【作者】 富灵杰；

【导师】 郑连杰；

【作者基本信息】 大连医科大学 ， 外科学， 2004， 硕士

【摘要】 背景和目的 全球不同的国家,脊髓损伤的年发病率为15~40/100万。急性脊髓损伤(ASCI)的主要原因是交通事故或交通意外、高处坠落或重物砸伤、生活致伤、体育活动如跳水、骑马及自然灾害等。由于损伤常导致损伤平面以下运动及感觉功能完全丧失,给个人、家庭、社会带来巨大负担,因此治疗脊髓损伤的意义重大。脊柱骨折合并脊髓损伤是骨科领域常见的疾患之一,其病理变化过程复杂。现代医学研究指出脊髓损伤产生于两种机制:即原发性损伤机制和继发性损伤机制。原发损伤为不可逆性改变,故治疗主要是针对脊髓创伤后出血、水肿、微循环障碍、局部组织生化改变等一系列继发性损伤的。神经营养因子对神经细胞有促进生长发育的功能,而且对损伤的神经元亦有保护、预防退变和促进再生的作用。中国传统医学认为:脊髓损伤所致的外伤性截瘫,属于“体惰”和“痿证”的范畴,中医理论认为脊髓损伤是因为外力损伤督脉,致使气乱血逆,瘀阻经络,气血不能温煦濡养肢体所致。督脉贯脊、络肾,入络于脑而督诸阳,故督脉受损必致伤肾,肾伤则不能司二阴而见二便功能障碍,不能总督诸阳而致血瘀络阻,经脉不通出现肢体麻木,感觉、运动功能障碍。治疗上要求活血化瘀,疏通督脉,通经活络、益气活血,补肾填精为主。本实验试用一系列较为客观的监测指标来评价牛脑提取液与滋补脾阴方药对大鼠急性脊髓损伤的疗效,并探讨其可能机制。材料及方法 选健康成年Sprague-Dawley大白鼠96只,随机分为硬膜内给牛脑提取液组(A组)、硬膜内给生理盐水组(B组)、腹腔内给牛脑提取液组(C组)、腹腔内给生理盐水组(D组)、口服滋补脾阴方药组(E组)、口服生理盐水组(F组),每组16只,观察时间为12周。采用改良Allen氏装置重物坠落(Weight Dropping, WD)法撞击脊髓背侧,即以质量为10g冲击棒从距脊髓2.5cm高度在玻璃管内垂直下落撞击在软质塑料片上,该塑片一端为凹面,与硬脊膜接触密切,传导势能给T8脊髓,致伤能量为25g·cm,通过预实验可确认该打击力量可致大鼠中等程度脊髓<WP=5>损伤,成功后于T10硬脊膜偏离后正中血管左侧剪开一小洞,将外径为0.61mm的PE-10聚乙烯导管向脊髓损伤区方向蛛网膜下腔内插入3mm,椎旁软组织缝合固定导管,另一端露出皮外,胶布封口,以备术后注药。模型制备过程应用显微器械,并严格无菌操作。硬膜内给牛脑提取液组(A组)、硬膜内给生理盐水组(B组)蛛网膜下腔置管,余造模后关闭切口。撞击成功标志:大鼠尾巴痉挛性摆动,双下肢及躯体回缩样扑动,双下肢呈弛缓性瘫痪。运用脊髓神经功能(BBB评分和Rivlin斜板法)、体感诱发电位、辣根过氧化酶(HRP)示踪、大体观察、组织学及形态计量分析、超微结构变化作为观察指标进行实验观察。结果 硬膜内给牛脑提取液组、腹腔内给牛脑提取液组和口服滋补脾阴方药组与其各自对照组相比,其脊髓神经功能评分、体感诱发电位、脊髓运输能力、大体观察、组织形态计量分析、髓鞘和神经元细胞结构皆有明显改善;硬膜内给牛脑提取液组各项观察指标明显优于腹腔内给牛脑提取液组,差异具有显著性。结论 牛脑提取液无论局部应用或全身应用均能促进大鼠脊髓损伤后神经纤维的修复与再生,但以硬膜内给药为佳;滋补脾阴方药能明显阻止脊髓的继发性损伤,促进大鼠脊髓损伤后神经功能的恢复。更多还原

【Abstract】 Background and Objective: The incidence of spinal cord injury is approximate 15~40 per million annually in different countries. The main reasons that lead to acute spinal cord injury are: traffic accidents, dropping from high places, and so on. The injury often results in the losses of motor, sensory functions below the injured level, that is to say, it brings about large burden on person, family and society. So the treatment of spinal cord injury has a meaningful sense. Spinal column fracture combining with spinal cord injury is a common disease and the process of pathology is complex. Nowadays, modern research concludes that there are two mechanisms that cause SCI: primary mechanism and secondary mechanism. While the treatment is mainly focus on the latter one. Neurotrophic factors can improve the growth functions of nerve cell and protect the injured neurons. Chinese traditional medicine deems that SCI is linked with “Tiduo” and “Weizheng”, so the way to improve SCI is to activate the blood, improve gas and so on. Our experiment aims on the effects and possible mechanisms of bovine brain extract (bBE) and nourishing Piyin Remede (nPR), also tries to find a better solution.Methods: Ninety-six healthy SD rats were divided into 6 equal groups randomly: bBE supplied through subarachnoid cavity (A group), NS supplied through subarachnoid cavity (B group), bBE supplied through abdomen cavity (C group), NS supplied through abdomen cavity (D group), nPR oral taken group (E group), NS oral taken group (F group).Each group has 16 rats and the observing time is 12 weeks. Animal models of incomplete injury of spinal cord were made by Allen’s equipment and a force of 10g×2.5cm on T8~ T9 segment. The force can make a mediate injury on spinal cord through a previous test. Furthermore, A and B group should place a microtube into the subarachnoid cavity. The whole process of model establishing should <WP=7>be aseptic. The BBB score and Rivlin plate, SEP, retrograde and label technique of Horseradish Peroxidase, gross observation, histological and morphological analyses were taken as the observed indices. Results: The value of observed indices of bBE supplied through subarachnoid cavity group, bBE supplied through abdomen cavity group, nPR oral taken group compared with their own control group improved evidently; the value of observed indices of bBE supplied through subarachnoid cavity group compared with bBE supplied through abdomen cavity group enhanced greatly.Conclusions: Bovine brain extract can stimulate the improvement of injured nerve fibers no matter it is used locally or generally, however, the former is better. Nourishing Piyin Remede can hold back the secondary spinal cord injury and accelerate the recovery of spinal nerve function.更多还原