胫神经腓肠肌运动支的超声显示及定位

目的 探讨高频超声成像技术对胫神经腓肠肌运动支显示的可行性及定位的准确性,为超声引导(下同)腓肠肌神经运动支的阻滞治疗提供依据.方法 应用高频超声成像技术,观察21例志愿者腓肠肌内、外侧头运动支的走行,分布及声像图特征.5例志愿者进行超声引导下电刺激验证,以确定超声定位的准确性.结果 (1)全部21例志愿者下肢腓肠肌运动支均有效显示,显示率100%;运动支的声像图特征为:横断面呈线状高回声包绕低回声的椭圆形或扁平状结构,其前后径和横径分别为(2.3±0.3)及(1.2±0.4)mm;纵切面呈2条线状高回声包夹低回声的条索状结构.运动神经肌支在肌门处进入肌肉后沿筋膜呈"树枝状"逐渐向下分支,起始部分成2～3条较大分支,向肌肉内、中、外侧亚部深入,并逐渐分成较细小的分支.(2)15例志愿者腓肠运动支由胫神经直接分出,6例存在变异情况,其中腓肠内侧头支与腓肠内侧皮神经共干者4例,腓肠肌外侧头肌支与比目鱼肌支共干者2例.(3)5例志愿者超声引导下电刺激验证,超声引导针尖均一次到达观察的目标神经,定位准确性100%.电刺激均引起腓肠肌有效收缩,电流强度为0.2～0.6 mA.4例志愿者除穿刺针在穿破皮肤时有局部轻微疼痛外,其余在进针过程中,电刺激验证中及结束后均未见明显疼痛及麻木症状.1例腓肠内侧头支与腓肠内侧皮神经共干者伴有小腿皮肤的麻木感.结论 高频超声可以清晰显示胫神经腓肠肌运动支,并能准确定位腓肠肌运动支主干及其运动分支,为腓肠肌神经运动支的阻滞治疗提供了理论基础.     

高频超声对臂丛神经显像和定位的价值

目的评价高频超声对臂丛神经显像和定位的价值。方法采用高频超声对30例志愿者行臂丛神经检查，主要在肌间沟、锁骨上、锁骨下及腋下4个部位。11例志愿者臂丛分布的4个部位上，在实时超声引导下进针及定位神经，然后在电神经器刺激下确认是否为神经。所有臂丛神经声像图特征、解剖的变化、进针和神经定位均被动态记录。结果臂丛神经在横断面上表现为圆形或椭圆形的低回声结构，内部由点状回声组成，肌间沟、锁骨上及腋下臂丛神经显示率均为100％，锁骨下臂丛神经显示率为97％。11例志愿者臂丛声像图上低回声结构在超声引导下行电刺激均被证实为神经组织。结论高频超声能提供高质量的臂丛神经声像图。超声引导下穿刺对臂丛神经阻滞麻醉有潜在应用价值。     

超声引导在经皮肾镜治疗肾及输尿管上段结石术中的应用价值探讨

目的评价超声引导在微创经皮肾镜取石术治疗。肾结石和输尿管上段结石中的应用价值：方法451例肾或输尿管上段结石患者,采用超声引导定位下肾穿刺,建立皮肾通道;碎石取石过程中超声监测有无结石残留并指导啐石取石;必要时超声引导下建立多个皮肾通道取石？结果450例患者在超声引导下成功建立了皮肾通道,1例超声引导穿刺失败。超声引导下穿刺成功率为99．8％（450／451）,其中402例患者经超声引导一次性穿刺成功,48例患者两次穿刺成功;82例患者超声引导下建立多个皮肾通道。结论微创经皮肾镜取石术采用超声引导定位穿刺建立皮肾通道,具有定位准确、安全、可重复、简便易行及避免放射线损伤等优点,可作为经皮肾镜引导穿刺的首选方法。     

