慢性脊髓损伤中的神经元功能障碍。

Neuronal dysfunction in chronic spinal cord injury.

机构信息

Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.

出版信息

Spinal Cord. 2011 May;49(5):582-7. doi: 10.1038/sc.2010.147. Epub 2010 Nov 9.

Abstract

This review describes the changes of spinal neuronal function that occur after a motor complete spinal cord injury (cSCI) in humans. In healthy subjects, polysynaptic spinal reflex (SR) evoked by non-noxious tibial nerve stimulation consists of an early SR component and rarely a late SR component. Soon after a cSCI, SR and locomotor activity are absent. After spinal shock; however, an early SR component re-appears associated with the recovery of locomotor activity in response to appropriate peripheral afferent input. Clinical signs of spasticity take place in the following months, largely as a result of non-neuronal changes. After around 1 year, the locomotor and SR activity undergo fundamental changes, that is, the electromyographic amplitude in the leg muscles during assisted locomotion exhaust rapidly, accompanied by a shift from early to dominant late SR components. The exhaustion of locomotor activity is also observed in non-ambulatory patients with an incomplete spinal cord injury (SCI). At about 1 year after injury, in most cSCI subjects the neuronal dysfunction is fully established and remains more or less stable in the following years. It is assumed that in chronic SCI, the patient's immobility resulting in a reduced input from supraspinal and peripheral sources leads to a predominance of inhibitory drive within spinal neuronal circuitries underlying locomotor pattern and SR generation. Training of spinal interneuronal circuits including the enhancement of an appropriate afferent input might serve as an intervention to prevent neuronal dysfunction after an SCI.

摘要

这篇综述描述了人类完全性脊髓损伤(cSCI)后脊髓神经元功能的变化。在健康受试者中,非伤害性胫神经刺激诱发的多突触脊髓反射(SR)由早期 SR 成分和很少的晚期 SR 成分组成。cSCI 后,SR 和运动活动立即消失。然而,在脊髓休克后,早期 SR 成分重新出现,与适当的外周传入输入引起的运动活动恢复有关。痉挛的临床症状在随后的几个月发生,主要是由于非神经元变化。大约 1 年后,运动和 SR 活动发生根本变化,即辅助运动时腿部肌肉的肌电图幅度迅速耗尽,同时从早期到占主导地位的晚期 SR 成分转变。不完全性脊髓损伤(SCI)患者即使不能行走也会出现运动活动耗尽。损伤后约 1 年,大多数 cSCI 患者的神经元功能障碍完全确立,在随后的几年中或多或少保持稳定。据假设,在慢性 SCI 中,由于患者的不动导致来自中枢和外周的输入减少,导致运动模式和 SR 产生的脊髓神经元回路中抑制性驱动占主导地位。对脊髓中间神经元回路的训练,包括增强适当的传入输入,可能作为一种干预措施,防止 SCI 后的神经元功能障碍。

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