经皮脊髓电刺激在脊髓损伤中的应用研究进展*

doi:10.3870/j.issn.1672-0741.25.07.036

摘要/Abstract

摘要： 脊髓损伤(spinal cord injury,SCI)作为一种严重的中枢神经系统疾病,常常导致患者自主神经、感觉和运动功能的损伤或丧失。虽目前治疗策略多样,但其治疗效果短暂且局限,无法达到显著效果。经皮脊髓电刺激(transcutaneous spinal cord electrical stimulation,TSCS)是一种新兴的神经调控技术,因其非侵入性、安全性高、可逆性、耐受性好且成本相对较低等优势,已成为SCI后康复治疗及神经科学研究中一种重要的非药物干预手段,在运动、痉挛、自主神经功能等方面疗效显著,在脊髓损伤后康复方向有很大的发展前景。目前国内TSCS的临床研究正在逐步深入,而临床应用仍缺乏客观和明确的理论依据,该文旨在综述TSCS的基本原理、潜在作用机制以及TSCS治疗SCI后功能障碍的应用研究进展,以期为TSCS治疗SCI后功能障碍的临床应用和科学研究提供参考。

关键词: 脊髓损伤, 经皮脊髓电刺激, 神经调控, 康复

Abstract: Spinal cord injury(SCI)is a devastating disorder of the central nervous system that frequently results in impairment or loss of autonomic,sensory,and motor functions.Although various therapeutic strategies are currently available,their effects are often transient and limited,failing to yield significant clinical outcomes.Transcutaneous spinal cord electrical stimulation(TSCS)is an emerging neuromodulation technique that has become an important non-pharmacological intervention in SCI rehabilitation and neuroscience research.Its advantages-including non-invasiveness,high safety,reversibility,good tolerability,and relatively low cost-have contributed to its significant therapeutic effects on motor function,spasticity,and autonomic nervous function,demonstrating great promise in the field of post-SCI rehabilitation.At present,clinical research on TSCS in China is gradually advancing,however its clinical application still lacks an objective and well-established foundation.This article aims to review the basic principles,potential mechanisms of action,and research progress on the application of TSCS in treating functional disorders after SCI,in order to provide a reference for both clinical practice and future scientific research in this area.

Key words: spinal cord injury, transcutaneous spinal cord stimulation, neuromodulation, rehabilitation

中图分类号:

R651.2

苟家斌, 任亚锋, 刘承梅, 孙伟娟. 经皮脊髓电刺激在脊髓损伤中的应用研究进展^*[J]. 华中科技大学学报（医学版）, 2026, 55(2): 290-295.

Gou Jiabing, Ren Yafeng, Liu Chengmei et al. Research Progress on the Application of Transcutaneous Spinal Cord Electrical Stimulation in Spinal Cord Injury[J]. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2026, 55(2): 290-295.

