Clinical And Pharmacological Research On The Treatment Of Spinal Cord Injury Based On The Du Channel Theory Based On "spinal Cord Decompression And Unblocking The Du Channel

Atlantoaxial dislocation(AAD)is a kind of life-threatening Atlantoaxial structural inst-ability,loss of physiological articular alignment,joint dysfunction and a series of neurological disorders caused by trauma,congenital deformity,degeneration,tumor,inflammation and other common multidisciplinary diseases.For serious or life-threatening nerve compression symptoms due to the dislocation of the upper cervical vertebra,severe spinal canal stenosis,and medulla oblongata compression,relieving spinal cord compression,restoring the strong support and protection of the spine is a strong guarantee to dredge Qi of the Governor Vessel(GV)and enable the function of the spinal cord,therefore,surgical treatment is the only effective treatment method.The spinal cord and GV have identical anatomical position,physiological function,pathogenesis and pathological mechanism.It can be said that the spinal cord is an important part of the GV.The spinal cord compression and the blockage of the GV have the same pathologic evolution.Therefore,the operation to relieve the spinal cord compression can be seen as the dredging of the GV on the anatomical structure.The damage caused by secondary injury of SCI is far greater than that caused by primary injury.Modern medicine lacks safe and effective treatment measures due to the complicated pathological mechanism of SCI which has not been clearly defined.Traditional Chinese Medicine(TCM)has recorded SCI and the theory of GV in the The Yellow Emperor’s Canon Internal Medicine Suwen more than 2,000 years ago.Long-term clinical practice has also proved the clinical efficacy of TCM manipulative therapy,acupuncture and decoction for mild and moderate SCI.Based on the above,Professor Tan concluded that the syndrome of AAD belongs to blood stasis of governor meridian(BSGV),which is the pathogenesis of blood stasis of GV and the final outcome of nerve compression caused by different etiology.For SCI caused by spinal osseous structure destruction and severe spinal stenosis,any individual treatment cannot achieve satisfactory efficacy,so the treatment principle should be based on "spinal cord decompression and dredging of the GV",namely"treatment from the GV".The purpose of surgical treatment is to improve the exterior environment of the injured spinal cord segment by decompression and other methods,restore the residual function of the spinal cord,stabilize the spine,limit the secondary injury and provide the basis for the later treatment.Perioperative Traditional Chinese Medicine treatment is used to further relieve the symptoms of the stasis of the GV,which may dredge the effect of the stasis of the GV.Professor Tan concluded that the main etiology of AAD included injury,wind-cold,concretions and gatherings,deficiency of liver and kidney,strain.It could be attributed to BSGV,which is the pathogenesis of AAD,which is the final condition of nerve compression by AAD caused by different causes.Medication should be used to remove Bi Zheng and dredge the stasis of the GV,tonifying liver and kidney,and treating both symptoms and the disease.Based on this,Tongdu Shuji decoction(basic prescription),which was designed for internal administration of spinal cord injury,was summarized:raw astragalus 30 g,ligusticum wallichii 15 g,red peony root 12 g,angelica tail 12 g,leech 10 g,peach kernel 12 g,safflower 15 g,radix rehmanniae recen 20 g,mulberry parasitic 12 g,radix achyranthis bidentatae 15 g,eucommia ulmoides 10 g,parsnip 15 g,tuckahoe 10 g,atractyloides 15 g,licorice 6 g.Few reports focus on the onset of concurrence of AAD and multilevel cervical spondylotic myelopathy(CSM),therefore,the incidence,radiological manifestations and results are still not clear.In view of reciprocal relationship of the upper and lower cervical spine both in the state of nature and the pathological stat,the incidence in clinic may be underestimated.The conventional treatment for patients of AAD coexisting with CSM is posterior long segment decompression and fusion,however encounters many problems,such as increased compensatory movement caused by stress concentration,surgical trauma,obvious postoperative pain and high incidence of complications.Shin et al.first proposed the concept of cervical Hybrid surgery,which aims to reduce fusion-related complications and maintain the mobility of the responsible segment.It is an attempt to perform specific surgery for different segments,as it may not always be the case that all degrees of degeneration are consistent with only one specific method.In recent years,Hybrid surgery has been preliminarily demonstrated to maintain segmental range of motion and reduce the risks associated with internal fixation and the incidence of ASD.Moreover,the longest occipital screws available is up to 12 mm length,basically in consideration of the safety.Under the circumstances,the pull-out strength may be insufficient,especially for long segment fixation.Thus,novel bicortical screws with stronger holding force can be considered.To sum up,this study reviewed a group of Hybrid surgery for posterior upper cervical fusion combined with multilevel spondyloplasty,and compared its clinical and radiological results with decompression and fusion alone,combined with Tongdu Shuji decoction in the treatment of AAD coexisting with CSM.Surgical decompression of spinal cord dredge the GV in anatomical morphology and structure.During the perioperative period,Tongdu Shuji decoction was used to promote blood circulation and remove blood stasis,tonify liver and kidney,and treat both symptoms and the disease to further relieve the symptoms of the stasis of the GV,and promote the recovery of nerve function.It is suggested that surgical treatment is closely related to dredging the GV,which is a valid proof to the academic thought of GV.The results showed that the Hybrid surgery had the identity clinical efficacy as that of posterior fusion alone in terms of restoring nerve function and fixing the spinal sequence.Besides,it is a potential alternative technique due to maintain the alignment of cervical vertebrae while sacrificing less range of motion.In occipitocervical fusion,posterior occipital plate combined with bicortical screw can be used.In addition,in view of unclear mechanism of Tongdu Shuji decoction for SCI,the second part of the study used network pharmacology and molecular docking methods to explore the material basis and molecular mechanism of Tongdu Shuji decoction in the treatment of SCI,proving that it has the characteristics of multi-component,multi-target and multi-pathway.TNF,IL6,TP53 are potential targets.According to the enrichment analysis results of KEGG pathway,relevant pathways were found,mainly including AGE-RAGE signaling pathway,IL-17 signaling pathway,TNF-related pathway,etc.,which laid the foundation for further revealing the exact regulatory mechanism.