1、脊髓(j su)損傷 臨床上的問題Spinal Cord InjuryThe Clinical Problem,Keith DK LukChair Professor&HeadDept of Orthopedics&TraumatologyUniversity of Hong Kong,第一页，共五十九页。,Anatomy 解剖(jipu)學,脊髓(j su)中樞神經系統Spinal cord(central nervous system)vs 馬尾叢 周邊神經系統Cauda equina(peripheral nervous system),C1 to L1,L2 to S4,第二页，共五十
2、九页。,脊髓(j su)損傷的發病率 Incidence of Spinal Cord Injury,在美國，每百萬人口(rnku)約有40宗新病例(每年10,000宗病例)40 new cases/million population in USA(about 10,000 cases per year)在歐洲,台灣及香港，每百萬人口約有20宗新病例20 new cases/million population in Europe,Taiwan&Hong Kong National Spinal Injury Statistical Center,USA.2004http:/www.spin
3、alcord.uab.edu,第三页，共五十九页。,一九九(ji ji)八至九九(ji ji)年度衛生署年報Department of Health Annual Report 1998/99,脊髓(j su)損傷 365 病人Spinal Cord Injury 365 patients,第四页，共五十九页。,2000年衛生署資料Department of Health Website Information,脊髓(j su)及神經受損 452 病人Injury to nerves and spinal cord 452 patients,第五页，共五十九页。,嚴重脊髓(j su)損傷 Mo
4、re Severe SCI,二零零四年上半年共有(n yu)71個病例First 6 months/200471 cases,第六页，共五十九页。,常見脊髓(j su)損傷的原因Common causes of spinal cord injury,交通意外(ywi)Motor vehicular accident高處墜下 Fall from height運動創傷 Sports&recreational injuries暴力 Violence,第七页，共五十九页。,香港常見導致脊髓(j su)受損的原因Common Causes of Spinal Cord Impairment in Hon
5、g Kong,退化(tuhu)病 Degenerative diseases創傷 Traumatic injuries腫瘤性疾病 Neoplastic diseases發炎性疾病 Inflammatory diseases,第八页，共五十九页。,第九页，共五十九页。,第十页，共五十九页。,第十一页，共五十九页。,第十二页，共五十九页。,第十三页，共五十九页。,第十四页，共五十九页。,第十五页，共五十九页。,殘疾的程度(chngd)Disability relates to:,受損水平(shupng)Level of injury四肢癱瘓 Quadriplegia下肢癱瘓 Paraplegia,
6、受損程度(chngd)Degree of injury部份受損 Incomplete完全受損 Complete,第十六页，共五十九页。,高位(o wi)脊髓受損High Spinal Cord Injury,依賴呼吸(hx)機 Ventilator dependent呼吸併發症 Respiratory complication完全依賴 Totally dependent,第十七页，共五十九页。,臨床問題 Clinical Problems,生理(shngl)問題 Physical 心理問題 病人,家屬 Psychological Patient,Family社交問題 就業,參與社會活動 Soc
7、io-economical Employment,Community access,第十八页，共五十九页。,生理(shngl)問題Physical Problems,喪失活動能力(nngl)Loss of motion失去感覺 Loss of sensation-Pressure ulcers 褥瘡 痛楚 Pain,第十九页，共五十九页。,生理(shngl)問題Physical Problems,交感神經功能 Autonomic dysreflexia-膀胱 尿滯留或小便(xiobin)失禁 Bladder retention or incontinence-大腸 便秘或失禁 Bowel co
8、nstipation or incontinence-功能性障礙 Sexual dysfunction 痙攣 Spasticity,第二十页，共五十九页。,完全癱瘓者:一年內:約5-10%的病人約有兩節段的改善(gishn)90%的病人有一節段的改善 少於1%的病人有兩節段以上的改善:For complete SCI:In one year:90%of SCI patients improve one level.5-10%of SCI patients improve two levels.less than 1%of SCI patients improve more than two l
