Traumatic spinal cord injury
Traumatic spinal cord injury
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外伤性脊髓损伤
DOI：
10.1038/nrdp.2017.18
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发表时间：
2017-04-27
影响因子：
81.5
通讯作者：
Fehlings, Michael G.
中科院分区：
文献类型：
--
作者：
Ahuja, Christopher S.;Wilson, Jefferson R.;Fehlings, Michael G.
创伤性脊髓损伤（SCI）对患者的身体，社会和职业健康造成了毁灭性的后果。SCI的人口结构正在发生变化，越来越多的老年人受到影响。在病理生理学上，最初的机械创伤（原发性损伤）使神经元和神经胶质细胞透化，并引发继发性损伤级联反应，导致随后数周内进行性细胞死亡和脊髓损伤。随着时间的推移，病变重塑，并由囊性空洞和胶质瘢痕组成，两者都有效地抑制再生。已经开发了几种SCI的动物模型和补充行为测试来模拟这种病理过程，并形成临床前和转化神经保护和神经再生策略的发展基础。诊断需要全面的病史、标准化的神经系统体格检查和脊髓放射成像。诊断后，需要迅速采取几种干预措施，包括重症监护室的血液动力学监测、早期手术减压、血压升高，以及可能使用甲基强的松龙。管理SCI的并发症，如肠和膀胱功能障碍，压疮和感染的形成，是解决患者受伤经历的所有方面的关键。
Traumatic spinal cord injury (SCI) has devastating consequences for the physical, social and vocational well-being of patients. The demographic of SCIs is shifting such that an increasing proportion of older individuals are being affected. Pathophysiologically, the initial mechanical trauma (the primary injury) permeabilizes neurons and glia and initiates a secondary injury cascade that leads to progressive cell death and spinal cord damage over the subsequent weeks. Over time, the lesion remodels and is composed of cystic cavitations and a glial scar, both of which potently inhibit regeneration. Several animal models and complementary behavioural tests of SCI have been developed to mimic this pathological process and form the basis for the development of preclinical and translational neuroprotective and neuroregenerative strategies. Diagnosis requires a thorough patient history, standardized neurological physical examination and radiographic imaging of the spinal cord. Following diagnosis, several interventions need to be rapidly applied, including haemodynamic monitoring in the intensive care unit, early surgical decompression, blood pressure augmentation and, potentially, the administration of methylprednisolone. Managing the complications of SCI, such as bowel and bladder dysfunction, the formation of pressure sores and infections, is key to address all facets of the patient's injury experience.