How many ligations of bilateral segmental arteries cause ischemic spinal cord dysfunction? An experimental study using a dog model
How many ligations of bilateral segmental arteries cause ischemic spinal cord dysfunction? An experimental study using a dog model
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DOI：
10.1097/01.brs.0000238717.51102.79
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发表时间：
2006-10-01
期刊：
影响因子：
3
通讯作者：
Ueda, Yasuhiro
中科院分区：
文献类型：
--
作者：
Fujimaki, Yoshiyasu;Kawahara, Norio;Ueda, Yasuhiro
研究设计.在犬中，将节段性动脉阻断多达7个节段，以研究对脊髓血流和神经功能的影响。研究双侧节段动脉结扎导致缺血性脊髓功能障碍的情况。背景资料概要。据报道，双侧节段动脉中断达3个节段不会损害脊髓功能。然而，据我们所知，结扎3个以上节段的影响尚未明确确定。将15只犬分为5组：假手术组，不结扎;第1组，结扎双侧节段动脉3个节段（T11-T13）;第2组，结扎双侧节段动脉4个节段（T10-T13）;第3组，结扎双侧节段动脉5个节段（T10-L1）;第4组，结扎双侧节段动脉7个节段（T9-L2）。采用激光多普勒血流仪测量T12脊髓血流量，同时测量脊髓诱发电位和运动诱发电位，直至结扎后10小时。另20只犬分为4组（1、2、3、4组），术后1周采用改良Tarlov评分系统评价神经功能。结扎后10小时，假手术组和第1、2、3和4组的脊髓血流量分别为99.3%、80.7%、71.5%、44.3%和25.0%。在第3组的2/3只犬和第4组的所有3只犬中观察到脊髓诱发电位异常。在第3组的1/3只犬和第4组的所有3只犬中观察到异常运动诱发电位。术后神经系统评价分别确定第1组和第2组中的所有5只犬以及第3组中的3只为5级。第3组和第4组中分别有2只和3只犬出现4级，第4组中有2只出现3级。在>= 5个连续节段中断双侧节段动脉有可能导致脊髓缺血，从而损伤脊髓。
Study Design. Segmental arteries were interrupted bilaterally for up to 7 levels to study the effects on spinal cord blood flow and neurologic function in dogs.Objective. To examine how many ligations of bilateral segmental arteries cause ischemic spinal cord dysfunction.Summary of Background Data. Interruption of bilateral segmental arteries for up to 3 levels has been reported not to damage spinal cord function. However, to our knowledge, the effects of ligating more than 3 levels have not yet been clearly determined.Methods. There were 15 dogs divided into 5 groups: sham group, no ligation; group 1, ligation of bilateral segmental arteries at 3 levels (T11-T13); group 2, at 4 levels (T10-T13); group 3, at 5 levels (T10-L1); and group 4, at 7 levels (T9-L2). Spinal cord blood flow at T12 measured by laser Doppler flowmetry, and spinal cord-evoked and motor-evoked potentials were measured simultaneously until 10 hours after ligation. Neurologic function was assessed using a modified Tarlov grading system 1 week after operation in 20 other dogs divided into 4 groups (1, 2, 3, and 4).Results. Spinal cord blood flow was 99.3%, 80.7%, 71.5%, 44.3%, and 25.0% in the sham group, and groups 1, 2, 3, and 4, respectively, 10 hours after ligation. Abnormal spinal cord-evoked potentials were observed in 2 of 3 dogs in group 3 and all 3 in group 4. Abnormal motor-evoked potentials were observed in 1 of 3 dogs in group 3 and all 3 in group 4. Postoperative neurologic evaluation identified all 5 dogs in groups 1 and 2, respectively, and 3 in group 3 as having grade 5. There were 2 dogs in group 3 and 3 in group 4 that had grade 4, and 2 in group 4 had grade 3.Conclusion. Interruption of bilateral segmental arteries at >= 5 consecutive levels risks producing a spinal cord ischemia capable of injuring the spinal cord.