脊髓电刺激对脊髓损伤治疗的研究进展

Research advances in spinal cord electrical stimulation for the treatment of spinal cord injury

摘要:

脊髓损伤的发病率逐年上升，其造成的一系列功能神经障碍及高额的护理费用可对患者的生活质量及身心健康造成严重的影响。现阶段随着对脊髓损伤后的细胞、分子机制及组织学事件有了深入研究，学界对脊髓损伤有了较充分的认知，但脊髓损伤后的一系列并发症仍未得到完全改善，患者迫切需要更安全、更有效的方式来进一步促进损伤后的功能恢复。目前，神经调控技术已被广泛应用于一线临床工作中，其中，脊髓电刺激在脊髓损伤的多领域取得了重大的突破：在脊髓损伤后的疼痛管理方面，提出了高频电刺激等多种新兴刺激模式，使镇痛作用更有效、更持久；在运动功能重建方面，能使完全脊髓损伤后的截瘫患者恢复较为复杂的运动功能；在括约肌功能的恢复领域，也可明显缓解神经源性膀胱和肠道功能障碍引起的大、小便功能障碍。就此，该文通过对脊髓电刺激在脊髓损伤后的疼痛、运动感觉功能障碍、括约肌功能障碍3个方面的研究现状及脊髓电刺激在功能重建方面可能存在的机制进行综述，进而探讨脊髓电刺激在脊髓损伤领域中的广泛应用前景，分析目前脊髓电刺激研究的不足之处，进而对脊髓电刺激技术的未来发展方向提出简单的设想，期望在将来的临床工作及临床研究中有指导作用。

Abstract:

The incidence rate of spinal cord injury （SCI） is increasing year by year， and a series of functional neurological disorders and high nursing costs caused by SCI can seriously affect the quality of life and physical and mental health of patients with SCI. At present， with the in-depth research on the cellular and molecular mechanisms and histological events after SCI， we have gained a full understanding of the mechanism of SCI； however， the complications after SCI have not been completely improved， and patients urgently need safer and more effective ways to further promote functional recovery after injury. Currently， neuromodulation techniques have been widely applied in clinical practice， among which spinal cord stimulation （SCS） has made major breakthroughs in various fields of spinal cord injury. As for pain management after SCI， various new stimulation modes， including high-frequency electrical stimulation， are proposed to achieve a more effective analgesic effect that lasts for a longer time； as for the reconstruction of motor function， SCS can help to restore relatively complex motor functions in patients with paraplegia after complete SCI； as for the recovery of sphincter function， SCS can effectively improve the difficulty in urination and defecation caused by neurogenic bladder and neurogenic intestinal dysfunction. Therefore， this article reviews the current status of research on SCS in pain， motor and sensory dysfunction， and sphincter dysfunction after SCI and the possible mechanism of SCS in functional reconstruction， and it also discusses the wide application prospect of SCS in the field of SCI， analyzes the shortcomings of research on SCS， and proposes the directions for the development of SCS， in order to guide future clinical work and research.