von Wild K R H, Brunelli G A
Medical Faculty of the Westphälische Wilhelms University Münster, Germany.
Acta Neurochir Suppl. 2003;87:107-12. doi: 10.1007/978-3-7091-6081-7_23.
Paraplegia means a lifelong sentence of sensory loss, paralysis and dependence. Complete spinal cord lesions cannot heal up to now despite intensive experimental research, remarkable efforts and recent achievements in bio-technology and re-engineering. Traumatic paraplegia due to spinal cord injury (SCI) is a quite frequent condition and related to the socio-economical situation of the population. It is experienced disproportionately by young people. The rise in gunshot wounds is dramatic. SCI has appeared refractory to treatment.
Since 1980 G.A.B. had tried surgical repair of the spinal cord (SC) after experimental bisection in rats, and since 1993 research was done on monkeys (macaca fascicularis) to be closer to human physiology. The sciatic nerve was removed and used as an autologous graft from the lateral bundle of the spinal cord (tractus corticospinalis ventro lateralis) to the three muscles of both legs being known to be most important for locomotion: M. gluteus maximus, M. gluteus medius and M. quadriceps femoris. The first fruitful transplantation in a human being was performed in July 2000.
The results in rats were promising and fulfilled the requirements of the American Task Force of the National Institute of Neurological and Communicative Disorders and Stroke of the US. The results in monkeys confirmed the paradigm so that we performed the first operation in a young lady suffering for four months from complete SC lesion T9 after approval by the ethical committee. First voluntary movements of the connected muscles after 17 months. 27 months after op she was able to walk up to 60 steps with the help of a walker and to climb steps in the water. Improvement is still continuing.
SCI has appeared refractory to any kind of treatment. Compensatory strategies are still experimental in human beings. Autologous nerve grafts from the spinal cord tissue (the lateral spinal bundle) connected to peripheral muscle nerves seem promising in paraplegics. But the physiology is still unclear when the glutamatergic upper motor neuron connected to motor end-plates (cholinergic) does work like in our patient.
Further studies in primates and paraplegic patients are necessary to clarify the bypass grafting of the SC to muscle groups distal to the complete SCI to restore locomotion.
截瘫意味着终身的感觉丧失、瘫痪和依赖。尽管进行了深入的实验研究、付出了巨大努力且生物技术和重新设计方面取得了最新成果，但完全性脊髓损伤至今仍无法治愈。脊髓损伤（SCI）导致的创伤性截瘫是一种相当常见的病症，且与人群的社会经济状况相关。年轻人受其影响尤为严重。枪伤数量急剧上升。SCI似乎对治疗具有抗性。
自1980年起，G.A.B.在大鼠实验性脊髓横断后尝试进行脊髓手术修复，自1993年起对猕猴（食蟹猴）开展研究，以便更接近人类生理学。切除坐骨神经，并将其作为自体移植物，从脊髓外侧束（皮质脊髓束腹外侧）连接至双腿对运动最为重要的三块肌肉：臀大肌、臀中肌和股四头肌。2000年7月在一名人类患者身上进行了首例成功移植。
大鼠实验结果很有前景，符合美国国立神经疾病与中风研究所美国特别工作组的要求。猕猴实验结果证实了该范例，因此在伦理委员会批准后，我们对一名患有T9完全性脊髓损伤四个月的年轻女性进行了首例手术。术后17个月，所连接肌肉首次出现自主运动。术后27个月，她能够借助助行器行走多达60步，并能在水中爬楼梯。改善仍在持续。
SCI似乎对任何治疗都具有抗性。补偿策略在人类中仍处于实验阶段。将脊髓组织（脊髓外侧束）的自体神经移植物连接至外周肌肉神经，对截瘫患者似乎很有前景。但当与运动终板（胆碱能）相连的谷氨酸能上运动神经元像在我们的患者中那样发挥作用时，其生理学机制仍不清楚。
有必要在灵长类动物和截瘫患者中进一步开展研究，以阐明将脊髓旁路移植至完全性SCI远端肌肉群以恢复运动功能的情况。