肌皮神经的高频超声显像及其宽景超声成像研究

高频超声诊断技术的发展拓宽了超声检查应用范围,其能清楚显示神经干的走行及其形态结构,观察其周围神经干是否卡压或水肿,因此能对神经损伤外科修复术后的患者进行跟踪观察及辅助神经麻醉阻滞的定位。目前国内有关超声对肌皮神经检查及超声对肌皮神经走行特点的宽景超声成像方面的研究报道较少。本研究应用高频超声对30例正常成人上臂肌皮神经走行特征进行观察,并测量其穿入和穿出喙肱肌走行于喙肱肌和肱二头肌之间处的前后径与横截面积,为临床对肌皮神经相关研究提供超声影像学依据。     

正常四肢神经干的超声测量及其意义

目的探讨正常外周四肢神经干的检查方法及超声表现。方法用高频超声探查48例正常人四肢神经干的超声声像图,观察其走行、形态及回声表现,并测量其内径。结果正常外周四肢神经干纵断面均呈束状,边界整齐,内为多条平行排列的带状强回声,横断面为圆形或椭圆形偏强回声,中间为点状强回声。本组正常正中神经0.30±0.04cm、尺神经0.23±0.05cm、桡神经0.25±0.06cm、坐骨神经0.59±0.08cm、腓总神经0.41±0.06cm、胫神经0.37±0.07cm。结论高频超声能为外周四肢神经干的影像学提供检查方法。     

股外侧皮神经超声探测方法学

目的提供高效、准确的股外侧皮神经超声探测的方法,并评估其解剖变异。方法以阔筋膜张肌和缝匠肌之间的间隙作为股外侧皮神经声像图定位标志,18 MHz超声探测150例志愿者的股外侧皮神经。测量神经与髂前上棘之间的距离,观察腹股沟韧带水平的神经分支数目和神经与腹股沟韧带之间的关系,并记录探查时间。结果所有受检者的股外侧皮神经在阔筋膜张肌和缝匠肌之间的肌间隙均清晰显示。股外侧皮神经与髂前上棘之间的平均距离为(15.4±4.1)mm。其中252条神经走行于腹股沟韧带的深面,此水平的神经由1~4根分支组成。鉴别一条神经的平均时间为7s。结论以阔筋膜张肌和缝匠肌的间隙作为声像图定位标志,有助于超声高效,准确地显示股外侧皮神经,超声可观察其解剖学变异。     

超声引导技术在小儿胭窝坐骨神经阻滞中的应用

目的:评价超声引导技术用于小儿胭窝坐骨神经阻滞的可行性及临床价值.方法:选择拟行足踝部手术患儿40例,年龄2～10岁.分为神经刺激器阻滞组(对照组)、超声引导与神经刺激器相结合阻滞组(实验组).分别进行胭窝坐骨神经阻滞,局麻药使用0.3%盐酸罗哌卡因(1 mL/kg).记录穿刺时间、试穿次数、局麻药起效时间,并评价感觉阻滞效果.结果:实验组患儿均可在超声扫描图像中清晰辨认坐骨神经、胫神经和腓总神经,坐骨神经分叉点距胭窝皱褶平均距离60 mm,坐骨神经平均深度15 mm.实验组穿刺用时较长,但较对照组试穿次数少,两支神经的局麻药起效时间短.注药后20 min内,实验组胫神经和腓总神经的阻滞完善率均高于对照组.结论:超声引导下行小儿胭窝坐骨神经阻滞,试穿次数少,局麻药起效时间短,感觉阻滞完善率高.     

超声引导下肌同沟神经阻滞在上肢手术中的应用

肌间沟神经阻滞穿刺传统方法多以解剖定位加异感定位作为穿刺成功的标志,因其缺乏客观性,技术不熟练者操作易引起穿刺点出血、阻滞不全、神经损伤等并发症.目前临床采用神经刺激器诱发神经支配区肌肉颤搐.近年又采用便携式彩色超声仪引导麻醉,将盲探改为直视下完成.本文比较应用超声引导结合神经刺激器与传统解剖定位结合神经刺激器行肌间沟神经阻滞,现报道如下.     

