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Objective:To observe the effect of microelectronic EMG bridge (EMGB) training on the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury. Methods:From March, 2016 to March, 2017, 20 patients with complete cervical 5 spinal cord injury were randomly divided into control group (n = 10) and experimental group (n = 10). The control group received routine wrist extensor muscle training, and the experimental group received EMGB training in addition, for 180 days. The motor function of the affected limb was evaluated by sEMG of extensor carpi radialis longus, Manual Muscle Test (MMT), Wolf Motor Function Test (WMFT) and Spinal Cord Lesion Independence Measure (SCIM). Results:After treatment, the peak value and average value of sEMG of extensor carpi longus of both sides increased in both groups (t > 2.510, P < 0.05), the peak value and average value of the left side were higher (t > 2.759, P < 0.05), and the peak value of the right side was higher (t = 2.691, P < 0.05) in the experiment group than in the control group, however, there was no significant difference in average value of the right side between two groups (t = 2.063, P = 0.054). The scores of MMT increased in both groups (t > 2.569, P < 0.05), and were higher in the experimental group than in the control group (t > 2.278, P < 0.05). The scores of WMFT and SCIM increased in both groups (t > 3.839, P < 0.05), however, there was no significant difference between two groups (t < 1.498, P > 0.05). Conclusion:EMGB training could improve the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury.
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The incidence and proportion of traumatic spinal cord injury in the elderly are increasing year by year, and it has become the main affected population of spinal cord injury in developed countries. Fall is the main cause of injury. The increase of spinal stenosis, the biomechanical changes of the spine and the hyperextension injuries may be the mechanism of spinal cord injury caused by minor trauma in this population. Traumatic spinal cord injury in the elderly usually requires early surgical treatment. When there are complicated comorbidities, unstable vital signs or mild spinal cord injury without major fracture or dislocation, non-surgical treatment and active rehabilitation can be considered. However, the specific indications and timing of surgery are still controversial. Compared with young people, most elderly patients present with incomplete cervical spinal cord injury and are expected to restore better limb function, following poor recovery of self-care ability. It is important to monitor the functional change throughout rehabilitation and adjust the hours and intensity of training accordingly.
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Spinal injuries caused by competitive sports are common. Spinal diseases are important issues that needs to be solved urgently in the fields of sports injury. Return to play recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data. This article reviewed the current situation of athletes return to play after spine and spinal cord injury based on disease classification, including cervical spine (cervical soft tissue injuries, cervical fracture and dislocation, cervical stenosis, cervical disk herniation, stingers and burners), thoracic spine (thoracic fracture), lumbar spine (lumbar strain, lumbar stenosis spondylolysis and spondylolisthesis, lumbar disk herniation), and spinal cord concussion and spinal cord injury. This article also analyzed the criteria for athletes to return to play after spine and spinal cord injuries. It may provide references for future clinical management and consensus/guidelines.
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Objective:To study the regularity of clinical symptoms of sympathetic cervical spondylosis. Methods:A retrospective study was conducted on 110 patients with sympathetic cervical spondylosis admitted to the outpatient department from 2017 to 2019. The regularity of clinical symptoms of the patients was analyzed, including the sympathetic symptoms of different systems, the property of dizziness, the sequence, time interval and correlation of the symptoms, and whether the numbness of the limbs was accompanied by the symptoms and signs of cervical spondylotic radiculopathy and cervical spondylotic myelopathy. Results:The sympathetic symptoms were complex, involved in digestive system (71.82%), cardiovascular system (83.64%), respiratory system (63.64%), sweat gland (48.18%), eyes (81.82%), ears (60.91%), brain (68.18%) and limbs (70%), mainly sympathetic excitatory. The dizziness of the patients was mainly manifested as muddled brain (66.36%), a few patients were accompanied by external objects or their own rotation and sloshing (23.64%), and a very few patients showed external objects or their own rotation and sloshing (8.18%). Most patients complained chronic neck pain before dizziness and other sympathetic symptoms, accounting for 58.18%. The mean time for progression from neck pain to dizziness was (68.98±64.42) months. There were 77 patients complaining limb numbness, but none of them was found symptoms or signs of cervical spondylotic radiculopathy or cervical spondylotic myelopathy. It seemed to be a part of sympathetic symptoms in the limbs. The severity of dizziness was positively correlated with the course of disease (r = 0.610, P < 0.001), and was also positively correlated with the score of sympathetic symptom (r = 0.301, P = 0.004). Conclusion:The symptoms of sympathetic cervical spondylosis are complex. Muddled brain is the main symptom of dizziness, not vertigo. As the disease progresses, dizziness and sympathetic symptoms gradually worsen. Most sympathetic cervical spondylosis develops from cervical spondylosis. Cervical spondylotic radiculopathy or cervical spondylotic myelopathy may be the more severe forms of cervical spondylosis that develop on this basis。
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Objective:To Compare and analyze the gut microbiota and biochemical indexes between patients with acute traumatic complete spinal cord injury and healthy subjects. Methods:From May, 2017 to May, 2018, a total of 44 patients with acute traumatic complete spinal cord injury (patient group) and 33 healthy controls (control group) were included. The clinical data and fresh blood, urine and fecal samples of the two groups were collected. The V3-V4 region of 16S rRNA gene was sequenced and analyzed. Results:The abundance of gut microbiota was higher in the patient group than in the control group, and the structural composition was different. Compared with the control group, the expression of Bacteroidetes decreased (P < 0.05), and the expression of Actinobacteria, Proteobacteria, Synergistetes, Saccharibacteria and Cyanobacteria increased in the patient group (P < 0.05). The serum glucose, low density lipoprotein, triglyceride and total cholesterol were significantly higher in the patient group than in the control group (P < 0 05). There was a significant correlation between these elevated markers and intestinal microbial community structure (P < 0.05). Conclusion:There is gut microbiota dysbiosis in patients with acute traumatic complete spinal cord injury, and the changes of the microbiota are related to the elevation of some serum biomarkers.
