脊髓损伤的病理改变及修复策略  

Pathological changes and repair strategies for spinal cord injury

作　　者：李建平[2] 何留民[3] 吴武田 LI JianPing;HE LiuMin;WU WuTian(Re-Stem Biotechnology Co.,Ltd.,Suzhou 215168,China;Guangdong-Hong Kong-Macao Institute of CNS Regeneration,Jinan University,Guangzhou 510632,China;Spine Surgery,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]江苏瑞思坦生物科技有限公司,苏州215168 [2]暨南大学粤港澳中枢再生研究院,广州510632 [3]中山大学第三附属医院脊柱外科,广州510630

出　　处：《中国科学：生命科学》2022年第10期1472-1483,共12页Scientia Sinica(Vitae)

基　　金：国家自然科学基金(批准号:81971165,32071354,31870964);国家重点基础研究发展计划(批准号:2014CB542205);广东省重点研发计划“精准医学与干细胞”重大科技项目(批准号:3242001)资助。

摘　　要：脊髓损伤造成神经组织坏死,传导通路中断,损伤平面以下运动和感觉功能丧失,导致瘫痪甚至死亡.脊髓损伤的病理变化极其复杂,早期主要为分子基因水平的改变,亚急性期主要为细胞组织水平的变化.这些变化引发继发性损伤,致使组织坏死、神经元死亡、轴突断裂并形成由瘢痕组织包裹的囊性空洞,抑制轴突再生.目前临床上仅能通过手术减压或者使用药物对症干预,无法从根本上改善受损神经的功能.脊髓损伤后功能难以恢复有多方面的原因:炎症反应贯穿脊髓损伤全过程,炎症介质导致损伤区域的神经元及胶质细胞变性坏死,轴突因瓦勒变性而萎缩;神经元再生能力弱,轴突再生乏力,并且瘢痕组织导致轴突无法穿越损伤区域与远端的轴突形成联系.本文就脊髓损伤后的病理改变进行综述并探讨修复策略.Spinal cord injury causes necrosis of nerve tissue, disruption of conduction pathways, loss of movement and sensation below the injury level, resulting in paralysis and even death. The pathological changes of spinal cord injury are extremely complex. At the early stage, the changes were mainly at the molecular/gene level, while the changes at the cell/tissue level were mainly in the subacute stage. These changes cause secondary damage, resulting in tissue necrosis, neuron death, axon rupture, the formation of cystic cavities wrapped by scar tissue and the subsequent inhibition of axon regeneration. At present, the function of the damaged nerve cannot be fundamentally improved by surgical decompression alone, or by symptomatic intervention with drugs. There are several reasons for the difficulty in functional recovery after spinal cord injury: inflammatory reactions take place through the whole process of spinal cord injury, and the inflammatory mediators lead to degeneration and necrosis of neurons and glial cells in the injured area, and axon atrophy due to valerosis. Regeneration of neurons and axons are both weak, and scar tissues prevent axons from crossing the damaged area to form connection with the contralateral axons. This article reviews the pathological changes after spinal cord injury and discusses the repair strategies.

关 键 词：脊髓损伤 修复 干细胞 材料 

分 类 号：R651.2[医药卫生—外科学]