全脊椎切除并脊髓低张保护犬脊髓传导功能及脊髓差异蛋白质组学的实验研究

Abstract: Spinal cord injury may occur because of displacements and impingement of the spinal cord during surgical correction of spinal deformities, especially in posterior vertebral column resection (PVCR) for severe rigid deformities. Knowledge regarding the pathophysiology of spinal cord tension changes and the relationship between the spinal shortening and spinal cord function protecting are important for the prevention and treatment of spinal cord injury. However, studies of spinal cord injury caused by displacement of the vertebral column are rare, and the effects of reduced cord tension have not been studied extensively. The purpose of this study was to investigate the effect and related mechanism on protecting and improving canine spinal cord function, by using our experienced PVCR technique with spinal shortening and reduced cord tension, and divided into steps to study 1) the effect on spinal cord tension, blood supply and neurophysiological function by varying degree of the sub-acute spinal shortening through the corrective gap created by PVCR, 2) the improvement of the tolerance ability of spinal cord keeping normal function by varying degree of the sub-acute spinal shortening through the corrective gap created by PVCR, 3) the positive effect on functional recovery following corrective-related spinal cord injury by proper sub-acute spinal shortening through the corrective gap created by PVCR, and 4) the differential proteomics expression of spinal cord involving spinal cord injury occurred and intervention performed. Based on the constructed canine model of L1 level PVCR, the research methods include real-time monitoring of the change of blood perfusion in spinal cord by laser doppler blood flow measurement technology, assessing spinal cord function by motive score, somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP) monitoring, inducing variously spinal displacements by the quantitative controller intraoperation. We focus on the results of quantization the effective range of spinal cord shortening on blood supply improvement and function protection of spinal cord, confirming the improvement of the tolerance ability of spinal cord and ability of recovery from corrective-related spinal cord injury by proper spinal shortening through the corrective gap created by PVCR, and analyzing the possible mechanism.

基于PVCR技术，拟构建犬腰1全脊椎切除动物模型，以激光多普勒血流测定技术实时监测脊髓血流变化；结合运动功能评分、体感诱发电位监测和运动诱发电位监测评估脊髓传导功能；并通过可定量的脊柱位移控制器分别复制术中各二维方向的脊柱位移，研究 1) 经PVCR切除间隙的脊柱不同程度的急性短缩对脊髓张力、血流及传导功能的影响；2) 经PVCR间隙的适当的急性脊柱短缩对脊髓耐受各向位移代偿性的影响；3) 经PVCR间隙的适当的急性脊柱短缩在矫形相关脊髓损伤后处理中的积极作用；4) 对比牵拉及前后成角致急性脊髓损伤及不同干预后脊髓蛋白组学的差异表达。以期确定脊柱短缩增加脊髓血供及保护脊髓功能的有效范围，明确适当的脊柱短缩和脊髓低张可提高脊髓对矫形手术中各种方向位移的代偿能力；探索矫形手术所致急性脊髓损伤术中的有效干预手段，并初步探讨其可能的生物学作用机制，为进一步探索机械性脊髓损伤的手术治疗方法建立基础。

背景：经后路全脊椎切除术(PVCR）完全切除1个或多个椎节所有的前后方骨性结构，制造了人为的需要附加重建技术的矫形空间，经此空间并以脊髓为铰链，实现了在保证脊髓可耐受的张力和皱褶的情况下对脊柱有效的矫形。本研究目的为初步揭示基于脊柱短缩的脊髓保护作用及其可能的机制。.主要内容：本研究基于课题组拟构建犬腰1全脊椎切除动物模型，研究 1) 经PVCR切除间隙的脊柱不同程度的急性短缩对脊髓血流及传导功能的影响；2) 经PVCR间隙的适当的急性脊柱短缩对脊髓耐受各向位移代偿性的影响；3) 经PVCR间隙的适当的急性脊柱短缩在矫形相关脊髓损伤后处理中的积极作用；4) 对比牵拉及前后成角致急性脊髓损伤及不同干预后脊髓蛋白组学的差异表达。以确定脊柱短缩增加脊髓血供及保护脊髓功能的有效范围，明确适当的脊柱短缩可提高脊髓对矫形手术中各种方向位移的代偿能力；探索矫形手术所致急性脊髓损伤术中的有效干预手段，为进一步探索机械性脊髓损伤的手术治疗方法建立基础。.研究结果：1..犬腰1犬脊椎切除并环周减压后脊髓白质血流增加，神经传导功能得到相应程度改善，对脊髓起到保护性作用。2..在构建犬腰1脊椎切除模型，并对切除椎体形成间隙进行短缩，适当的短缩≦2/4时，脊髓白质血流增加，脊髓传导功能获得改善，可增加对脊髓的耐受性；不适当的短缩≧3/4时，脊髓血流量明显降低，脊髓传导功能障碍。3. 脊髓牵张能明显降低脊髓白质血流及脊髓神经功能传导，导致脊髓损伤。.关键数据：0/4＋前后成角＋椎体切除脊髓血流PU值301.23，诱发电位SEP潜伏期值29.5，诱发电位波幅度1.16，0/4＋成角＋脊髓短缩236.36，31.1，0.94；1/4+成角＋椎体切除296.39，31.5，1.09；1/4+成角＋短缩 254.62±9.54，32.9，0.9；2/4+成角＋椎体切除310.28，32.4，1.08；2/4+前后成角＋脊髓短缩275.84，33.5，1.03；3/4＋椎体切除295.24，30.6，1.12；3/4+脊髓短缩 235.37，32.9，0.76；4/4＋椎体切除 309.87，29.7，1.21；4/4＋椎体切除＋脊髓短缩 309.87，32.6，0.65。.科学意义.揭示基于脊柱短缩的脊髓保护作用及其可能的机制，为临床应用及推广PVCR技术安全治疗严重僵硬的脊柱畸形提供理论依据。