脊柱损伤的法医临床学鉴定研究进展

随着社会和现代交通、建筑事业的发展,脊柱损伤的病人发病率呈上升趋势,尤其道路交通事故为其损伤的首要原因。脊柱损伤的现场急救、临床诊断与治疗为人们所关注。然而,伴随着事件的进一步处理,对病人的损伤进行法医学鉴定显得尤为重要。目前,有关脊柱损伤的鉴定标准仅仅是确定的标准,没有规定标准的适用条件。同时,也易导致鉴定人对标准的理解与应用存在差异,由此导致了鉴定结论的争议。本文对脊柱损伤的法医临床学应用研究进展作一综述。     

胸、腰椎骨折脱位并截瘫病人手术前后的护理

外伤性截瘫是脊柱损伤最严重的并发症,由于脊柱骨折、脱位造成脊髓损伤,损伤平面以下感觉、运动、反射、膀胱、肛门括约肌之功能不同程度丧失,多数病人终身残废。因此做好截瘫病人的护理始终贯穿在治疗和康复的全过程。我院于１９９４年１月至１９９８年３月共收治胸、...     

胸腰椎骨折病人的护理

脊柱骨折是骨科的一种常见病,多因车祸、跌伤及高处坠落所致,且多伴有不同程度的脊髓损伤.由于胸腰椎骨折病人需长期卧床,痛苦大,并发症多,心理压力大,因此该类损伤病人的围手术期护理和术后康复指导对巩固手术治疗效果及预防术后并发症的发生、降低致残率及提高病人的生活质量有着重要意义.     

富血小板血浆在脊柱脊髓损伤治疗中的应用进展

富血小板血浆是近些年来比较热门的一种血液制品,其来源于自体,且制备方法简单,又富含大量血小板及多种生长因子,能够加速骨愈合,增强骨再生,促进软组织及神经损伤恢复,因此得到了广泛的关注。国内外的研究人员根据富血小板血浆所具有的特点,针对各个方面对其进行了大量的研究实验,并且在临床骨科疾病的治疗中也已经开始了实验性应用,如骨缺损、骨再生,肌腱、韧带及软组织损伤,脊柱脊髓损伤等。尤其是在脊柱脊髓损伤的治疗方面,无论是单独应用富血小板血浆治疗,还是联合应用富血小板血浆与脊髓神经前体细胞、骨髓间充质干细胞等有利于脊髓神经损伤恢复的细胞因子复合物共同治疗,均取得了突破性的进展,为研究脊柱脊髓损伤的治疗提供了新的方向。     

多发伤患者院前急救应用简易脊髓损伤评估法的护理观察

目的探讨多发伤患者院前急救应用简易脊髓损伤评估法的护理及效果。方法选取我院2013年1月~2014年11月院前急救以脊柱损伤为主的多发伤患者40例为研究对象,应用简易脊髓损伤评估法对护理的实施进行有效评估及指导。结果 40例患者中,除1例患者在抢救时死亡,2例患者现场检查已瘫痪外,其余患者经院前急救处理后均顺利转运至医院进一步治疗,无继发性损伤的发生。结论简易脊髓损伤评估法应用于脊柱损伤为主的多发伤患者院前急救护理中,能有效预防或避免出现继发性损伤,效果显著。     

脊柱跳跃型骨折的临床研究进展

脊柱跳跃型骨折指多节段非相邻的椎体骨折(multiple-level noncontiguous spinal fractures,MNSF)。对于非高龄患者,此类骨折通常为暴力性高能量损伤。由于MNSF受伤机制的复杂性,患者的临床表现不尽相同,导致其常发生漏诊或延迟诊断。目前,临床上对于MNSF发病率和损伤原因有很多报道,特别是其致伤机制,也存在很多理论。脊柱跳跃性骨折的治疗需全面考虑,如脊柱的不稳定性、畸形和骨折节段之间正常的椎体数目甚至患者想要减少住院时间的要求等。治疗时应按照各自损伤部位的情况决定治疗方案,强调个体化治疗。需要手术治疗的患者应依据其损伤特点选择相应术式,重建脊柱稳定性。本文主要就近年来MNSF的临床研究进展了进行总结,旨在为MNSF的临床诊疗提供参考。     

