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Neurological Surgery No Shinkei Geka Volume 21, Issue 1 （January 1993）

Neurological Surgery 脳神経外科 21巻1号（1993年1月発行）

Japanese English

研究

急性脊髄損傷に対する実験的研究—病理学的変化の時間的推移について Experimental Study for Acute Spinal Cord Injury—A histopathological study 川田和弘 ¹ , 森本哲也 ¹ , 山田與徳 ¹ , 大橋孝男 ¹ , 辻本正三郎 ¹ , 星田徹 ¹ , 角田茂 ¹ , 榊寿右 ¹ Kazuhiro KAWATA ¹ , Tetsuya MORIMOTO ¹ , Takao OHASHI ¹ , Shozaburo TSUJIMOTO ¹ , Toru HOSHIDA ¹ , Shigeru TSUNODA ¹ , Toshisuke SAKAKI ¹ ¹奈良県立医科大学脳神経外科 ¹Department of Neurosurgery, Nara Medical University キーワード： Spinal cord injury , Edema , Leukocyte , Spinal hemorrhage Keyword: Spinal cord injury , Edema , Leukocyte , Spinal hemorrhage pp.45-51

発行日 1993年1月10日 Published Date 1993/1/10

DOI https://doi.org/10.11477/mf.1436900585

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Abstract 文献概要
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I．はじめに

　脊髄損傷に伴う脊髄病態に関する研究は古くから行われているが，外傷後の二次的脊髄変化に関してはなお十分に解明されていない^14,23,27）．脊髄の二次的変化の原因について外傷により生じる虚血が重要視されているが^4），その虚血の背景として傷害された部位から生じる出血や脊髄浮腫の上下への伸展が大きな役割を果たすものと思われるが，特に許後を考えると，頭側への病理学的変化の伸展に興味が持たれる．また最近，受傷直後から受傷部の毛細血管に出現してくる白血球が微小循環を障害したり，さらにはfree radicalの発生で浮腫を増強するという報告もある^10,15,22）．われわれは今回，ラットを用いてRivlinら^24）のepidural clip methodにて脊髄損傷を作り，経時的な病理学的変化を調べ，特に白血球の浸潤という観点からその変化を観察した，その結果，興味ある知見を得たので報告し，脊髄外傷が二次的に脊髄循環に及ぼす影響について考察する．

The microscopic appearance of a rat spinal cord which was acutely compressed by aneurysmal clip for one mi-nute, was investigated 15 minutes, 30 minutes, 1 hour, 3 hours and 6 hours after the injury. Although the result-ing small hemorrhagic lesion involved primarily only the central gray matter of the injured portion 15 minutes af-ter compression injury, hemorrhage, necrosis and edema in the central gray matter enlarged progressively until 3 hours after injury. Petechial hemorrhage, necrosis and edema were observed in the surrounding area one hour after spinal compression. Then these pathological changes extended rostrally and caudally, but their exten-sion was more significantly remarkable in the rostral side than in the caudal side 3 hours after compression. It was observed that leukocytes begin to infiltrate into the injured capillary walls and plug up the capillary lu-men 30 minutes after the injury. Three hours following the injury, leukocytes (lymphocyte, macrophage) extra-vasated into the surrounding spinal tissue.

From these histopathological observations, we reached the following conclusions.

A. Secondary injuries play an important role in grave impairment of neurological function of the spinal cord following acute trauma.

B. Pathological findings (hemorrhage necrosis and edema) extend more prominently to the rostral side, be-cause the direction of spinal blood flow may he rostra] inthe thoracic spinal cord.

C. Severe disturbance of iotraspinal capillary blood flow leading to grave spinal damage may be evoked, because leukocytes infiltrate into the capillary around the injured area and plug up the their lumen about 30 minutes after the injury.