本文選題：脊髓損傷 + 康復��； 參考：《南京醫(yī)科大學》2017年博士論文

【摘要】：第一部分:康復治療對脊髓損傷患者功能恢復的影響背景:既往研究表明,運動康復治療可以促進脊髓損傷(spinal cord injury,SCI)運動功能恢復。但有關運動康復治療是否會促通SCI后上行和/或下行兩條傳導通路,以及運動效應與神經傳導通道的關系尚不清楚。目的:觀察康復治療對不同程度胸腰段脊髓損傷患者體感誘發(fā)電位(SEPs)和修訂的Barthel指數(shù)(MBI)的影響,并探討體感誘發(fā)電位和修訂的Barthel指數(shù)的應用價值。方法:取脊髓損傷患者19例,按照美國脊髓損傷學會脊髓損傷程度的分級(ASIA)對患者進行分類。所有的患者都進行為期1個月的運動治療、作業(yè)治療、神經肌肉電刺激和心理治療�？祻椭委熐昂蠓謩e對患者進行SEPs檢查和修訂的Barthel指數(shù)評分。結果:A、B、C、D級脊髓損傷患者MBI評分和SEPs相關指標,康復前后比較均有明顯的統(tǒng)計學意義(P0.05),不同病程康復前后比較均有明顯的統(tǒng)計學意義(P0.05),而且SEPs和MBI之間存在直線相關性。結論:康復治療能改善脊髓損傷患者功能,不同類型脊髓損傷的康復價值不一,體感誘發(fā)電位結合修訂的Barthel指數(shù)評分法,能夠準確評估康復效果。第二部分:三種高頻電療對急性脊髓損傷大鼠神經功能恢復的對比研究背景:短波、超短波和微波已被證實對外周神經損傷具有營養(yǎng)、再生及功能恢復作用,但短波、超短波和微波對脊髓損傷后的神經修復效果尚不清楚。目的:觀察無熱量短波、超短波和微波對急性脊髓損傷大鼠神經功能恢復和BDNF-TrkB表達的影響,并探討其可能作用機制。方法:成年雌性SD大鼠120只,隨機分為Sham組(24只)、SCI組(24只)、SW組(24只)、USW組(24只)和MW組(24只)。應用改良Allen' s法制備大鼠脊髓損傷模型。Sham組僅行椎板切除術暴露硬脊膜,不予打擊。SW組、USW組和MW組在脊髓損傷造模后24小時分別給予受損部位無熱量短波、超短波和微波治療,10 min/次,1次/d,至取材前。SCI組不給予任何治療。在造模后1d、7d、14d和21d用BBB評分、體感誘發(fā)電位(SEPs)和運動誘發(fā)電位(MEPs)評定脊髓損傷后后肢功能恢復情況并獲取損傷段脊髓標本,用免疫組織化學方法檢測SCI組、SW組、USW組和MW組脊髓在損傷后不同時段BDNF-TrkB的表達。應用方差分析法比較三種治療效果,對BBB評分、SEPs、MEPs和BDNF-TrkB進行相關分析。結果:BBB評分結果提示,SW組和USW組大鼠7d、14d、21d時的BBB評分均較SCI組和MW組明顯提高(P0.01);SCI組和MW組BBB評分7d時變化不明顯(P0.05),14d后MW組優(yōu)于SCI組(P0.05)。SEPs和MEPs結果顯示,SW組和USW組大鼠7d、14d、21d時的神經功能較SCI組和MW組明顯改善(P0.01);MW組與SCI組相比,在7d時潛伏期和波幅無差異(P0.05),在14d和21d時潛伏期和波幅明顯改善(P0.01)。免疫組織化學方法提示,與SCI組相比,SW組、USW組和MW組在一定時間段能上調損傷脊髓區(qū)BDNF-TrkB 的表達(P0.05)。7d 和 14d 時SW 組和USW 組的BDNF-TrkB 表達較SCI組和MW組高(P0.01),各時間點MW組的BDNF-TrkB表達較SCI組差異無統(tǒng)計學意義(P0.05)。在術后7d、14d和21d,BBB評分與SEPs、MEPs和BDNF-TrkB表達呈線性相關,BDNF與TrkB正相關,SEPs和MEPs正相關。結論:無熱量短波、超短波和微波均能促進損傷脊髓的神經傳導功能恢復,其機制可能與短波、超短波和微波上調損傷區(qū)脊髓BDNF-TrkB的表達有關,其中超短波的效果優(yōu)于短波,而短波的效果要優(yōu)于微波,且微波不宜過早使用。
[Abstract]:The first part: the effect of rehabilitation therapy on the background of the functional recovery of patients with spinal cord injury: Previous studies have shown that exercise rehabilitation therapy can promote spinal cord injury (spinal cord, injury, SCI). But the recovery of motor function rehabilitation training will promote through SCI uplink and / or two pathways, and the relationship between exercise and effect nerve conduction channel is unclear. Objective: To observe the effect of rehabilitation therapy on different degree of patients with thoracolumbar spinal cord injury somatosensory evoked potential (SEPs) and modified Barthel index (MBI) effect, and to explore the application value of somatosensory evoked potential and revised Barthel index. Methods: 19 cases of patients with spinal cord injury, according to classification of American Spinal Injury Association Degree of spinal cord injury (ASIA) to classify the patients. All patients were treated for 1 months exercise, operation therapy, neuromuscular electrical stimulation and rehabilitation therapy. The complex respectively before and after treatment in patients were examined by SEPs and modified Barthel index score. Results: A, B, C, SEPs and MBI score in patients with spinal cord injury related indicators of D, before and after rehabilitation were statistically significant (P0.05), obvious statistical significance before and after different duration of rehabilitation were significant (P0.05), and there was a linear correlation between SEPs and MBI. Conclusion: rehabilitation therapy can improve the function of patients with spinal cord injury, spinal cord injury rehabilitation value of different types of a somatosensory evoked potentials and the revised Barthel score method, able to accurately assess the effect of rehabilitation. The second part: three high frequency electrotherapy on acute spinal cord injury recovery of nerve in rats background: the function of shortwave, ultrashort wave and microwave has been confirmed with nutrition on peripheral nerve injury, regeneration and functional recovery, but the shortwave, ultrashort wave and micro wave on the nerve after spinal cord injury 淇鏁堟灉灝氫笉娓呮.鐩殑:瑙傚療鏃犵儹閲忕煭娉，

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