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

【摘要】：第一部分:康復(fù)治療對(duì)脊髓損傷患者功能恢復(fù)的影響背景:既往研究表明,運(yùn)動(dòng)康復(fù)治療可以促進(jìn)脊髓損傷(spinal cord injury,SCI)運(yùn)動(dòng)功能恢復(fù)。但有關(guān)運(yùn)動(dòng)康復(fù)治療是否會(huì)促通SCI后上行和/或下行兩條傳導(dǎo)通路,以及運(yùn)動(dòng)效應(yīng)與神經(jīng)傳導(dǎo)通道的關(guān)系尚不清楚。目的:觀察康復(fù)治療對(duì)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(yīng)用價(jià)值。方法:取脊髓損傷患者19例,按照美國(guó)脊髓損傷學(xué)會(huì)脊髓損傷程度的分級(jí)(ASIA)對(duì)患者進(jìn)行分類(lèi)。所有的患者都進(jìn)行為期1個(gè)月的運(yùn)動(dòng)治療、作業(yè)治療、神經(jīng)肌肉電刺激和心理治療。康復(fù)治療前后分別對(duì)患者進(jìn)行SEPs檢查和修訂的Barthel指數(shù)評(píng)分。結(jié)果:A、B、C、D級(jí)脊髓損傷患者M(jìn)BI評(píng)分和SEPs相關(guān)指標(biāo),康復(fù)前后比較均有明顯的統(tǒng)計(jì)學(xué)意義(P0.05),不同病程康復(fù)前后比較均有明顯的統(tǒng)計(jì)學(xué)意義(P0.05),而且SEPs和MBI之間存在直線相關(guān)性。結(jié)論:康復(fù)治療能改善脊髓損傷患者功能,不同類(lèi)型脊髓損傷的康復(fù)價(jià)值不一,體感誘發(fā)電位結(jié)合修訂的Barthel指數(shù)評(píng)分法,能夠準(zhǔn)確評(píng)估康復(fù)效果。第二部分:三種高頻電療對(duì)急性脊髓損傷大鼠神經(jīng)功能恢復(fù)的對(duì)比研究背景:短波、超短波和微波已被證實(shí)對(duì)外周神經(jīng)損傷具有營(yíng)養(yǎng)、再生及功能恢復(fù)作用,但短波、超短波和微波對(duì)脊髓損傷后的神經(jīng)修復(fù)效果尚不清楚。目的:觀察無(wú)熱量短波、超短波和微波對(duì)急性脊髓損傷大鼠神經(jīng)功能恢復(fù)和BDNF-TrkB表達(dá)的影響,并探討其可能作用機(jī)制。方法:成年雌性SD大鼠120只,隨機(jī)分為Sham組(24只)、SCI組(24只)、SW組(24只)、USW組(24只)和MW組(24只)。應(yīng)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(shù)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(shí)分別給予受損部位無(wú)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(píng)分、體感誘發(fā)電位(SEPs)和運(yùn)動(dòng)誘發(fā)電位(MEPs)評(píng)定脊髓損傷后后肢功能恢復(fù)情況并獲取損傷段脊髓標(biāo)本,用免疫組織化學(xué)方法檢測(cè)SCI組、SW組、USW組和MW組脊髓在損傷后不同時(shí)段BDNF-TrkB的表達(dá)。應(yīng)用方差分析法比較三種治療效果,對(duì)BBB評(píng)分、SEPs、MEPs和BDNF-TrkB進(jìn)行相關(guān)分析。結(jié)果:BBB評(píng)分結(jié)果提示,SW組和USW組大鼠7d、14d、21d時(shí)的BBB評(píng)分均較SCI組和MW組明顯提高(P0.01);SCI組和MW組BBB評(píng)分7d時(shí)變化不明顯(P0.05),14d后MW組優(yōu)于SCI組(P0.05)。SEPs和MEPs結(jié)果顯示,SW組和USW組大鼠7d、14d、21d時(shí)的神經(jīng)功能較SCI組和MW組明顯改善(P0.01);MW組與SCI組相比,在7d時(shí)潛伏期和波幅無(wú)差異(P0.05),在14d和21d時(shí)潛伏期和波幅明顯改善(P0.01)。免疫組織化學(xué)方法提示,與SCI組相比,SW組、USW組和MW組在一定時(shí)間段能上調(diào)損傷脊髓區(qū)BDNF-TrkB 的表達(dá)(P0.05)。7d 和 14d 時(shí)SW 組和USW 組的BDNF-TrkB 表達(dá)較SCI組和MW組高(P0.01),各時(shí)間點(diǎn)MW組的BDNF-TrkB表達(dá)較SCI組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在術(shù)后7d、14d和21d,BBB評(píng)分與SEPs、MEPs和BDNF-TrkB表達(dá)呈線性相關(guān),BDNF與TrkB正相關(guān),SEPs和MEPs正相關(guān)。結(jié)論:無(wú)熱量短波、超短波和微波均能促進(jìn)損傷脊髓的神經(jīng)傳導(dǎo)功能恢復(fù),其機(jī)制可能與短波、超短波和微波上調(diào)損傷區(qū)脊髓BDNF-TrkB的表達(dá)有關(guān),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(guò)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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