医院外突发急症现场自救互救知识讲座(17)--脊柱损伤

1　脊柱是怎样受伤的　　脊椎骨十分坚硬 ,脊椎骨之间有坚强的韧带相连 ,脊柱外还有层层肌肉保护。但是 ,如果外界暴力作用大于脊柱的保护机制 ,就会产生脊柱损伤。高处坠落、塌方、交通事故和地震等等是造成很多脊柱损伤的常见原因。常见的脊柱损伤大致有几种 :脊柱半脱位、脱位及脊椎骨骨折 ,这一切都有可能对脊髓造成不同程度的损伤。轻者的神经功能受到影响 ,重者会造成死亡或从脊柱损伤部位平面以下的神经功能全部丧失 ,这就是我们有时能见到的“截瘫”。脊柱损伤的位置越高 ,截瘫的位置就越高 ,病情就越重。人的神经细胞基本上没有再…     

低温在脊髓损伤治疗中应用的研究进展

脊髓损伤多由高空坠落、车祸、运动冲击等原因引起,是脊柱外科的一种常见疾病,至今仍是一个治疗难题。低温疗法是一种重要的物理治疗手段,以多种机制减少脊髓损伤后有害因素的产生,是一种有效的脊髓保护途径。其在脊髓损伤的研究中表现出很好的效果,为脊髓损伤的治疗提供了新的思路,然而也发现一些低温治疗导致的全身性或某些系统为主的不良影响,需要我们进一步研究和解决,以期达到更好的治疗效果。本文就低温治疗用于脊髓损伤应用中的研究进展进行综述。     

脊柱外固定装置的研制与应用

脊柱外固定器(见图1)是治疗脊柱损伤的一种新型装置。由于脊柱骨折脱位是临床常见的骨科疾病之一,过去在治疗方法上,多沿用石膏固定,外科手术治疗及至少2～3个月的卧床休息,由于病员卧床时间长,并发症多,治疗效果不佳。我院自1985年以来,研制了脊柱外固定器(External SpineSkeletal Fixation),简称“ESSF”器械。在临床上进行闭合式安装,固定脊柱,使病人能     

IFN-γ、IL-12及TNF-α在脊柱结核病人血清和病灶中的表达以及对疾病的影响

目的:检测IFN-γ、IL-12及TNF-α在脊柱结核病人血清和病灶中的表达水平,探讨血清和病灶中IFN-γ、IL-12及TNF-α的表达水平与脊柱结核的相关性。方法:2014年12月至2016年3月期间,纳入符合标准的脊柱结核病人46例为实验组,椎体骨折病人48例为对照组。应用ELISA检测两组人群血清中IFN-γ、IL-12、TNF-α的平均浓度;病灶标本免疫组化染色检测其IFN-γ、IL-12、TNF-α的平均光密度值。结果:实验组血清中IFN-γ,IL-12,TNF-α平均浓度分别为26.82±7.81 pg/mL,25.93±12.84pg/mL,68.13±16.24 pg/mL,对照组血清中平均浓度分别为46.89±7.81 pg/mL,49.45±22.38 pg/mL,26.65±10.11 pg/mL;实验组病灶中IFN-γ,IL-12,TNF-α平均光密度值分别为0.273±0.076,0.380±0.054,0.306±0.052,对照组病灶中平均光密度值分别为0.092±0.024,0.183±0.034,0.180±0.031。实验组与对照组血清及病灶中IFN-γ、IL-12及TNF-α的表达水平比较,差异有统计学意义(P0.05)。结论:脊柱结核病人的血清IFN-γ、IL-12浓度呈低表达,TNF-α浓度呈高表达;脊柱结核病人病灶中IFN-γ、IL-12及TNF-α表达增加;检测脊柱结核病人IFN-γ、IL-12及TNF-α血清水平含量能为其机体免疫力的状态、判断结核病情程度和进展及为临床诊断提供参考依据。     