参考文献

[1] 王子恒,曾妮,王先斌,等.经颅直流电刺激治疗脊髓损伤后神经病理性疼痛的研究进展[J].中国康复医学杂志,2025,40(3):470-475.
Wang Z H,Zeng N,Wang X B,et al.Research progress of transcranial direct current stimulation in the treatment of neuropathic pain after spinal cord injury[J].Chinese Journal of Rehabilitation Medicine,2025,40(3):470-475.
[2] 王宁华,顾新,周谋望,等.基于循证医学证据的脊髓损伤患者躯干控制障碍康复评定和康复治疗专家共识[J].中国康复医学杂志,2024,39(3):305-311.
Wang N H,Gu X,Zhou M W,et al.Expert consensus on rehabilitation assessment and treatment for trunk control impairment in individuals with spinal cord injury:Based on evidence-based medicine[J].Chinese Journal of Rehabilitation Medicine,2024,39(3):305-311.
[3] Quadri S A,Farooqui M,Ikram A,et al.Recent update on basic mechanisms of spinal cord injury[J].Neurosurg Rev,2020,43(2):425-441.
[4] Lu Y,Shang Z,Zhang W,et al.Global incidence and characteristics of spinal cord injury since 2000-2021:A systematic review and meta-analysis[J].BMC Med,2024,22(1):285.
[5] Hofstoetter U S,Minassian K.Transcutaneous spinal cord stimulation:Advances in an emerging non-invasive strategy for neuromodulation[J].J Clin Med,2022,11(13):3836.
[6] Gerasimenko Y,Gorodnichev R,Moshonkina T,et al.Transcutaneous electrical spinal-cord stimulation in humans[J].Ann Phys Rehabil Med,2015,58(4):225-231.
[7] Shealy C N,Mortimer J T,Reswick J B.Electrical inhibition of pain by stimulation of the dorsal columns:Preliminary clinical report[J].Anesth Analg,1967,46(4):489-491.
[8] Hubli M,Dietz V,Schrafl-Altermatt M,et al.Modulation of spinal neuronal excitability by spinal direct currents and locomotion after spinal cord injury[J].Clin Neurophysiol,2013,124(6):1187-1195.
[9] Megía García A,Serrano-Muñoz D,Taylor J,et al.Transcutaneous spinal cord stimulation and motor rehabilitation in spinal cord injury:A systematic review[J].Neurorehabil Neural Repair,2020,34(1):3-12.
[10] Alashram A R,Padua E,Raju M,et al.Transcutaneous spinal cord stimulation effects on spasticity in patients with spinal cord injury:A systematic review[J].J Spinal Cord Med,2023,46(4):582-589.
[11] Brock J A,Yeoh M,McLachlan E M.Enhanced neurally evoked responses and inhibition of norepinephrine reuptake in rat mesenteric arteries after spinal transection[J].Am J Physiol Heart Circ Physiol,2006,290(1):H398-H405.
[12] 田婷,李晓光.脊髓损伤再生修复中的问题与挑战[J].中国组织工程研究,2021,25(19):3039-3048.
Tian T,Li X G.Problems and challenges in regeneration and repair of spinal cord injury[J].Chinese Journal of Tissue Engineering Research,2021,25(19):3039-3048.
[13] Shah M,Peterson C,Yilmaz E,et al.Current advancements in the management of spinal cord injury:A comprehensive review of literature[J].Surg Neurol Int,2020,11:2.
[14] Hofstoetter U S,Freundl B,Binder H,et al.Common neural structures activated by epidural and transcutaneous lumbar spinal cord stimulation:Elicitation of posterior root-muscle reflexes[J].PLoS One,2018,13(1):e0192013.
[15] Wecht J R,Savage W M,Famodimu G O,et al.Posteroanterior cervical transcutaneous spinal cord stimulation:Interactions with cortical and peripheral nerve stimulation[J].J Clin Med,2021,10(22):5304.
[16] Benavides F D,Jo H J,Lundell H,et al.Cortical and subcortical effects of transcutaneous spinal cord stimulation in humans with tetraplegia[J].J Neurosci,2020,40(13):2633-2643.
[17] Adeel M,Lai C H,Lin B S,et al.Effects of paired stimulation with specific waveforms on cortical and spinal plasticity in subjects with a chronic spinal cord injury[J].J Formos Med Assoc,2022,121(10):2044-2056.
[18] Malloy D C,Knikou M,Côté M P.Adapting human-based transcutaneous spinal cord stimulation to develop a clinically relevant animal model[J].J Clin Med,2022,11(7):2023.
[19] Danner S M,Hofstoetter U S,Freundl B,et al.Human spinal locomotor control is based on flexibly organized burst generators[J].Brain,2015,138(Pt 3):577-588.
[20] Al'joboori Y,Hannah R,Lenham F,et al.The immediate and short-term effects of transcutaneous spinal cord stimulation and peripheral nerve stimulation on corticospinal excitability[J].Front Neurosci,2021,15:749042.
[21] Barss T S,Parhizi B,Porter J,et al.Neural substrates of transcutaneous spinal cord stimulation:Neuromodulation across multiple segments of the spinal cord[J].J Clin Med,2022,11(3):639.
[22] Tajali S,Balbinot G,Pakosh M,et al.Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury:A systematic review[J].Front Neurosci,2024,18:1372222.
[23] Hofstoetter U S,Freundl B,Danner S M,et al.Transcutaneous spinal cord stimulation induces temporary attenuation of spasticity in individuals with spinal cord injury[J].J Neurotrauma,2020,37(3):481-493.
[24] Rupp R,Biering-Sørensen F,Burns S P,et al.International standards for neurological classification of spinal cord injury:Revised 2019[J].Top Spinal Cord Inj Rehabil,2021,27(2):1-22.
[25] De Miguel-Rubio A,Rubio M D,Alba-Rueda A,et al.Virtual reality systems for upper limb motor function recovery in patients with spinal cord injury:Systematic review and meta-analysis[J].JMIR Mhealth Uhealth,2020,8(12):e22537.
[26] Moritz C,Field-Fote E C,Tefertiller C,et al.Non-invasive spinal cord electrical stimulation for arm and hand function in chronic tetraplegia:A safety and efficacy trial[J].Nat Med,2024,30(5):1276-1283.
[27] Chandrasekaran S,Bhagat N A,Ramdeo R,et al.Targeted transcutaneous spinal cord stimulation promotes persistent recovery of upper limb strength and tactile sensation in spinal cord injury:A pilot study[J].Front Neurosci,2023,17:1210328.
[28] Inanici F,Brighton L N,Samejima S,et al.Transcutaneous spinal cord stimulation restores hand and arm function after spinal cord injury[J].IEEE Trans Neural Syst Rehabil Eng,2021,29:310-319.
[29] Sayenko D G,Rath M,Ferguson A R,et al.Self-assisted standing enabled by non-invasive spinal stimulation after spinal cord injury[J].J Neurotrauma,2019,36(9):1435-1450.
[30] Tharu N S,Wong A Y L,Zheng Y P.Transcutaneous electrical spinal cord stimulation increased target-specific muscle strength and locomotion in chronic spinal cord injury[J].Brain Sci,2024,14(7):640.
[31] Chen B,Li Y,Yu B,et al.Reactivation of dormant relay pathways in injured spinal cord by KCC2 manipulations[J].Cell,2018,174(3):521-535.e13.
[32] 薛玉满,徐西林,刘泽霖,等.腹部灸法联合夹脊电针对脊髓损伤后肌痉挛患者肌张力及痉挛程度的改善作用[J].辽宁中医药大学学报,2025,27(1):169-173.
Xue Y M,Xu X L,Liu Z L,et al.Effect of abdominal moxibustion combined with Jiaji electroacupuncture on the muscle tone and spasticity relief of patients with myospasm after spinal cord injury[J].Journal of Liaoning University of Traditional Chinese Medicine,2025,27(1):169-173.
[33] Massey S,Vanhoestenberghe A,Duffell L.Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury:Systematic review and meta-analysis[J].Front Rehabil Sci,2022,3:1058663.
[34] Malloy D C,Côté M P.Multi-session transcutaneous spinal cord stimulation prevents chloride homeostasis imbalance and the development of hyperreflexia after spinal cord injury in rat[J].Exp Neurol,2024,376:114754.
[35] Cowan H,Lakra C,Desai M.Autonomic dysreflexia in spinal cord injury[J].BMJ,2020,371:m3596.
[36] Henke A M,Billington Z J,Gater D R Jr.Autonomic dysfunction and management after spinal cord injury:A narrative review[J].J Pers Med,2022,12(7):1110.
[37] Peters C G,Harel N Y,Weir J P,et al.Transcutaneous spinal cord stimulation to stabilize seated systolic blood pressure in persons with chronic spinal cord injury:Protocol development[J].Neurotrauma Rep,2023,4(1):838-847.
[38] Phillips A A,Squair J W,Sayenko D G,et al.An autonomic neuroprosthesis:Noninvasive electrical spinal cord stimulation restores autonomic cardiovascular function in individuals with spinal cord injury[J].J Neurotrauma,2018,35(3):446-451.
[39] Kreydin E,Zhong H,Latack K,et al.Transcutaneous electrical spinal cord neuromodulator(TESCoN)improves symptoms of overactive bladder[J].Front Syst Neurosci,2020,14:1.
[40] Solinsky R,Burns K,Tuthill C,et al.Transcutaneous spinal cord stimulation and its impact on cardiovascular autonomic regulation after spinal cord injury[J].Am J Physiol Heart Circ Physiol,2024,326(1):H16-H122.
[41] Ahuja C S,Fehlings M.Concise review:bridging the gap:Novel neuroregenerative and neuroprotective strategies in spinal cord injury[J].Stem Cells Transl Med,2016,5(7):914-924.
[42] García-Alén L,Kumru H,Castillo-Escario Y,et al.Transcutaneous cervical spinal cord stimulation combined with robotic exoskeleton rehabilitation for the upper limbs in subjects with cervical SCI:Clinical trial[J].Biomedicines,2023,11(2):589.
[43] Tharu N S,Alam M,Ling Y T,et al.Combined transcutaneous electrical spinal cord stimulation and task-specific rehabilitation improves trunk and sitting functions in people with chronic tetraplegia[J].Biomedicines,2022,11(1):34.
[44] Angeli C A,Gerasimenko Y.Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals[J].Front Bioeng Biotechnol,2023,11:1073716.
[45] Widerström-Noga E.Neuropathic pain and spinal cord injury:Management,phenotypes,and biomarkers[J].Drugs,2023,83(11):1001-1025.
[46] Choi E,Gattas S,Brown N J,et al.Epidural electrical stimulation for spinal cord injury[J].Neural Regen Res,2021,16(12):2367.

