Study Design: 

This was a narrative review.

Objective: 

The objective of this study was to review the standards of care and triage protocol for gunshot wounds to the spine, highlighting innovative future treatment options that may be implemented in patients with spinal cord injury (SCI).

Summary of Background Data: 

With the increased availability of firearms among the United States population, gunshot wounds to the spine are becoming a clinically relevant and devastating issue. Such injuries result in severe and diverse complications. SCIs due to gunshot wounds are the leading cause of morbidity and mortality, as they often result in complete or incomplete paraplegia. Current standards of care focus on preventing further damage rather than total cure or treatment of SCI.

Methods: 

A literature review was performed on the standards of care, triage protocol, associated conditions, current therapeutic options, and innovative treatment options for patients with gunshot wounds to the spine.

Results: 

The general standards of care for spinal gunshot wounds involve maintaining or renewal of mechanical spinal steadiness and neurological activity while limiting complications of treatment. Current treatment options include management of mean arterial pressure goals, drug therapies consisting of antibiotics, and surgical approaches. With recent innovations in molecular biology and cell transplantation, potentially new and promising treatment options for patients with SCI exist. These options include cell transplantation therapies, platelet-rich plasma administration, exosomal treatments, and mitochondrial-targeted therapeutics. Stem cell transplantation is promising, as several clinical studies have been completed. However, loss-to-follow-up, lack of long-term evaluation, and questionable randomization has limited the use of stem cells in the standard of care practice. Although not studied on human models to a gunshot wound, exosomal and mitochondrial-based treatment options have been studied both in vitro and in animal models with SCI.

Conclusion: 

Newly emerging molecular and cellular therapy modalities for SCI contribute to the recovery process and may be utilized in conjunction with the current modalities for better outcomes.

中文翻译：

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脊柱枪伤的研究治疗：叙述性回顾

学习规划： 

这是一篇叙述性评论。

客观的： 

本研究的目的是审查脊柱枪伤的护理标准和分诊方案，强调未来可用于脊髓损伤 (SCI) 患者的创新治疗方案。

背景数据摘要： 

随着美国人口中枪支数量的增加，脊柱枪伤正在成为一个与临床相关且具有破坏性的问题。此类损伤会导致严重且多样的并发症。枪伤引起的脊髓损伤是发病和死亡的主要原因，因为它们常常导致完全或不完全截瘫。目前的护理标准侧重于预防脊髓损伤的进一步损害，而不是彻底治愈或治疗 SCI。

方法： 

对脊柱枪伤患者的护理标准、分诊方案、相关病症、当前治疗方案和创新治疗方案进行了文献综述。

结果： 

脊柱枪伤的一般护理标准包括维持或恢复脊柱机械稳定性和神经活动，同时限制治疗并发症。目前的治疗选择包括平均动脉压目标管理、抗生素药物治疗和手术方法。随着分子生物学和细胞移植领域的最新创新，为 SCI 患者提供了潜在的新的、有前途的治疗选择。这些选择包括细胞移植疗法、富含血小板的血浆给药、外泌体治疗和线粒体靶向治疗。干细胞移植前景广阔，多项临床研究已经完成。然而，失访、缺乏长期评估以及可疑的随机化限制了干细胞在标准护理实践中的使用。尽管尚未在人体枪伤模型上进行研究，但已经在体外和 SCI 动物模型中研究了基于外泌体和线粒体的治疗方案。

结论： 

新出现的 SCI 分子和细胞治疗方式有助于恢复过程，并且可以与当前的方式结合使用以获得更好的结果。