硫化氢与脊髓损伤治疗

脊髓损伤(spinal cord injury,SCI)是一种由于脊髓外部损伤或内部病变引起的暂时性或永久性的功能损伤,其症状包括肌肉功能损伤、自主运动功能减退或丧失等。目前,流行病学调查发现,我国SCI患病率较高,具有较高的社会和医疗负担。因此,合理引导SCI病人进行治疗和康复尤为重要。硫化氢（hydrogen sulfide,H2S）是一种重要的神经信号分子,近年来H2S对SCI康复的作用机制逐渐成为研究热点,例如一些国内外研究团队对SCI后缺血-再灌注损伤（ischemia reperfusion injury,I/R injury）、降低SCI后氧化应激及抗炎作用等机制,以及SCI康复临床治疗研究均取得了一定的成果。本文通过H2S对SCI康复的机制研究和临床治疗发展进行综述,旨在为后续研究及临床应用提供参考。     

硫化氢与脊髓损伤治疗

脊髓损伤(spinal cord injury,SCI)是一种由于脊髓外部损伤或内部病变引起的暂时性或永久性的功能损伤,其症状包括肌肉功能损伤、自主运动功能减退或丧失等。目前,流行病学调查发现,我国SCI患病率较高,具有较高的社会和医疗负担。因此,合理引导SCI病人进行治疗和康复尤为重要。硫化氢（hydrogen sulfide,H2S）是一种重要的神经信号分子,近年来H2S对SCI康复的作用机制逐渐成为研究热点,例如一些国内外研究团队对SCI后缺血-再灌注损伤（ischemia reperfusion injury,I/R injury）、降低SCI后氧化应激及抗炎作用等机制,以及SCI康复临床治疗研究均取得了一定的成果。本文通过H2S对SCI康复的机制研究和临床治疗发展进行综述,旨在为后续研究及临床应用提供参考。     

The Cell Neural Adhesion Molecule Contactin-2 (TAG-1) Is Beneficial for Functional Recovery after Spinal Cord Injury in Adult Zebrafish

The cell neural adhesion molecule contactin-2 plays a key role in axon extension and guidance, fasciculation, and myelination during development. We thus asked, whether contactin-2 is also important in nervous system regeneration after trauma. In this study, we used an adult zebrafish spinal cord transection model to test the functions of contactin-2 in spinal cord regeneration. The expression patterns of contactin-2 at different time points after spinal cord injury were studied at the mRNA level by qPCR and in situ hybridization, and contactin-2 protein levels and immunohistological localization were detected by Western blot and immunofluorescence analyses, respectively. Contactin-2 mRNA and protein levels were increased along the central canal at 6 days and 11 days after spinal cord injury, suggesting a requirement for contactin-2 in spinal cord regeneration. Co-localization of contactin-2 and islet-1 (a motoneuron marker) was observed in spinal cords before and after injury. To further explore the functions of contactin-2 in regeneration, an anti-sense morpholino was used to knock down the expression of contactin-2 protein by application at the time of injury. Motion analysis showed that inhibition of contactin-2 retarded the recovery of swimming functions when compared to standard control morpholino. Anterograde and retrograde tracing at 6 weeks after injury showed that knock down of contactin-2 inhibited axonal regrowth from NMLF neurons beyond lesion site. The combined observations indicate that contactin-2 contributes to locomotor recovery and successful regrowth of axons after spinal cord injury in adult zebrafish.     

Forensic uncertainty,fragile remains,and DNA as a panacea: an ethnographic observation of the challenges in twenty-first-century Disaster Victim Identification

This is an account of ethnographic research examining the specialist scientific processes known as ‘Disaster Victim Identification’ (DVI) in three settings: Québec, the United States, and the United Kingdom. In cases of multiple deaths, a series of actions accompanied by a plethora of tools are often invoked, housed at a disaster scene, forensic laboratories, a family assistance centre, and a mortuary. In this article, I examine a process dedicated to connecting the biological remains of the deceased with a confirmed validation of personhood. I describe a situation where responders/scientists will attempt multiple testing and re-testing of human remains, often pushing boundaries of available science. I argue that the search for certainty in identification lies at the heart of the activation of DVI processes, particularly when it is connected to DNA testing. Observing intimate forensic settings and the bricolage of the forensic anthropologist's labour has allowed me to track the production of the science of identity. I then reflect on the wider implications of these observations for affected communities and the responding scientists. Finally, I argue that there is complexity and ambivalence surrounding the increased use of technologies when applied to identification of victims.     