9、evels半癱瘓者:比較難估計,不過整體比完全癱瘓者優勝For incomplete SCI less predictable,tends to be better than complete injuries NSCISC,2004.http:/www.spinalcord.uab.edu,Natural history,第二十一页，共五十九页。,傳統的療法 Conventional management,脊髓是不能被修補或再生 Repair,regeneration of the spinal cord is not possible集中(jzhng)復康治療主流治療方向增強殘餘功能恢復功
10、能 減低傷殘 Focus on rehabilitationMain stream managementMaximize residual functionsFunctional restoration Minimize disabilities,第二十二页，共五十九页。,截癱性步行(bxng)Paraplegic walking,第二十三页，共五十九页。,半癱瘓 Incomplete Paraplegia,第二十四页，共五十九页。,家居(jij)改善 Home modification,第二十五页，共五十九页。,公共(gnggng)交通工具 Transportation,第二十六页，共五十九
11、页。,第二十七页，共五十九页。,香港現有的服務Current Services in Hong Kong,幾乎所有(suyu)的脊髓復康服務均由醫院管理局提供 Nearly all spinal cord rehabilitation are provided by HA三間由醫管局提供的脊髓復康醫院 3 SCI units under the Hospital Authority香港區：麥理浩復康院,MacLehose Rehabilitation Centre 九龍區：九龍醫院,Kowloon Hospital新界區：大埔醫院,Tai Po Hospital高技術水準的設備-FES,矯具等
12、State-of-the-art facilitiesFES,orthosis,etc,第二十八页，共五十九页。,脊髓損傷的治療及再生(zishng)的可能Potential for spinal cord repair and regeneration,再生(zishng)療法Regenerative therapies,第二十九页，共五十九页。,脊髓(j su)損傷研究的重要性 Importance of Spinal Cord Injury(SCI)Research,第三十页，共五十九页。,研究脊髓(j su)損傷的病理組織學 To investigate pathohistology
13、of Spinal Cord Injury：,甚麼因素阻止了脊髓(j su)損傷後軸突的再生？What stop axonal regeneration in Spinal Cord Injury?,如何促進脊髓損傷受損神經元的存活(cn hu)和再生？How to enhance survival and regeneration of injured neurons in Spinal Cord Injury?,這些問題的答案將會給脊髓損傷病人提供新的療法。Answer to these questions will contribute significantly for the new
14、 treatment methods for Spinal Cord Injury patients.,損傷後神經元如何、為何死亡？how and why neurons die after injury?,第三十一页，共五十九页。,確定已用於脊髓損傷病人(bngrn)臨床試驗的幹細胞、施萬細胞以及Oefactory Ensheathing Cells 細胞(OEC-嗅鞘上皮細胞)移植等治療方法的機制。To confirm and prove mechanisms of treatment methods that have been used in clinical trial study
15、for the Spinal Cord Injury patients,such as stem cell,Schwanns cell and OEC cell(Oefactory Ensheathing Cells)transplantations.,為脊髓(j su)損傷新藥的檢測提供動物模型。To provide animal models for testing effects of new drugs for Spinal Cord Injury.,第三十二页，共五十九页。,Neuroscience Exploring the Brain,Second Edition.Bear MF
16、,Connors BW,Paradiso MA,脊髓的主要(zhyo)功能（Main Functions of the Spinal Cord）,將感覺訊息從外周傳向腦，運動訊息從腦傳向外周。,構成局部回路(hul)和反射。To perform locomotion and reflex.,To convey sensory impulses from periphery to the brain and to convey motor impulses from the brain to the periphery.,第三十三页，共五十九页。,神經细胞(xbo)死亡（Neuronal cell death）a.原發損傷 Primary injury(空洞cavity)b.繼發損傷 Secondary injury,脊髓(j su)損傷後有侍解決的問題,2.軸突切斷（Axotomy）,3.脱髓鞘（Demyelination）,4.膠質癍痕（Glial scar）,5.抑制性分子(fnz)（Inhibit molecules,NI-35,NI-250）,6.血液供應不良（Poor Blo