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Objective:To explore the related factors affecting the functional outcome of adult spinal cord injury and to establish a predictive model. Methods:A retrospective analysis was made on the medical records of 110 adult spinal cord injured patients with paraplegia from September, 2016 to December, 2018. Quantitative indicators that affected functional outcome were systematically collected, including age, length of stay, number of other diagnostic, number of complications, number of comorbidities, number of operations, days from onset to rehabilitation intervention, and the total scores of Lower Extremity Motor Subscore (LEMS), light touch (LT), pin prick (PP) and modified Barthel Index (MBI) at admission (MBIa) and discharge (MBId), the change values and change rates of MBI were calculated. The correlation coefficients among variables were analyzed. Multivariate linear regression models were established for the MBI total score at discharge and change of MBI score from admission to discharge (MBIc). Results:MBId was significantly correlated with MBIa, the total score of LEMS at admission (LEMSa), the total score of PP at admission, the total score of LT at admission, the number of days from onset to rehabilitation intervention, the number of operations and the number of comorbidities. The fitted regression equation was: MBId = 28.24 + 0.52 × MBIa + 0.24 × LEMSa - 1.23 × number of comorbidities (R2 = 0.64, P < 0.001). The MBIc was significantly correlated with MBIa, the days from onset to rehabilitation intervention and the length of stay. The fitted regression equation was: MBIc = 18.44 - 0.29 × MBIa + 0.06 × length of stay (R2 = 0.29, P < 0.001). Conclusion:The spinal cord injured patients with better functional status, higher motor score and less comorbidity at admission, and longer hospitalization have better functional recovery.
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After spinal cord injury, patients often suffer from limb spasm, which affects their daily life and the progress of rehabilitation. Balance among spinal cord excitability network, presynaptic inhibition and motor neuron excitability was broken, background of motor neuron activity changed, membrane ion channels, serotonin receptors and transporter concentration changed after spinal cord injury, which promote formation and development of spasm.
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Objective To study the dynamic changes of the intestinal function of neurogenic bowel dysfunction rats caused by spi-nal cord injury using X-ray radiography. Methods Twenty-four female Sprague-Dawley rats were divided into control group (n=12) and spinal cord injury group (n=12). The T10spinal cord injury model was established using aneurysm clip (70 grams calibration force) for 60 seconds. The control group exposed the dura only. X-ray Barium was used to observe the dynamic changes of in-testinal function, and HE staining was used to observe the pathology of the colon before and four weeks after modeling. Results Compared with the control group, gastric emptying and intestinal transit function significantly reduced in the spinal cord injury group (P<0.05). Conclusion The spinal cord injury model can be successfully duplicated with aneurysm clip in rats; neurogenic bowel dysfunction occurs after spinal cord injury, gastric emptying and intestinal transit function are weakened.
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Objective To further explore the complication of spinal cord injury occured after transcatheter arterial chemoemboliza-tion(TACE)for hepatocellular carcinoma via inferior phrenic artery. Methods The clinical and imaging data of one patient with spinal cord injury caused by TACE for hepatocellular carci-noma via inferior phrenic artery was retrospectively analyzed.The pathologic mechanism,risk factors and out-come of rehabilitative treatment were discussed after literature review. Results The abnormal opening of communicating branches between inferior phrenic artery and spinal cord blood supply-ing was the underlying mechanism inducing spinal cord injury after TACE. The risk factors included contrast agent,chemotherapy drug,embolic agent,and multiple interventional therapy,etc.Most patients returned almost to normal state within several months after early rehabilitation. Conclusion Spinal cord injury occurred after TACE for hepatocellular carcinoma via inferior phrenic artery is an ex-tremely rare complication.Most patients have a favorable outcome with early detection and timely rehabilitation.
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Neurogenic bowel dysfunction is one of the most common complications of spinal cord injury.It can cause abdominal distension,constipation,fecal incontinence,difficult defecation,prolonged defecation and other symptoms.At present, neurogenic bowel dysfunction is mainly evaluated through general condition,physical examination,experimental exami-nation,professional scales and intestinal microbiota,etc.
