Martínez-Torija Mario, Esteban Pedro F, Santos-De-La-Mata Angela, Castillo-Hermoso Matilde, Molina-Holgado Eduardo, Moreno-Luna Rafael
Pathophysiology and Regenerative Medicine Group, Hospital Nacional de Parapléjicos, SESCAM, 45071 Toledo, Spain.
Pathophysiology and Regenerative Medicine, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45004 Toledo, Spain.
J Clin Med. 2025 Feb 26;14(5):1556. doi: 10.3390/jcm14051556.
: Spinal cord injury (SCI) is a complex medical condition with widespread effects that extend beyond motor and sensory impairments. In addition to nervous system damage, SCI patients experience various secondary complications, including vascular dysfunction, altered body composition, and metabolic disturbances. Among the most common secondary pathologies is the development of pressure injuries (PIs), chronic wounds that significantly affect quality of life and can be challenging to treat. Understanding the physiological and cellular mechanisms behind these complications is crucial for improving care and therapeutic outcomes. : We conducted a comprehensive literature search in PubMed, Scopus, and Google Scholar using keywords related to spinal cord injury, pressure ulcer/pressure injuries, metabolic and vascular dysfunction, biomechanics, and regenerative therapies. Studies were selected based on their relevance to the pathophysiology, risk factors, and novel therapeutic approaches for PIs in SCI patients. : Vascular dysfunction, characterized by impaired blood flow and microcirculatory issues, predisposes SCI patients to ischemia and tissue necrosis, particularly in areas subjected to prolonged pressure. Additionally, changes in body composition, such as increased adiposity and muscle atrophy, further compromise tissue integrity and healing capacity. The inflammatory response, mediated by cytokines such as IL-1, IL-6, and TNF-α, exacerbates these effects by sustaining a pro-inflammatory environment that delays the transition of macrophages to the M2 phenotype, critical for wound healing. External factors, such as poor nutrition, infections, and immobility, also play a significant role in worsening the wound healing process. : Chronic SCI induces a cascade of physiological changes that predispose patients to the development of PIs and complicate their recovery. The intricate interplay of vascular, metabolic, and inflammatory responses creates a hostile environment for wound healing. A deeper understanding of these systemic effects is essential not only for developing targeted therapeutic strategies to improve chronic wound healing but also for refining preventive approaches that minimize their occurrence. Advancing this knowledge will ultimately help enhance the quality of life for individuals with SCI.
脊髓损伤（SCI）是一种复杂的病症，其影响广泛，不仅限于运动和感觉障碍。除了神经系统损伤外，脊髓损伤患者还会经历各种继发性并发症，包括血管功能障碍、身体成分改变和代谢紊乱。最常见的继发性病变之一是压疮（PIs）的形成，这是一种慢性伤口，会显著影响生活质量，且治疗颇具挑战性。了解这些并发症背后的生理和细胞机制对于改善护理和治疗效果至关重要。
我们在PubMed、Scopus和谷歌学术搜索中进行了全面的文献检索，使用了与脊髓损伤、压疮/压力性损伤、代谢和血管功能障碍、生物力学以及再生疗法相关的关键词。根据研究与脊髓损伤患者压疮的病理生理学、危险因素和新型治疗方法的相关性来选择研究。
血管功能障碍的特征是血流受损和微循环问题，使脊髓损伤患者易发生缺血和组织坏死，特别是在长期受压的部位。此外，身体成分的变化，如肥胖增加和肌肉萎缩，会进一步损害组织完整性和愈合能力。由白细胞介素 -1、白细胞介素 -6和肿瘤坏死因子 -α等细胞因子介导的炎症反应，通过维持促炎环境加剧了这些影响，这种环境会延迟巨噬细胞向对伤口愈合至关重要的M2表型转变。外部因素，如营养不良、感染和活动受限，在恶化伤口愈合过程中也起着重要作用。
慢性脊髓损伤会引发一系列生理变化，使患者易发生压疮并使恢复过程复杂化。血管、代谢和炎症反应之间复杂的相互作用为伤口愈合创造了不利环境。深入了解这些全身效应不仅对于制定有针对性的治疗策略以改善慢性伤口愈合至关重要，而且对于完善预防措施以尽量减少其发生也很重要。推进这方面的知识最终将有助于提高脊髓损伤患者的生活质量。