经皮脊髓电刺激在脊髓损伤中的应用研究进展^*

Research Progress on the Application of Transcutaneous Spinal Cord Electrical Stimulation in Spinal Cord Injury

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 5

编辑推荐

Metrics

本文评价

[1]	王钊鑫, 向国林. 康复新液通过miR-449a/Notch1轴改善脂多糖诱导的口腔黏膜上皮细胞炎症损伤^*[J]. 华中科技大学学报（医学版）, 2026, 55(2): 226-234.
[2]	王丹丹, 任彬彬△. 脊髓损伤后神经病理性疼痛发病机制及神经调控技术治疗研究进展[J]. 华中科技大学学报（医学版）, 2025, 54(6): 916-923.
[3]	罗锐, 周弘, 严子能, 倪常茂, 余锦波, 孙玉东, 吕向心, 李睿远, 周宇, 黄立, 叶哲伟. 脑机接口在脊髓损伤中的应用现状及前景[J]. 华中科技大学学报（医学版）, 2025, 54(3): 428-432.
[4]	王晓陆, 尹宗生. Agrin/Rapsyn对脊髓损伤大鼠小胶质细胞抑炎作用的实验研究[J]. 华中科技大学学报（医学版）, 2025, 54(1): 60-66.
[5]	吴远珏, 尚罗锐, 刘宇寒, 蔡红琳, 周方园, 李妍, 潘广涛, 章梦琪, 金艳, 杨炼, 杨胜兰△ . 新型冠状病毒肺炎康复期患者膳食蛋白质摄入与肺功能异常的相关性研究#br#[J]. 华中科技大学学报（医学版）, 2022, 51(1): 82-87.