Synthesis and biological evaluation of 4-quinazolinones as Rho kinase inhibitors

Rho kinase (ROCK) is an attractive therapeutic target for various diseases including glaucoma, hypertension, and spinal cord injury. Herein, we report the development of a series of ROCK-II inhibitors based on 4-quinazolinone and quinazoline scaffolds. SAR studies at three positions of the quinazoline core led to the identification of analogs with high potency against ROCK-II and good selectivity over protein kinase A (PKA).     

脊髓缺血损伤合并脓毒症后脊髓ZnT1表达的研究

目的：研究脊髓缺血损伤合并脓毒血症后大鼠脊髓的病理改变及脊髓组织中锌转运体1（zinc transporter1,ZnT1）的表达规律。方法：将32只wistar大鼠随机分为假手术组（s组,n=8）、腹主动脉阻断组（I／R组,n=8）、内毒素组（LPS组,n=8）和腹主动脉阻断＋内毒素组（I／R＋LPS组,n=8）。用HE染色的方法检测脊髓组织病理损害,用免疫组织化学的方法检测脊髓组织中ZnTl的表达规律。结果：1．病理结果改变：除S组外,I／R组、LPS组、UR＋LPS组三组大鼠HE染色切片中均可见脊髓组织损伤,各组脊髓损伤的严重程度有以下规律：S组〈I/R组〈LPS组〈I／R＋LPS组。2．免疫组化结果：脊髓损伤组ZnT1的表达较假手术组均增加（P〈0．05）。结论：1．脊髓缺血损伤合并内毒素攻击可导致严重的脊髓损伤。2．腹主动脉阻断合并内毒素攻击所致脊髓损伤早期脊髓组织中ZnT1表达上调,可能通过调节脊髓损伤早期脊髓组织中锌稳态平衡进而在脊髓损伤后脊髓神经元的病理生理活动中发挥重要作用,这一实验结果可为寻找早期脊髓损伤预防措施提供新的思路。     

Cadence control system for paediatric functional electrical stimulation cycling

Functional electrical stimulation can be used to enable spinal cord injured children to participate in cycling training as part of a fitness programme or exercise testing procedure. Exercise can reduce the impact of secondary health conditions due to the injury. Functional electrical stimulation has shown promising results in adults with a spinal cord injury, but additional considerations are needed to realise the method for the child with spinal cord injury, partly owing to their limited force producing capacity. An electric motor provides a practical means of performing cycling at controlled cadences, exercising for longer durations and can also be used for recreational outdoor cycling. Here, a novel real-time control technique is developed for cadence regulation during cycling. A feedback control structure is developed based on an empirical model derived from separate identification tests and pole placement and then verified in a series of reference-tracking tests. The system produced cadence responses in close agreement with reference values in all cases and demonstrated satisfactory robustness of stability characteristics. This approach moves towards the practical application of the technology as a training tool for paediatric spinal cord injured subjects.     

Translational constraint influences dynamic spinal canal occlusion of the thoracic spine: an in vitro experimental study

Mechanical constraints to spine motion can arise in a variety of real-world situations such as when shoulder belts prevent anterior translation of the thorax during automotive collisions. The effect of such constraint on spinal column-spinal cord interaction during injury remains unknown. The purpose of the present study was to compare maximal dynamic spinal canal occlusion, measured via a specialized transducer, in cadaveric upper thoracic spine specimens under a variety of anterior-posterior constraint conditions. Four injury models were produced using 24 cadaveric spine specimens (T1-T4). Incremental compressive trauma was applied under constrained (i.e. blocked anterior-posterior translation) flexion-compression, pure-compression and extension-compression, and under unconstrained (i.e. free anterior-posterior translation) flexion-compression. All displacements were applied at 500 mm/s. For all three constrained trauma groups, complete transducer occlusion occurred between 20 and 30 mm of compressive displacement. The extension-compression caused transducer occlusion significantly less than the other constrained models (p < 0.022) at 20 mm compression. For unconstrained flexion-compression, a compression of up to 50 mm resulted in a mean of 26% transducer occlusion. The constrained pure-compression tests led to burst fracture with significant body height loss at T2. The constrained flexion-compression and extension-compression tests caused fracture-dislocation injury at the T2-T3 level. Constrained trauma clearly led to more spinal canal occlusion than the unconstrained in these models, and more severe injury to the spinal column. The results add to our understanding of the effect of column injury pattern on spinal cord injury. This information has clear implications for the design of injury prevention devices.