多发性硬化临床表现多样,其中大脑半球型多表现为精神症状、癫痫、偏瘫或感觉异常等,而以截瘫及排尿障碍为表现者少见。本文对表现为“脑性截瘫”的3 例MS患者的临床和MRI特点进行回顾分析,以此提高对于MS的认识水平。
Objective To observe the result of reconstructing quadriceps femoris function in the paraplegia rats by using the 7th cervical nerve root (C7) transposition with autologous and allogeneic neural transplantation. Methods Twenty16-week-old SPF male Wistar rats were adopted to prepare frozen sciatic nerve. Thirty-six Wistar rats were divided into 2 groups (group A and group B, n=18). The left paraplegia model was establ ished with left spinal cord hemisection by the micro scissors under the operation microscope. After the model establ ishment, the homolateral autologous sciatic nerve was bridged with the femoral nerve root by the translocation of C7 in group A, while the allogeneic sciatic nerve was bridged with the femoral nerve root by the translocation of C7 in group B. At 16 weeks and 24 weeks after operation, 9 rats in each group were selected for the neuroelectric-physiological test and then the histomorphology of the nerves was observed under the microscope and the electron microscope. The fresh weight recovery rate of quadriceps femoris was calculated. Results At 16 and 24 weeks after operation, the nerve action-evoked potential (NAP) was (1.14 ± 0.07) mV and (1.21 ± 0.07) mV in group A, and (0.87 ± 0.06) mV and (0.99 ± 0.05) mV in group B; the nerve conduction velocity (NCV) was (17.34 ± 2.15) m/s and (19.00 ± 3.02) m/s in group A, and (11.23 ± 1.45) m/s and (12.54 ± 1.59) m/s in group B, respectively, indicating significant differences (P lt; 0.05) between 2 groups. At 16 and 24 weeks after operation, HE staining and Bielschowsky staining showed that group A had a large number of nerve fiber regeneration, with a regular arrange of axons; while group B had l ittle nerve fiber regeneration with a scattered arrange of axons. At 24 weeks after operation, images in TEM showed a large number of regeneration myel inated nerve fibers and a small number of unmyel inated nerve fibers through the transplanted nerve in two groups. At 16 weeks after operation, the number of myel inated nerve fibers in group A and group B was (438 ± 79) and (196 ± 31) / vision, the areas of myel inated nerve fiberswere (5 596.00 ± 583.94) and (4 022.63 ± 615.75) μm2 / vision; after 24 weeks, the number of myel inated nerve fibers in groups A and B were (642 ± 64) and (321 ± 75)/vision, the areas of myel inated nerve fibers were (6 689.50 ± 1 142.10) and ( 4 733.00 ± 982.22) μm2/vision, indicating significant differences between two groups (P lt; 0.05). There was no statistically significant difference (P gt; 0.05) in the wet weight recovery rate of quadriceps between group A and group B at 16 weeks (87.96% ± 4.93% vs. 86.47% ± 7.47%) and at 24 weeks after operation (90.10% ± 4.22% vs. 87.66% ± 3.14%). Conclusion C7 transposition combined with autograft and allograft of sciatic nerve can reconstruct the partial function of the quadriceps femoris in paraplegia rats. The effect of graft is better than that of graft obviously.
ObjectiveTo explore the risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection and to construct a nomogram prediction model for postoperative paraplegia in these patients. MethodsStanford type A aortic dissection patients admitted to the First Affiliated Hospital with Nanjing Medical University from January 2021 to August 2024 were selected as the research subjects, and the occurrence of postoperative paraplegia was statistically analyzed. LASSO regression was used to screen the predictive factors, and further multivariate Logistic regression analysis was conducted to identify the independent risk factors. A nomogram model was constructed based on R software (4.2.3), and internal validation was performed using the Bootstrap method. ResultsA total of 353 patients with Stanford type A aortic dissection were included, among whom 27 (7.65%) developed paraplegia after surgery. Multivariate logistic regression analysis showed that preoperative hypotension, prolonged cardiopulmonary bypass time, prolonged aortic cross-clamping time, preoperative renal insufficiency, postoperative infection, non-type I spinal cord blood supply, and intraoperative mean arterial pressure <60mmHg were independent risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection (P<0.05). The area under the receiver operating characteristic curve of the nomogram model was 0.920 [95% CI (0.879, 0.961)]; the calibration curve showed that the predicted values of the nomogram model were basically consistent with the actual values (Hosmer-Lemeshow test, χ2=3.201, P=0.921); the decision curve analysis showed that within the threshold probability range of 1% to 100%, the nomogram prediction results had good benefit values for the intervention of postoperative paraplegia in patients with Stanford type A aortic dissection. ConclusionPreoperative hypotension, prolonged cardiopulmonary bypass time, prolonged aortic cross-sectional time, renal insufficiency, postoperative infection, non-type I spinal cord blood supply, and intraoperative mean arterial pressure <60 mmHg are all independent risk factors for postoperative paraplegia in patients with Stanford type A aortic dissection. The nomogram model constructed based on the above risk factors can effectively predict the postoperative paraplegia risk of patients with Stanford type A aortic dissection.
