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硬膜外电极刺激在3例AIS D级不完全性脊髓损伤患者中的作用

Role of Epidural Electrode Stimulation in Three Patients with Incomplete AIS D Spinal Cord Injury.

作者信息

Chen Yu-Chen, Huang Xiang-Ling, Cheng Hung-Yu, Wu Ciou-Chan, Wu Ming-Yung, Yan Lian-Cing, Chen Shin-Yuan, Tsai Sheng-Tzung, Lin Shinn-Zong

机构信息

Departments of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Zhongyang Rd., Hualien City 970, Hualien County, Taiwan.

Department of Medical Informatics, Tzu Chi University, No. 701, Sec. 3, Zhongyang Rd., Hualien City 970, Hualien County, Taiwan.

出版信息

Biomedicines. 2025 Jan 10;13(1):155. doi: 10.3390/biomedicines13010155.

Abstract

: To determine whether epidural electrical stimulation (EES) improves sensory recovery and walking function in patients with chronic spinal cord injury (SCI) with a grade on the American Spinal Cord Injury Association impairment scale (AIS) of C or D at the cervical level. : Three individuals with cervical-level chronic AIS D SCI were enrolled in the study. The mean injury duration and age were 4.8 ± 4.5 (range: 1.5-10) and 56.7 ± 9 years, respectively. The participants received personalized electrical stimulation for 36 weeks and were evaluated for their SCI characteristics, the result of an AIS assessment according to the lower extremity sensorimotor scale, their muscle activity, and preoperative walking ability parameters, initially as well as at weeks 8 and 36 of the EES intervention. : Participants receiving EES significantly increased the muscle activity in most lower limb muscles. Regarding the AIS assessment of the lower extremities, one participant fully regained a light touch sensation, while two fully recovered their pinprick sensation (AIS sensory scores increased from 14 to 28). One participant achieved a full motor score, whereas the others' scores increased by 19 and 7 points. Compared with preoperative gait parameters, two participants showed improvements in their walking speed and cadence. Walking symmetry, an important parameter for assessing walking function, improved by 68.7%, 88%, and 77% in the three participants, significantly improving the symmetry index ( = 0.003). : Thus, EES may be an effective strategy for sensory impairment recovery, as well as muscular activity and strength improvement. These findings may facilitate stable walking in subjects with chronic incomplete SCI, but larger clinical trials are warranted. trial: NCT05433064.

摘要

目的

确定硬膜外电刺激(EES)能否改善美国脊髓损伤协会损伤量表(AIS)评定为C级或D级的慢性颈髓损伤(SCI)患者的感觉恢复及步行功能。

方法

三名慢性颈髓损伤AIS D级患者纳入本研究。平均损伤持续时间和年龄分别为4.8±4.5年(范围:1.5 - 10年)和56.7±9岁。参与者接受个性化电刺激36周,并在EES干预初始、第8周和第36周对其SCI特征、根据下肢感觉运动量表进行的AIS评估结果、肌肉活动及术前步行能力参数进行评估。

结果

接受EES的参与者多数下肢肌肉的肌肉活动显著增加。在下肢AIS评估方面,一名参与者完全恢复了轻触觉,两名参与者完全恢复了针刺觉(AIS感觉评分从14分提高到28分)。一名参与者获得了完全运动评分,其他两名参与者的评分分别提高了19分和7分。与术前步态参数相比,两名参与者的步行速度和步频有所改善。步行对称性是评估步行功能的重要参数,三名参与者的步行对称性分别提高了68.7%、88%和77%,对称性指数显著改善(P = 0.003)。

结论

因此,EES可能是恢复感觉障碍以及改善肌肉活动和力量的有效策略。这些发现可能有助于慢性不完全性SCI患者稳定行走,但仍需进行更大规模的临床试验。试验编号:NCT05433064。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4af/11762847/e89af3757733/biomedicines-13-00155-g001.jpg

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