中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2024, Vol. 19 ›› Issue (12): 2773-2784.doi: 10.4103/NRR.NRR-D-23-01198

• 原著:脊髓损伤修复保护与再生 • 上一篇    

手术干预结合负重行走训练可促进慢性脊髓损伤患者的康复： 随机对照临床试验

  

  • 出版日期:2024-12-15 发布日期:2024-03-30
  • 基金资助:
    中国香港脊髓损伤基金

Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury: a randomized controlled study

Hui Zhu1, James D. Guest2, Sarah Dunlop3, 4, Jia-Xin Xie5, Sujuan Gao6, Zhuojing Luo7, Joe E. Springer8, Wutian Wu9, Wise Young10, Wai Sang Poon11, Song Liu1, Hongkun Gao1, Tao Yu1, Dianchun Wang1, Libing Zhou9, Shengping Wu1, Lei Zhong1, Fang Niu1, Xiaomei Wang1, Yansheng Liu1, *, Kwok-Fai So9, *, Xiao-Ming Xu12, *, †#br#   

  1. 1Kunming Tongren Hospital, Kunming, Yunnan Province, China; 2Neurological Surgery, and the Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA; 3School of Biological Sciences, The University of Western Australia, Perth, WA, Australia; 4Minderoo Foundation, Perth, WA, Australia; 5Clinical Center for Spinal Cord Injury, Kunming General Hospital of Chengdu Military Command, Kunming, Yunnan Province, China; 6Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA; 7Department of Orthopedic Spinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China; 8Spinal Cord and Brain Injury Research Center, Department of Physical Medicine and Rehabilitation, University of Kentucky College of Medicine, Lexington, KY, USA; 9Guangdong-HongKong-Macau Institute of CNS Regeneration, Jinan University, Guangzhou, Guangdong Province, China; 10W. M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, USA; 11Neurosurgery Department, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administration Region, China; 12Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
  • Online:2024-12-15 Published:2024-03-30
  • Contact: Yansheng Liu, BS, 807354743@qq.com; Kwok-Fai So, PhD, hrmaskf@hku.hk; Xiao-Ming Xu, MD, PhD, xu26@iupui.edu.
  • Supported by:
    This study was supported by Hong Kong Spinal Cord Injury Fund (HKSCIF), China (to HZ).

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摘要：

对于慢性脊髓损伤患者来说，传统的治疗方法主要是康复干预。除此之外，其他治疗主要侧重于脊髓损伤并发症，如尿路感染、压疮、骨质疏松症、血栓形成等。但目前还没有治疗脊髓损伤的有效药物，外科医生也很少对慢性脊髓损伤患者进行手术治疗。因此，迫切需要进一步开发针对慢性脊髓损伤患者的有效疗法。此次随机对照研究纳入慢性胸段脊髓损伤患者30例，比较负重行走训练强化康复治疗与强化康复治疗结合手术干预治疗的效果。该研究于 2016 年 2 月 3 日在 ClinicalTrials.gov 注册（NCT02663310）。结果发现，与只接受负重行走训练的患者相比，接受手术干预结合负重行走训练的患者更脊髓损伤严重程度和痉挛症状减轻，肠道和膀胱功能恢复更快，且具备安全性。因此主张针对慢性 SCI 治疗可考虑手术结合负重行走训练强化康复治疗干预。

https://orcid.org/0000-0003-4039-4246 (Kwok-Fai So); https://orcid.org/0000-0002-7229-0081 (Xiao-Ming Xu)

Abstract: For patients with chronic spinal cord injury, the conventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection, pressure sores, osteoporosis, and deep vein thrombosis. Surgery is rarely performed on spinal cord injury in the chronic phase, and few treatments have been proven effective in chronic spinal cord injury patients. Development of effective therapies for chronic spinal cord injury patients is needed. We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal cord injury to compare intensive rehabilitation (weight-bearing walking training) alone with surgical intervention plus intensive rehabilitation. This clinical trial was registered at ClinicalTrials.gov (NCT02663310). The goal of surgical intervention was spinal cord detethering, restoration of cerebrospinal fluid flow, and elimination of residual spinal cord compression. We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement, reduced spasticity, and more rapid bowel and bladder functional recovery than weight-bearing walking training alone. Overall, the surgical procedures and intensive rehabilitation were safe. American Spinal Injury Association Impairment Scale improvement was more common in T7–T11 injuries than in T2–T6 injuries. Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

Key words: chronic spinal cord injury, intensive rehabilitation, locomotor training, neurological recovery, surgical intervention, weight-bearing walking training