Objective To evaluate the method of the allogenous boneplate reconstructing the spinal channel and grafting in treatment of thoracolumbar burst fracture with paraplegia. Methods Thirty-six patients with thoracolumbar burst fracture with paraplegia were included in this study. Their ages ranged from 18 to 56 (average, 38). The vertebral injury involvedT11 in 3 patients，T12 in 10 patients，L1 in 14 patients，L2 in 7 patients，and L3 in 2 patients. Neurological deficits were classified by the Frankel grading. There were 9 patients in grade A, 11 patients in grade B, 13 patients in grade C, and 3 patients in grade D. All the patients were treatedwith the anterior approach, decompression of the spinal channel, interbody graft, and internal fixation. The grafting materials consisted of the allogenous femoral bone plate that was degreased in advance and implanted in the intervertebral posterior region, with cut ribs and bone mills during the decompression. Results Postoperative CT scanning showed clearance of the spinal cord compression and expansion of the spine channel. During the follow-up period averaged 2 years, almost all the patients showed an improvement in the neurological function. Spinal fusion occurred in 32 patients. There was no screw loosened or broken. Only 1 patient failed to achieve the fusion. Conclusion The anterior approach, allograft bone plate reconstructing the spine channel is a safe and effective method in treatment of the thoracolumbar burst fracture with paraplegia, which may be a replacement of the autogenous illiac bone graft.
ObjectiveTo explore an method and the effectiveness of surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity (Cobb angle≥55°) and paraplegia. MethodsBetween January 2009 and January 2013, 13 cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia were treated by one-stage posterior vertebral column resection (PVCR), debridement, bone grafting, and instrumentation fixation. Of 13 patients, 7 were male and 6 were female with an average age of 23.5 years (range, 14-49 years). The disease duration was 13-38 months (mean, 19 months). The Cobb angle of kyphosis was (65.23±7.95)°. The visual analogue scale score (VAS) was 7.38±0.31. In 13 patients with incomplete paraplegia, 1 case was classified as Frankel grade B, 7 cases as grade C, and 5 cases as grade D. The lesion involved 2 vertebrae bodies in 7 cases (T8, 9 in 1 case, T11, 12 in 2 cases, and T12, L1 in 4 cases), 3 vertebrae bodies in 4 cases (T10-12 in 2 cases, T9-11 in 1 case, and T11-L1 in 1 case), and 4 vertebrae bodies in 2 cases (T4-7 in 1 case and T6-9 in 1 case). Imaging examination showed paravertebral abscess in 10 cases. ResultsHealing of incision by first intention was obtained in all patients. The neurological injury and pulmonary infection occurred in 3 cases and 2 cases respectively, which were cured after symptomatic treatment. Thirteen patients were followed up 12-48 months (mean, 17 months). The erythrocyte sedimentation rate restored to normal level in all cases at 3-7 months after operation. All the patients achieved bony fusion at 10-20 months (mean, 14 months) after operation. No fixation loosening, displacement, or fracture occurred during follow-up. Common toxic symptom of tuberculosis disappeared, and there was no recurrence of local tuberculosis. The Cobb angle of kyphosis was corrected to (22.38±1.76)° at 1 week and (22.15±1.83)° at last follow-up, showing significant difference when compared with preoperative one (P < 0.05). There was no significant difference in Cobb angle of kyphosis between at 1 week after operation and at last follow-up (P > 0.05). The Frankel grading was grade B in 1 case, grade C in 10 cases, and grade D in 2 cases at 1 week after operation; and it was grade D in 1 case and grade E in 12 cases at last follow-up; significant differences were found between at pre-and post-operation (P < 0.05), and between at 1 week after operation and at last follow-up (P < 0.05). The VAS score was 4.08±0.76 at 1 week and 0.62±0.14 at last follow-up, showing significant differences between at pre-and post-operation (P < 0.05) and between at 1 week after operation and at last follow-up (P < 0.05). ConclusionOne-stage PVCR, debridement, bone grafting, and instrumentation fixation is proved to be successful in treating thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia.
目的 观察社区康复护理对地震伤截瘫患者的疗效。 方法 2008年12月－2009年6月，选取都江堰市多家医院共87例康复期地震伤截瘫患者，其中观察组选取在社区采取康复护理措施的患者，对照组选取在住院期间进行健康宣教和出院时按常规进行出院指导的患者，比较两组研究对象的日常生活活动能力、并发症发生率和治疗效果。 结果 观察组日常生活活动能力优于对照组（F=8.042，P=0.009），并发症发生率低于对照组（泌尿系统感染：χ2=6.464，P=0.011），治疗效果优于对照组（U=598.500，P=0.001）。 结论 社区康复护理有利于改善地震伤截瘫患者的日常生活活动能力并预防并发症，对提高患者的生存质量有着十分重要的意义。