中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (5): 820-829.doi: 10.4103/1673-5374.297080

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

手术与负重步行训练可改善完全性脊髓损伤患者的神经功能：前瞻性自身对照试验

  


  • 出版日期:2021-05-15 发布日期:2020-12-29
  • 基金资助:

    这项工作得到了香港脊髓损伤基金会的部分支持

Surgical intervention combined with weight-bearing walking training improves neurological recoveries in 320 patients with clinically complete spinal cord injury: a prospective self-controlled study

Yansheng Liu1, 2, Jia-Xin Xie2, Fang Niu1, 2, Zhexi Xu1, 2, Pengju Tan1, 2, Caihong Shen1, 2, Hongkun Gao1, 2, Song Liu1, 2, Zhengwen Ma3, Kwok-Fai So4, 5, Wutian Wu5, 6,    #br# Chen Chen7, Sujuan Gao8, Xiao-Ming Xu7, *, Hui Zhu1, 2, *#br#   

  1. 1 Kunming International Spine and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China;  2 Clinical Center for Spinal Cord Injury, Kunming General Hospital of Chengdu Military Command, Kunming, Yunnan Province, China;  3 Department of Laboratory Animal Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China;  4 Department of Ophthalmology and State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administration Region, China;  5 Guangdong-Hongkong-Macau Institute for Central Nervous System Regeneration, Jinan University, Guangzhou, Guangdong Province, China;  6 Re-Stem Biotechnology, Co., Ltd., Suzhou, Jiangsu Province, China;  7 Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA;  8 Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
  • Online:2021-05-15 Published:2020-12-29
  • Contact: Xiao-Ming Xu, PhD, xu26@iupui.edu; Hui Zhu, MD, kmzhuhui@sina.com.
  • Supported by:
    This work was supported in part by the Hong Kong Spinal Cord Injury Fund.

PDF

41

摘要：

创伤性脊髓损伤研究领域虽然已经取得了较大进展，但对于患者而言，获益仍有限。为确定外科手术干预联合长期负重步行训练的干预完全脊髓损伤的临床效果。此次前瞻性自身对照试验共纳入320例完全性脊髓损伤患者，年龄16-60岁，201和119例分中坚力量接受了早期（≤7天）和延迟（8-30天）外科手术以减少椎管内或髓内压。术后15d，所有患者均接受了“昆明运动训练计划（KLTP）”的负重步行训练，为期6个月。结果发现与基线相比，术后15d和联合干预3和6个月美国脊髓损伤协会损害量表和10分昆明运动量表评估神经功能明显改善。这些结果说明外科手术联合负重运动训练促进完全性脊髓损伤患者神经功能恢复的效果较为显著，且作用持久。这项研究得到解放军昆明总医院和昆明同仁医院科学与研究委员会的批准，并于2019年7月26日在ClinicalTrials.gov（NCT04034108）注册。

https://orcid.org/0000-0002-7229-0081 (Xiao-Ming Xu); 

https://orcid.org/0000-0001-7306-6973 (Hui Zhu)

Abstract: Although a large number of trials in the SCI field have been conducted, few proven gains have been realized for patients. In the present study, we determined the efficacy of a novel combination treatment involving surgical intervention and long-term weight-bearing walking training in spinal cord injury (SCI) subjects clinically diagnosed as complete or American Spinal Injury Association Impairment Scale (AIS) Class A (AIS-A). A total of 320 clinically complete SCI subjects (271 male and 49 female), aged 16–60 years, received early (≤ 7 days, n = 201) or delayed (8–30 days, n = 119) surgical interventions to reduce intraspinal or intramedullary pressure. Fifteen days post-surgery, all subjects received a weight-bearing walking training with the “Kunming Locomotion Training Program (KLTP)” for a duration of 6 months. The neurological deficit and recovery were assessed using the AIS scale and a 10-point Kunming Locomotor Scale (KLS). We found that surgical intervention significantly improved AIS scores measured at 15 days post-surgery as compared to the pre-surgery baseline scores. Significant improvement of AIS scores was detected at 3 and 6 months and the KLS further showed significant improvements between all pair-wise comparisons of time points of 15 days, 3 or 6 months indicating continued improvement in walking scores during the 6-month period. In conclusion, combining surgical intervention within 1 month post-injury and weight-bearing locomotor training promoted continued and statistically significant neurological recoveries in subjects with clinically complete SCI, which generally shows little clinical recovery within the first year after injury and most are permanently disabled. This study was approved by the Science and Research Committee of Kunming General Hospital of PLA and Kunming Tongren Hospital, China and registered at ClinicalTrials.gov (Identifier: NCT04034108) on July 26, 2019.

Key words: American Spinal Injury Association Impairment Scale–A, functional recovery, human, intramedullary decompression, spinal cord injury, surgical intervention, walking training