超声引导下肌间沟神经阻滞在上肢手术中的应用

肌间沟神经阻滞穿刺传统方法多以解剖定位加异感定位作为穿刺成功的标志,因其缺乏客观性,技术不熟练者操作易引起穿刺点出血、阻滞不全、神经损伤等并发症。目前临床采用神经刺激器诱发神经支配区肌肉颧搐。近年又采用便携式彩色超声仪引导麻醉,将盲探改为直视下完成。本文比较应用超声引导结合神经刺激器与传统解剖定位结合神经刺激器行肌间沟神经阻滞,现报道如下。     

超声在经皮肾镜碎石术治疗肾结石中的应用

目的评价超声定位引导穿刺在经皮肾镜碎石术治疗肾结石中的应用价值。方法采用超声监测下定位引导穿刺,经皮肾镜碎石术治疗肾结石35例。结果除1例肾穿刺后,发现肾内有积脓,另1例穿刺后肾结构及结石显示不清外,均定位穿刺碎石成功。结论采用超声引导定位经皮肾镜碎石术治疗肾结石,具有定位准确、安全、可重复、避免放射线损伤等优点,且术中监测、术后随访简便易行,具有较大的临床应用价值。     

Penetrating injuries to the nerves of the lower extremity: principles of diagnosis and treatment

Background. Lower extremity nerve injuries caused by wounds are often not noticed immediately after trauma. The purpose of this article was to analyze the localization of penetrating injuries to the nerves, the mechanism and extent of the lesions, and the microsurgical techniques used. The diagnostic and therapeutic basics in penetrating injuries of lower extremity nerves are also described. Material and methods. The clinical material consisted of 67 patients treated surgically for penetrating injuries of lower extremity nerves. Results. In our material we observed penetrating injuries to the common peroneal nerve (41 cases), tibial nerve (9 cases), sciatic nerve (6 cases), combined common peroneal and tibial nerves (8 cases), and miscellaneous (foot injuries, 3 cases). The mechanism of injury included 51 cases of neurotmesis (primary injuries) and 16 cases of nerve compression (secondary injuries). In 5 cases, lesions of the major vessels and common peroneal and tibial nerves were observed. Conclusions. Penetrating injuries to the common peroneal nerve are the most frequent lesions of the peripheral nervous system within the lower limbs. The early detailed inspection of wounds, especially those localized in areas posing a particular threat to peripheral nerves, is an essential part of surgical treatment.     

超声诊断外周神经病变的临床价值

目的探讨高频超声在外周神经病变和损伤中的诊断价值。方法应用高频超声检查15例正常查体肢体外周神经、12例外周神经损伤及6例神经肿瘤，术前超声检查与术中探查结果作比较分析。结果正常神经纵切面声像图为多条线性的平行较强回声；横切面为圆形中等回声结构，中心为点状强回声。2例外周神经完全离断，显示连续性中断，近端形成神经瘤；7例外周神经部分损伤，显示连续性部分中断；3例卡压性损伤，神经水肿增粗，内部呈束状低回声不清晰。6例神经肿瘤与神经相连续。结论高频超声可作为外周神经病变和损伤首选的检查方法，值得临床推广应用。     

Ultrasound of radial, ulnar, median, and sciatic nerves in healthy subjects and patients with hereditary motor and sensory neuropathies.

This study was conducted to evaluate the capability of ultrasonography to visualize extremity nerves. Fifty healthy women and men and 10 patients suffering with hereditary motor and sensory neuropathy (HMSN) were examined. The radial nerve lateral to the humerus, ulnar nerve distal to the cubital tunnel, median nerve in the middle of the forearm and proximal to the palmar crease, sciatic nerve in the middle of the thigh and tibial and common peroneal nerves just distal to their bifurcation, were investigated, employing a 7.5-MHz electronic linear-array transducer. In healthy subjects, the median, ulnar and radial nerves could be identified in all cases, the sciatic nerve in 37 cases, the tibial and peroneal nerves in 10 cases. The median values of thicknesses were about 3 mm for arm nerves and 6 to 7 mm for the sciatic nerve. Nerve sizes did not correlate with subjects' height, weight or age. In the majority of the patients, arm and sciatic nerves were also visible. Thicknesses were normal in 34, increased in 11 and decreased in six of 51 nerves. In conclusion, ultrasonography allows reliable imaging of the major arm nerves and, occasionally, facilitates visualization of the sciatic, tibial and peroneal nerves in healthy subjects. Nerve size and structure did not differ significantly between patients with HMSN and healthy subjects.     

