0.05);the Reuters score in Groups Ⅱ and Ⅲ increased and differed from that the control group (P ＜0.01),but the difference between Groups Ⅱ and Ⅲ was insignificant (P ＞ 0.05).Critical angle and obstacle rate of the inclined plane in control group were (68.4 ± 3.0)° and 0％.One day after reperfusion,critical angles of the inclined plane in Groups Ⅰ,Ⅱ and Ⅲ were (58.8 ± 4.1) °,(38.5 ± 2.8) ° and (29.8 ± 1.8) °,and the obstacle rates were (14.5 ± 0.9) ％,(43.6 ± 2.4) ％ and (56.0 ± 2.9) ％.There were significant differences compared to control group (P ＜ 0.01).Slight decrease in critical angle of the inclined plane but a minor increase in the obstacle rate was detected in Groups Ⅱ and Ⅲ at 3 d and 7 d after reperfusion,and the differences were significant compared to control group (P ＜ 0.01).Three days after reperfusion,critical angle of the inclined plane raised and obstacle rate of the inclined plate fell in group Ⅰ,not significantly different from these in control group (P ＞ 0.05).Latencies of CSEP N1 and P1 waves in Group Ⅱ [(33.1 ± 1.8) ms and (58.6 ± 4.0) ms] were longer than these in control group [(23.7±0.5)msand (48.1±4.1)ms]andgroup Ⅰ [(26.2±0.7)ms and (50.2±4.2)ms] (P＜ 0.01) 7 days after reperfusion,but the differences between control group and Group Ⅰ were insignificant (P ＞ 0.05).While the CSEP wave disappeared in Group Ⅲ.Conclusions Severity of spinal cord inschemia/reperfusion injury is related to the duration of ischemia.Hindlimb dysfunction caused by ischemia/reperfusion injury is characterized mainly by spastic paraplegia.
