中国神经再生研究(英文版) ›› 2022, Vol. 17 ›› Issue (9): 2036-2042.doi: 10.4103/1673-5374.335161

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

新型上行神经调控:神经根磁刺激促进电生理修复和皮质突触重建改善脊髓损伤后的运动功能

  

  • 出版日期:2022-09-15 发布日期:2022-03-08

Nerve root magnetic stimulation improves locomotor function following spinal cord injury with electrophysiological improvements and cortical synaptic reconstruction

Ya Zheng1, Dan Zhao1, †, Dong-Dong Xue2, Ye-Ran Mao3, Ling-Yun Cao4, Ye Zhang5, Guang-Yue Zhu1, Qi Yang1, Dong-Sheng Xu4, 6, 7, *   

  1. 1Department of Rehabilitation, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China; 2Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, Hebei Province, China; 3Department of Rehabilitation, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; 4School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; 5Department of Rehabilitation, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China; 6Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China; 7Rehabilitation Engineering Research Center for Integrated Traditional Chinese and Western Medicine, Ministry of Education, Shanghai, China
  • Online:2022-09-15 Published:2022-03-08
  • Contact: Dong-Sheng Xu, MD, dxu0927@shutcm.edu.cn.
  • Supported by:
    This study was supported by the National Natural Science Foundation of China (General Program), Nos. 81772453, 81974358 (both to DSX). 

摘要:

脊髓损伤后,由于大多数损伤脊髓还残存部分控制肢体运动的神经通路,因此如何通过残留的神经纤维重建神经环路对于运动功能的恢复至关重要。该课题组在以往研究中设计了一种新型的多靶点磁刺激方案,即运动皮质+神经根磁刺激,可使慢性不完全脊髓损伤患者运动功能得到明显改善。实验在T10脊髓钳夹伤大鼠模型建立后3 d,于L5椎体对应神经根给予3周的重复磁刺激方案(5 Hz,20串,25脉冲/串)。我们发现,该神经根磁刺激有助于促进脊髓损伤后的运动功能恢复,并可使损伤脊髓的神经传导功能增强。此外,该神经根磁刺激也促进了感觉运动皮质突触结构损伤的恢复。上述数据证实,神经根磁刺激是一种有效的、非侵入性的上行感觉传入的手段,可以提高脊髓损伤后残存脊髓通路的神经传导功能,并促进感觉运动皮质的突触重建,从而促进慢性脊髓损伤后运动功能的恢复。 

https://orcid.org/0000-0002-8477-5377 (Dong-Sheng Xu)

关键词: 诱发电位, H反射, 运动活动, 神经传导, 神经可塑性, 康复, 感觉-运动皮质, 脊髓损伤, 突触, 经颅磁刺激

Abstract: Following a spinal cord injury, there are usually a number of neural pathways that remain intact in the spinal cord. These residual nerve fibers are important, as they could be used to reconstruct the neural circuits that enable motor function. Our group previously designed a novel magnetic stimulation protocol, targeting the motor cortex and the spinal nerve roots, that led to significant improvements in locomotor function in patients with a chronic incomplete spinal cord injury. Here, we investigated how nerve root magnetic stimulation contributes to improved locomotor function using a rat model of spinal cord injury. Rats underwent surgery to clamp the spinal cord at T10; three days later, the rats were treated with repetitive magnetic stimulation (5 Hz, 25 pulses/train, 20 pulse trains) targeting the nerve roots at the L5–L6 vertebrae. The treatment was repeated five times a week over a period of three weeks. We found that the nerve root magnetic stimulation improved the locomotor function and enhanced nerve conduction in the injured spinal cord. In addition, the nerve root magnetic stimulation promoted the recovery of synaptic ultrastructure in the sensorimotor cortex. Overall, the results suggest that nerve root magnetic stimulation may be an effective, noninvasive method for mobilizing the residual spinal cord pathways to promote the recovery of locomotor function. 

Key words: evoked potentials, H-reflex, motor activity, nerve conduction, neural plasticity, rehabilitation, sensorimotor cortex, spinal cord injury, synapses, transcranial magnetic stimulation