无细胞神经支架复合骨髓间充质干细胞构建组织工程人工神经修复坐骨神经缺损

背景：作者已经成功制备了无细胞神经移植物,并且复合骨髓间充质干细胞构建组织工程人工神经桥接大鼠坐骨神经缺损。目的：无细胞神经移植物复合骨髓间充质干细胞构建组织工程人工神经修复大鼠坐骨神经缺损后运动功能的恢复。方法：成年雄性SD大鼠构建大鼠坐骨神经15mm缺损模型,分别应用组织工程人工神经、组织工程神经支架或自行神经桥接坐骨神经缺损。桥接后20周再生神经电生理学测定,手术侧胫骨前肌湿质量、腓肠肌组织学及透视电镜分析。结果与结论：桥接20周后,组织工程人工神经与自体神经移植组胫骨前肌湿质量比较,差异无显著性意义（P〉0.05）,神经干传导速度为（30.56±2.15）m/s。结果提示,无细胞神经移植物复合骨髓间充质干细胞构建的组织工程人工神经桥接大鼠坐骨神经缺损后,可以促进再生神经运动功能的恢复。     

毛囊干细胞对坐骨神经损伤修复的影响

背景:毛囊干细胞具有多分化潜能,可分化成神经细胞,极有希望成为治疗周围神经损伤的种子细胞。目的:观察毛囊干细胞对坐骨神经损伤修复的影响。方法:体外分离培养SD大鼠乳鼠胡须处的毛囊干细胞,经鉴定备用。36只SD大鼠随机分为实验组和对照组,建立坐骨神经损伤模型后,实验组于坐骨神经损伤处的上方注入浓度约106L-1的毛囊干细胞50μL,对照组注射等量的磷酸盐缓冲液。结果与结论:各组坐骨神经功能指数均随观察时间进行性增加,其中实验组大鼠神经功能恢复早于对照组;免疫组织化学检测移植后的毛囊干细胞大量存活并分化成神经细胞。结果提示毛囊干细胞能够有效的促进损伤的坐骨神经修复。     

Long-Term Results of Nervous Tissue Alterations Caused by Epineurial Electrode Application: An Experimental Study in Rat Sciatic Nerve

In order to evaluate the long-term effects of epineurial electrode application for functional electrical stimulation (FES) the left sciatic nerve of seven rats was exposed. Four ring-shaped stainless steel wire electrodes were sutured to the epineurium of each nerve in the same manner as performed clinically for carrousel stimulation in man. The nerves were reexposed 1 year after implantation and the stimulation threshold to obtain a tetanic contraction in the lower limb was determined for each electrode. Afterwards the animals were sacrificed. The electrodes were excised and cross sections of the sciatic nerve directly at site of the electrodes, 2-mm proximal and 2-mm distal to them were harvested for histologic and planimetric assessment of nerve lesions. The area of damaged neural tissue was expressed as a percentage of the total cross-sectional area within the perineural sheath. The sciatic nerves of the right side served as controls. The values for the stimulation thresholds ranged between 0.1 and 1.0 mA (mean 0.43 mA). By morphometric examination five of seven nerves were seen altered, the altered areas captured between 1% and 4.8% of the total cross-sectional area of the nerves within the perineural sheath. Besides two specimens, all altered nerve segments exhibited distinct signs of nerve fiber regeneration. The clinical implications of the results for long-term electrical stimulation, such as phrenic pacing, are discussed.     

