脊髓火器伤和打击伤早期病理生理变化的对照研究
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摘要
建立猪胸腰段脊髓火器伤模型和改良Allen’s打击后全瘫模型,观察早期全身及局部病理改变。结果发现:胸腰段脊髓火器伤早期死亡原因可能是多发伤引起的低血容量性休克,而心脏损伤和肾脏损伤加速了早期死亡。两组伤后1h即可发现神经元破坏、崩解,6h发现神经胶质细胞表达增加。细胞凋亡基因P-53和Bax基因在脊髓损伤后3h出现转录水平(mRNA)和蛋白水平的表达量增加,6h内随着时间延长而表达上调。而Bcl-2基因在脊髓损伤后6h出现转录水平(mRNA)和蛋白水平的表达量增加。脊髓火器伤的波及范围较打击伤更为广泛。
The porcine models of gunshot injury to thoraciclumbar spinal cord andcomplete paraplegia of contusion model of SCI using the modified Allen's method were established in this study, which we analyze the early systemic and local pathophysical changes. It is concluded that hypovolumic shock from multiple organ injury cause death, meanwhile, one of the most important role in the high mortality at early stage is heart and kidney injury. Just lh after the injury the destruction and lysis of neuron could be observed, 6h after injury the number of glial cells increased in both models. Levels of transcription and protein expression of P-53 and bax gene began to increase since 3h after injury and up-regulated during the following 6h after injury, which bcl-2 gene began to rise since 6h. However, the injury area of gunshot SCI would be more extensive than that of the Allen's method induced injury.
The porcine models of gunshot injury to thoraciclumbar spinal cord andcomplete paraplegia of contusion model of SCI using the modified Allen's method were established in this study, which we analyze the early systemic and local pathophysical changes. It is concluded that hypovolumic shock from multiple organ injury cause death, meanwhile, one of the most important role in the high mortality at early stage is heart and kidney injury. Just lh after the injury the destruction and lysis of neuron could be observed, 6h after injury the number of glial cells increased in both models. Levels of transcription and protein expression of P-53 and bax gene began to increase since 3h after injury and up-regulated during the following 6h after injury, which bcl-2 gene began to rise since 6h. However, the injury area of gunshot SCI would be more extensive than that of the Allen's method induced injury.
引文
1 谢中光,吴海燕,姜陆林,等.脊髓及椎管旁的损伤研究[J].中华创伤杂志,1991,7(S):33-36
2 胥少汀.实验性脊髓枪伤的损伤机理及分型[J].中华外科杂志,1990,28(10):588-591
3 Tarlov LM, Klinger H, Vitale S, et al. Spinal cord compression studies[J]. Arch Neurol Psychiat, 1953,70:813-819
4 NATO. Emergency surgery: First United States revision. Washington DC: United States Government Printing Office, 1975,11
5 Owen Smith MS. High velocity missle wounds. London: Edward Amold L t. 1981, 21
6 Fackler ML. Gunshot wound review. Ann Emerg Md, 1996, 28:22
7 Harvey EN, Korr IM, Oster G, et al. Secondary damage in wounding due to pressure changes accompany the passage of high velocity missiles. Surgery, 1957, 21:218
8 Suneson A, Hansson HA, Seeman T. Pressure wave injuries to the nervous system caused by high energy missile extremity impact. J Trauma, 1990, 30:281
9 Suneson A, Hansson HA, Seeman T. Pressure wave injuries to the nervous system caused by high energy missile extremity impact. J Trauma, 1990, 30:281
10 Janzon B, Seeman J. Muscle devitalization in high-energy missile wounds and its dependence on energy transfer. J Trauma, 1985, 25:138
11 刘荫秋,周宝桐,李曙光,等.高速投射物远达效应的机理及其对伤情转归的初步探讨.中华创伤杂志,1991,7(增刊):7
12 王正国.枪弹致伤力和致伤机制的再认识.中华创伤杂志,1998,5:263-265
13 周华东.高速投射物的远达效应极其发生机理.战伤参考资料,1997,26(1):16-19
14 Suneson A, Hansson HA, Seeman T. Central and peripheral nervous damage following high energy missile wounds in the high. J Trauma, 1988, 2B (Supp1):s197
15 万茂枪.弹伤坏死组织界限的判定.国外医学军事医学分册,1989,3:129-132
16 Sala F, Menna G, Bricolo A, et al. Role of glycemia in acute spinal cord injury. Data from a rat experimental model and clinical experience.Ann N Y Acad Sci. 1999,890:133-54
17 陈家禄,周青山,吴秀枝,等.高血糖对急性脊髓损伤后果的影响.中华实验外科杂志,1999 16(3):233
18 李秀江,杜玉君.危重病人血清酶学变化及其意义[J].中国急救医学,1999,19(11):669
19 Lawson NS, et al. Serum enzyme in experimental ballistic injury to extremities. Arch Surg. 1973;103:741
20 Syracuse D, Seaver PR, Rich N. Bone as a secondary missile: an experimental study in the fragmenting of bone by high-velocity missiles. J Trauma. 1989,29(5):609-12
21 Splavski B, Saric G, Vrankovic D, et al. Computed tomography of the spine as an important diagnostic tool in the management of war missile spinal trauma. Arch Orthop Trauma Surg. 1998,117(6-7):360-363
22 Denis E The three columns of the spine and its significance in the classification of acute thoracolumbar spine injuries. Spine. 1983,8:817-3123 Meyer PR, Apple DF, Bohlman HH, et al. Symposium: Management of fractures of the thoracolumbar spine. Contemp Orthop, 1988,16:57-86
24 Kulkarni MV, Mc Ardle CB, Kopanicky D, et al. Acute spinalcord injury imaging at 1.5T. Radiology, 1987,164:837-840
25 Bondurant FL, Cotler HB, Kulkrani MV, et al. Acute spinal cord injury: A study using physical examination and magnetic resonance imaging. Spine, 1990,15:161-164