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@#Objective To retrospectively analyze the features and related factors of deep venous thrombosis(DVT)in patients with traumatic paraplegia during early rehabilitation. Methods Inpatients of our hospital from June,2014 to June,2017 were included and patients with traumatic paraplegia during early rehabilitation were analyzed.The clinical information,lower limbs deep vein ultrasonic testing and laboratory examination were collected to analyze features and related factors of DVT. Results A total of 269 patients with traumatic paraplegia during early rehabilitation were analyzed and 62 patients had DVT in lower limbs(23.0%),in which 50 patients had an isolated distal DVT and 28 cases occurred in bilateral lower limbs(45.2%).No patients younger than 14 had DVT in lower limbs(n=31).Logistic regression analysis showed that increased D-dimer (OR=1.348, 95% CI 1.193~1.525), advanced age (OR=3.450, 95% CI 1.372~8.674),male(OR=2.872,95% CI 1.095~7.533)and diabetes(OR=5.319,95% CI 1.094~25.872)were indepen-dent related factors for DVT. Conclusion The incidence of DVT in lower limbs of traumatic paraplegia patients during early rehabilitation is high. DVT develops mainly distally to the popliteal vein and bilaterally of lower limbs. Prepubertal children have a low incidence of DVT.Increased D-dimer,advanced age,male and diabetes are independent related factors for DVT.
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<p><b>OBJECTIVE</b>To investigate the clinical outcomes of semicircular decompression in treating old thoracolumbar fractures and intractable neuropathic pain.</p><p><b>METHODS</b>From September 2009 to September 2013, 21 patients with old thoracolumbar fracture and intractable neuropathic pain were treated with semicircular decompression. Among initial surgery, posterior pedicle screw fixation was used in these patients, with or without laminectomy. All patients were male, range in age from 20 to 28 years old with an average of (25.00±2.38) years. Vertebral body residual bone block resulted in intra-spinal placeholder more than 50%. All patients were complete spinal cord injury (ASIA grade) or cauda equina injury. VAS scores was from 6 to 10 points with the mean of 7.14±0.91. In these patients, MRI, CT, X-rays were performed; denomination and dosage of analgesics were recorded; nerve function and pain status were respectively evaluated by ASIA grade and VAS score before and after operation.</p><p><b>RESULTS</b>All patients were followed up from 8 to 32 months with an average of (17.29±6.02) months. All bone fragments of spinal canal were removed and spinal cord decompressions were achieved. At final follow-up, VAS scores were from 0 to 8 points with an average of (2.43±2.46) points, and were obviously reduced than peroperative data (P<0.05). Eleven cases of them stopped analgesic intake and 7 cases reduced using. Three patients' symptoms and VAS scores were not improved.</p><p><b>CONCLUSION</b>Old thoracolumbar fractures and intractable neuropathic pain need receive imaging examination as soon as possible and consider semicircular decompression therapy if bone fragments were in vertebral canal and spinal canal stenosis existed. This therapy can effectively relieve pain and profit nerve functional recovery.</p>
Subject(s)
Adult , Humans , Male , Young Adult , Decompression, Surgical , Methods , Lumbar Vertebrae , Wounds and Injuries , General Surgery , Neuralgia , General Surgery , Pain, Intractable , General Surgery , Spinal Fractures , General Surgery , Thoracic Vertebrae , Wounds and Injuries , General Surgery , Visual Analog ScaleABSTRACT
@#Objective To probe into the quantizing rule of the thoracic vertebra rotation.Methods6 healthy corpses specimen were fixed on a wooden apparatus and rotated from 0° to 90° for X-ray examination.A X-ray examination was taken at each 5° rotational point.The characteristic of the image at each examinational point was observed.ResultsThere was radiology characteristic at each rotational point.ConclusionThe thoracic vertebra rotational degree could be quantized by X-ray examinations.
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@#Objective To probe into the quantizing rule of the thoracic vertebra rotation.Methods6 healthy corpses specimen were fixed on a wooden apparatus and rotated from 0° to 90° for X-ray examination.A X-ray examination was taken at each 5° rotational point.The characteristic of the image at each examinational point was observed.ResultsThere was radiology characteristic at each rotational point.ConclusionThe thoracic vertebra rotational degree could be quantized by X-ray examinations.
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@#ObjectiveTo investigate the effect of a cervical back muscle trainer. MethodsA cervical back muscle trainer designed by ourself was used in 128 patients with different kinds of cervical spondylosis. The situation of pain and activity of daily life of the patients before and 1 month after treatment were recorded and compared. ResultsThe neck pain of all of the patients nearly completely disappeared in a month and their activity of daily life improved significantly(P<0.01). ConclusionThe cervical back muscle trainer can improve the stability of cervical vertebrae through increasing the strength of the cervical back muscle, which can be used as an assistant rehabilitation approach of all kinds of cervical spondylosis.