脊髓刺激重建运动功能: 治疗效果和作用机制  

Therapeutic efficacy and mechanisms of spinal cord stimulation in motor function restoration

作　　者：李经纬 张立波 王海璐 吕雪靖 Jingwei Li;Libo Zhang;Hailu Wang;Xuejing Lu(Key Laboratory of Mental Health,Institute of Psychology,Chinese Academy of Sciences,Beijing 100101,China;Department of Psychology,University of Chinese Academy of Sciences,Beijing 100049,China;Neuroscience and Behaviour Laboratory,Italian Institute of Technology,Rome 00161,Italy;School of Special Education and Rehabilitation,Binzhou Medical University,Yantai 264003,China)

机构地区：[1]中国科学院心理研究所,中国科学院心理健康重点实验室,北京100101 [2]中国科学院大学心理学系,北京100049 [3]Neuroscience and Behaviour Laboratory,Italian Institute of Technology,Rome 00161,Italy [4]滨州医学院特殊教育与康复学院,烟台264003

出　　处：《科学通报》2025年第4期556-566,共11页Chinese Science Bulletin

基　　金：国家自然科学基金(32171077);中国科学院青年创新促进会人才专项经费资助

摘　　要：运动神经系统异常通常会导致不同程度的运动功能损伤,严重危害患者的正常生活.近年来,脊髓电刺激技术在运动功能重建方面展现出较好的治疗效果,包括使瘫痪多年的患者恢复了站立、行走、自主运动和抓握等能力.现有的脊髓电刺激技术主要包括硬膜外脊髓刺激和经皮脊髓刺激两大类,两者都对脊髓损伤、中风、脑性瘫痪等疾病导致的运动功能障碍患者有运动功能重建作用.本文回顾了这两类脊髓电刺激技术的发展历程和治疗效果,总结了它们的治疗参数、影响因素,探讨了它们治疗运动功能障碍的潜在神经机制,并分析了它们各自的优缺点.最后,本文提出了未来研究方向,包括新型刺激方法的开发、中枢神经机制的研究和个性化刺激参数的优化等.深入研究脊髓电刺激重建运动功能的疗效和机制,将有助于改善患者的生活质量,造福更多患者.Neurological injuries and disorders such as spinal cord injury, stroke, and cerebral palsy often result in persistent motorfunction deficits, severely impairing patients’ independence, mobility, and overall quality of life. Over the past few years,spinal cord stimulation (SCS), including epidural spinal cord stimulation (eSCS) and transcutaneous spinal cordstimulation (tSCS), has emerged as a promising therapeutic approach to restore motor functions, demonstrating outcomesonce considered unattainable. By carefully optimized stimulation parameters, both techniques have enabled patients toregain standing and walking abilities, perform voluntary movements, improve grasping functions, and undertake otheressential motor tasks, even in individuals who have been paralyzed for many years.Epidural spinal cord stimulation was initially introduced for chronic pain relief. Subsequent research revealed that eSCScan re-engage spinal motor networks and central pattern generators, enabling not only rhythmic locomotor-like activity butalso gradual improvements in voluntary control. Advanced protocols employing multi-electrode arrays and brain-spineinterfaces can target specific spinal segments and muscle groups with high precision. These advancements allow patientswith complete or incomplete spinal cord injuries to partially recover motor functions—even when stimulation is notapplied—suggesting that eSCS fosters long-lasting neuroplastic changes. Moreover, eSCS has shown encouragingtherapeutic potential for other neurological conditions, such as stroke and Parkinson’s disease, by delivering targetedstimulation that enhances limb coordination, gait stability, and fine motor skills.Transcutaneous spinal cord stimulation offers a noninvasive, safe, and cost-effective alternative to eSCS. Although tSCScurrently lacks spatial specificity and multi-target flexibility for eSCS, it has produced remarkable improvements in upperand lower limb function for patients with spinal cord injuries. Additionally, it has shown initial promis

关 键 词：脊髓刺激 硬膜外脊髓刺激 经皮脊髓刺激 运动功能障碍 

分 类 号：R741.05[医药卫生—神经病学与精神病学]