背景:运动功能障碍的恢复对于不完全性颈髓损伤(SCI)患者很重要。增强肌肉力量的恢复,研究和治疗都主要集中在直接损伤部位的上运动神经元损伤。然而,越来越多的证据表明SCI对周围神经系统有下游影响,这可能导致术后肌肉力量的改善不良。这项研究的目的是调查早期与对不完全宫颈SCI患者损伤部位远端下部运动神经元(LMNs)的延迟手术干预。
方法:对胫骨前肌(TA)进行运动单位数指数(MUNIX),47例宫颈不完全SCI患者的趾短伸肌(EDB)和外展肌(AH)(早期与延迟手术治疗:17vs.30)和34名健康受试者术后约12个月。所有患者均采用美国脊髓损伤协会(ASIA)运动量表和医学研究委员会(MRC)量表进行进一步评估。
结果:接受早期和延迟手术治疗的患者之间的ASIA运动评分和MRC评分均无差异(P>0.05)。相比之下,接受早期手术治疗的患者在双侧EDB和双侧TA中显示出较低的MUSIX值,随着右侧EDB和右侧TA中更大的MUNIX值,与接受延迟手术治疗的患者相比(P<0.05)。
结论:宫颈SCI对损伤部位远端LMNs有负面影响。早期手术干预可以改善损伤部位远端LMNs的功能障碍,减少次级运动神经元损失,最终改善临床预后。
BACKGROUND: Recovery of motor dysfunction is important for patients with incomplete cervical spinal cord injury (SCI). To enhance the recovery of muscle strength, both research and treatments mainly focus on injury of upper motor neurons at the direct injury site. However, accumulating evidences have suggested that SCI has a downstream effect on the peripheral nervous system, which may contribute to the poor improvement of the muscle strength after operation. The aim of this study is to investigate the impact of early vs. delayed surgical intervention on the lower motor neurons (LMNs) distal to the injury site in patients with incomplete cervical SCI.
METHODS: Motor unit number index (MUNIX) was performed on the tibialis anterior (TA), extensor digitorum brevis (EDB) and abductor hallucis (AH) in 47 patients with incomplete cervical SCI (early vs. delayed surgical-treatment: 17 vs. 30) and 34 healthy subjects approximately 12 months after operation. All patients were further assessed by American spinal injury association (ASIA) motor scales and Medical Research Council (MRC) scales.
RESULTS: There are no difference of both ASIA motor scores and MRC scales between the patients who accepted early and delayed surgical treatment (P > 0.05). In contrast, the patients undergoing early surgical treatment showed lower MUSIX values in both bilateral EDB and bilateral TA, along with greater MUNIX values in both right-side EDB and right-side TA, compared to the patients who accepted delayed surgical treatment (P < 0.05).
CONCLUSIONS: Cervical SCI has a negative effect on the LMNs distal to the injury site. Early surgical intervention in Cervical SCI patients may improve the dysfunction of LMNs distal to the injury site, reducing secondary motor neuron loss, and eventually improving clinical prognosis.