中国神经再生研究(英文版) ›› 2022, Vol. 17 ›› Issue (8): 1703-1710.doi: 10.4103/1673-5374.332203

• 综述:退行性病与再生 • 上一篇    下一篇

创伤性脊髓损伤进程中不能被忽视的因素:椎管内压升高

  

  • 出版日期:2022-08-15 发布日期:2022-01-21
  • 基金资助:
    重庆英才计划项目(CSTC021YCJH-bgzxm041)

Elevated intraspinal pressure in traumatic spinal cord injury is a promising therapeutic target

Chao-Hua Yang1, 2, *, Zheng-Xue Quan2, *, Gao-Ju Wang1, Tao He2, Zhi-Yu Chen2, Qiao-Chu Li2, Jin Yang1, Qing Wang1, *   

  1. 1Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China; 2Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • Online:2022-08-15 Published:2022-01-21
  • Contact: Qing Wang, MS, wqspine2004@163.com; Zheng-Xue Quan, MD, quanzx18@163.com; Chao-Hua Yang, MD, 14211330003@fudan.edu.cn.
  • Supported by:
    This work was supported by a grant from Chongqing Yingcai Plan Project, No. cstc2021ycjh-bgzxm0041 (to ZXQ).

摘要:

目前对急性创伤性脊髓损伤推荐的管理主要目的是降低继发性损伤发生率和促进功能恢复。有研究发现,升高的椎管内压可能在继发性脊髓损伤的进程中发挥重要作用,不可被忽视。然而,创伤性脊髓损伤后导致椎管内压升高的因素、详细的时间变化进程以及椎管内压升高对创伤性脊髓损伤病理生理的影响尚未有文章全面总结。为此,文章总结了引起椎管内压升高的因素以及变化过程,并阐述以升高的椎管内压作为靶点的治疗措施:(1)椎管内压的升高主要是由于出血、水肿、血脊髓屏障破坏是以时间依赖的方式引起的,并且在创伤性脊髓损伤后第3天升高到达峰值。(2)在这个时间窗内,硬脑膜成形术和高渗盐水治疗可能是减低椎管内压的一个有希望的治疗方式,而其他治疗方法如骨减压、脊髓切开、止血和甲基强的松龙治疗,需要进一步的研究验证。

https://orcid.org/0000-0003-0148-2980 (Qing Wang); https://orcid.org/0000-0003-1778-932X (Zheng-Xue Quan);

https://orcid.org/0000-0002-6665-0378 (Chao-Hua Yang)

关键词:

血脊髓屏障, 减压, 硬脊膜切开术, 硬脑膜成形术, 水肿, 出血椎管内压, 脊髓切开术, 脊髓损伤, 治疗靶点

Abstract: The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery. Elevated intraspinal pressure (ISP) likely plays an important role in the processes involved in secondary spinal cord injury, and should not be overlooked. However, the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature. Here, we review the etiology and progression of elevated ISP, as well as potential therapeutic measures that target elevated ISP. Elevated ISP is a time-dependent process that is mainly caused by hemorrhage, edema, and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury. Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window. Other potential treatments such as decompression, spinal cord incision, hemostasis, and methylprednisolone treatment require further validation.

Key words: blood-spinal cord barrier, decompression, duraplasty, durotomy, edema, hemorrhage, intraspinal pressure, myelotomy, spinal cord injury, therapeutic target