Intraexaminer and Interexaminer Reliability of Manual Palpation and Pressure Algometry of the Lower Limb Nerves in Asymptomatic Subjects

Objective

Nerve palpation is a method of clinically identifying mechanosensitivity of neural tissue by means of pressure algometry and manual palpation. There are few investigations of the reliability of lower limb nerve palpation, and femoral nerve palpation has never been previously reported. The aim of this study was to investigate the reliability of nerve palpation of the femoral, sciatic, tibial, and common peroneal nerves and to report normative values for the femoral nerve.

Methods

The 4 lower limb nerves were palpated in 39 healthy volunteers using pressure algometry and manual digital palpation. Measurements were taken twice by 1 rater (intrarater reliability) and once by a second rater (interrater reliability).

Results

Intraclass correlation coefficients for pressure pain thresholds (PPTs) via pressure algometry of the femoral, common peroneal, tibial, and sciatic nerves were 0.69, 0.84, 0.64, and 0.9 for intrarater reliability, respectively, and 0.82, 0.7, 0.56, and 0.75 for interrater reliability. κ Values for manual palpation were 0.59, 0.55, 0.42, and 0.60 for intrarater reliability and 0.30, 0.49, 0.37, and 0.60 for interrater reliability. Males demonstrated significantly higher PPTs than females for the femoral, sciatic, and tibial nerves, and differences in PPTs were present between right and left sides.

Conclusion

Nerve palpation of the femoral, common peroneal, and sciatic nerves using pressure algometry demonstrated good to excellent reliability, whereas the tibial nerve PPTs showed moderate to good reliability. Manual palpation measurements demonstrated fair to moderate reliability.     

Tissue distribution of vitamin B12 and its dynamics in nervous tissues]

Tissue distributions and intracellular localization of vitamin B12 (abbr B12) were described in spinal cords, roots and peripheral nerves of humans. The followings are results. 1) B12 contents of spinal cords are found to increase with centripetal slope. 2) Higher contents of B12 were found in ventral horn than lateral and posterior columns. 3) Motor nerves contained higher B12 contents than sensory nerves. 4) Considerable amounts of cyano-B12 was main component among B12-derivatives in nerve tissues. 5) Intracellular B12 was rich in mitochondrial fraction. 6) By ligation of sciatic nerves, B12 bound to nerves was released from nerve tissues and cyanide ions were later released, though its mechanisms remains unknown.     

超声诊断糖尿病周围神经病变

目的 探讨超声在糖尿病周围神经病变(DPN)诊断中的应用价值。方法 收集我院DPN患者40例(DPN组),选取正常对照30名(正常对照组),观察两组坐骨神经、腓总神经、胫神经的连续性和神经内部回声,测量并比较两组神经的前后径(D₁)和横径(D₂),并计算横截面积(CSA)。结果 正常对照组神经纵断面声像图呈束条状高或中等回声,内含多数平行、被高回声分开断续的线状低回声;横断面呈圆形、卵圆形高回声,其内分布细点状低回声。DPN组表现为受累神经肿大、增粗,内部回声减低,神经内平行线状结构消失。DPN组坐骨神经、腓总神经、胫神经的D₁、D₂、CSA均较正常对照组明显增加,差异均有统计学意义(P均<0.01)。结论 超声能够清晰显示DPN患者受累神经结构、位置以及病变范围,对DPN有较高的诊断价值,并可指导临床选择治疗和手术方案。     

高频超声在上肢外周神经损伤中的诊断价值

目的探讨高频超声对外周神经损伤的诊断价值。方法用高频超声检查了15例正常上肢外周神经及8例术前上肢外周神经损伤患者。结果正常外周神经纵切面超声表现为中等条索状,内有线性平行回声,横切面呈圆形,内有点状回声,2例外周神经完全损伤,连续性中断,近端形成损伤性神经瘤。6例外周神经部分损伤,连续性部分中断,部分近端形成神经瘤。结论高频超声对外周神经损伤能提供新的影像诊断方法。