26 Dorland's Illustrated Medical Dictionary, 29~(th) edition. Saunder's Company, 2000.1463.
27 NATO. Emergency War Surgery. U.S. Government Printing Office. Washington D.C, 1975, 82-87
28 徐道妙,徐启明,艾宇航,等.器官功能监测与维护在多发伤治疗中的价值[J].湖南医科大学学报,2000,25(3):288-290
29 李主一.脊柱脊髓火器伤分析.解放军医学,1990,15(5):373-374
30 姚元章,程晓斌,周健,等.影响创伤性失血性休克病人预后的危险因素分析.中国实用外科学杂志,2000,15(7):409-410
31 赖西南,王丽丽.外军野战救治进展.人民军医,2000,43(7):379
2 胥少汀.实验性脊髓枪伤的损伤机理及分型[J].中华外科杂志,1990,28(10):588-591
3 Tarlov LM, Klinger H, Vitale S, et al. Spinal cord compression studies[J]. Arch Neurol Psychiat, 1953,70:813-819
4 NATO. Emergency surgery: First United States revision. Washington DC: United States Government Printing Office, 1975,11
5 Owen Smith MS. High velocity missle wounds. London: Edward Amold L t. 1981, 21
6 Fackler ML. Gunshot wound review. Ann Emerg Md, 1996, 28:22
7 Harvey EN, Korr IM, Oster G, et al. Secondary damage in wounding due to pressure changes accompany the passage of high velocity missiles. Surgery, 1957, 21:218
8 Suneson A, Hansson HA, Seeman T. Pressure wave injuries to the nervous system caused by high energy missile extremity impact. J Trauma, 1990, 30:281
9 Suneson A, Hansson HA, Seeman T. Pressure wave injuries to the nervous system caused by high energy missile extremity impact. J Trauma, 1990, 30:281
10 Janzon B, Seeman J. Muscle devitalization in high-energy missile wounds and its dependence on energy transfer. J Trauma, 1985, 25:138
11 刘荫秋,周宝桐,李曙光,等.高速投射物远达效应的机理及其对伤情转归的初步探讨.中华创伤杂志,1991,7(增刊):7
12 王正国.枪弹致伤力和致伤机制的再认识.中华创伤杂志,1998,5:263-265
13 周华东.高速投射物的远达效应极其发生机理.战伤参考资料,1997,26(1):16-19
14 Suneson A, Hansson HA, Seeman T. Central and peripheral nervous damage following high energy missile wounds in the high. J Trauma, 1988, 2B (Supp1):s197
15 万茂枪.弹伤坏死组织界限的判定.国外医学军事医学分册,1989,3:129-132
16 Sala F, Menna G, Bricolo A, et al. Role of glycemia in acute spinal cord injury. Data from a rat experimental model and clinical experience.Ann N Y Acad Sci. 1999,890:133-54
17 陈家禄,周青山,吴秀枝,等.高血糖对急性脊髓损伤后果的影响.中华实验外科杂志,1999 16(3):233
18 李秀江,杜玉君.危重病人血清酶学变化及其意义[J].中国急救医学,1999,19(11):669
19 Lawson NS, et al. Serum enzyme in experimental ballistic injury to extremities. Arch Surg. 1973;103:741
20 Syracuse D, Seaver PR, Rich N. Bone as a secondary missile: an experimental study in the fragmenting of bone by high-velocity missiles. J Trauma. 1989,29(5):609-12
21 Splavski B, Saric G, Vrankovic D, et al. Computed tomography of the spine as an important diagnostic tool in the management of war missile spinal trauma. Arch Orthop Trauma Surg. 1998,117(6-7):360-363
22 Denis E The three columns of the spine and its significance in the classification of acute thoracolumbar spine injuries. Spine. 1983,8:817-3123 Meyer PR, Apple DF, Bohlman HH, et al. Symposium: Management of fractures of the thoracolumbar spine. Contemp Orthop, 1988,16:57-86
24 Kulkarni MV, Mc Ardle CB, Kopanicky D, et al. Acute spinalcord injury imaging at 1.5T. Radiology, 1987,164:837-840
25 Bondurant FL, Cotler HB, Kulkrani MV, et al. Acute spinal cord injury: A study using physical examination and magnetic resonance imaging. Spine, 1990,15:161-164
26 Dorland's Illustrated Medical Dictionary, 29~(th) edition. Saunder's Company, 2000.1463.
27 NATO. Emergency War Surgery. U.S. Government Printing Office. Washington D.C, 1975, 82-87
28 徐道妙,徐启明,艾宇航,等.器官功能监测与维护在多发伤治疗中的价值[J].湖南医科大学学报,2000,25(3):288-290
29 李主一.脊柱脊髓火器伤分析.解放军医学,1990,15(5):373-374
30 姚元章,程晓斌,周健,等.影响创伤性失血性休克病人预后的危险因素分析.中国实用外科学杂志,2000,15(7):409-410
31 赖西南,王丽丽.外军野战救治进展.人民军医,2000,43(7):379