Ultrasound‐Guided Posterior Antebrachial Cutaneous Nerve Block: Technical Description and Block Distribution in Healthy Volunteers

The posterior antebrachial cutaneous nerve branches from the radial nerve proximal to the elbow and supplies sensation to the posterior aspect of the forearm. With a high‐frequency linear transducer, the posterior antebrachial cutaneous nerve was identified in 8 healthy volunteers. Under aseptic conditions and with an ultrasound‐guided in‐plane technique, 1% lidocaine was injected circumferentially around the nerve. In each participant, the block was successful, and neither incidental blocks of other nerves nor any other complications were observed. These results demonstrate that the posterior antebrachial cutaneous nerve can be blocked to provide anesthesia or analgesia to the posterior forearm.     

Ultrasound‐Guided Diagnosis and Injection of the Lateral Femoral Cutaneous Nerve with an Anatomical Variation

Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). There are many variations in the course of the LFCN. A 55‐year‐old woman presented with pain and tingling sensations on the anterolateral aspect of her left thigh. Physical examination revealed hypoesthesia of the proximal anterolateral thigh on the left side. During the electrodiagnostic study, sensory nerve action potential of the LFCN could not be obtained on both sides. Through those clinical and electrophysiological findings, we prediagnosed the case as MP and planned to perform diagnostic nerve block. For the injection to perform, ultrasonography was used. During the ultrasonographic evaluation, the left LFCN was visualized lateral to the anterior superior iliac spine (ASIS). Then ultrasound‐guided nerve block with 2 cc lidocaine 2% for diagnostic purpose was performed in this region. Immediately after the injection, the patient's complaints relieved completely, and hence the patient was diagnosed as having MP with an LFCN anatomical variation. Two months later her complaints persisted, and ultrasound‐guided LFCN injection with 2 mL of lidocaine 2% + 1 cc of betametazone was performed. One month after the second injection, her complaints were relieved markedly and she resumed her daily activities. In conclusion, the course of the LFCN is quite variable. We present a relatively rare anatomical variation of the LFCN, crossing lateral to the ASIS, diagnosed with ultrasonography. Ultrasonography can be performed to visualize the LFCN, especially a nerve with an anatomical variation.     

强度—时间曲线测定周围神经损伤72例

刺激神经肌肉运动点找出１０个脉冲宽度刺激点的基强度并绘出曲线,以探讨强度－时间曲线测定周围神经损伤的实用价值。结果：７２例周围神经损伤患者,正常神经支配３０例,部分失神经支配２６例,完全失神经支配１６例。提示强度－时间曲线测定对于周围神经损伤具有协助诊断,判断预后和指导治疗和作用。     

电疗法对周围神经损伤修复的研究进展

近年来,周围神经损伤的修复和再生有了若干进展。本文分别从低频电疗法与直流电疗法、中频电疗法、高频电疗法（超短波、分米波与毫米波）等角度探讨国内外学者在电疗法对周围神经损伤修复方面的研究及进展。 由于周围神经对不同程度的损伤有不同的病理过程和不同的再生方式,因此,周围神经损伤后,电疗法的选择应按照神经恢复的不同阶段要求来调整治疗方法。但其作用机制仍有待进一步深入研究。     

微囊化转染神经生长因子基因细胞移植在周围神经再生中的作用

目的探讨应用免疫隔离技术进行转染神经生长因子（NGF）基因的3T3细胞移植促进周围神经损伤后再生的可行性.方法采用海藻酸钠-聚赖氨酸-海藻酸钠（APA）微胶囊包埋NGF-3T3细胞并进行培养;制备坐骨神经横断损伤SD大鼠模型,96只SD大鼠随机分A组（微囊化NGF-3T3细胞组）、B组（空胶囊组）、C组（转染NGF的3T3细胞组）和D组（阴性对照组）.分别采用神经干动作电位（NAP）、神经传导速度（NCV）和坐骨神经功能指数（SFI）检测坐骨神经功能恢复情况.结果微囊化NGF-3T3细胞培养后保持活性和增殖能力,将具有分化潜能的大鼠嗜铬细胞瘤细胞与其共培养,7 d时细胞胞体分化成多边形或锥形,形成突起;培养10 d左右NGF分泌量最高,达269 pg/ml;培育50 d仍然保持在208 pg/ml.移植术后4、8及12周时,A组大鼠的NAP及NCV均大于B、C、D组（P＜0.05）,而B、C、D三组之间无显著性差异（P＞0.05）;A组大鼠的SFI恢复情况优于B、C、D组（P＜0.05）,而B、C、D三组之间无显著性差异（P＞0.05）.结论微囊化NGF-3T3细胞在体外培养一定时间后,仍保持增殖能力和生物活性,移植到大鼠周围神经损伤局部后可长时间存活,并通过持续分泌NGF起到促进周围神经修复的作用.     

应用人工神经修复大鼠坐骨神经损伤的实验研究

目的观察应用复合碱性成纤维细胞生长因子(bFGF)-壳聚糖导管修复大鼠周围神经损伤的效果。方法成年Wistar大鼠25 只分为假手术组(n=10)、单纯损伤组(n=5)和人工神经修复组(n=10)。假手术组仅暴露坐骨神经5 mm,单纯损伤组暴露坐骨神经并切断,人工神经修复组以复合bFGF-壳聚糖导管桥接缺损。术后对实验动物的坐骨神经进行大体观察,对运动进行行为观察,以及组织化学和免疫组织化学方法评价神经再生情况和靶肌肉恢复情况。结果术后5 周,与单纯损伤组相比,人工神经修复组运动功能有一定程度恢复。人工神经修复组再生的坐骨神经已经通过bFGF-壳聚糖导管越过缺损并与远端相连接。免疫组织化学方法显示,坐骨神经再生段可观察到神经微丝(NF)阳性和S-100 阳性纤维。应用Masson 染色方法,可观察到人工神经修复组腓肠肌去纤维化程度相对于单纯损伤组有明显改善。结论应用bFGF-壳聚糖导管能有效修复周围神经损伤并使大鼠运动功能得到改善。     

弥散张量成像在周围神经损伤中的应用进展

弥散张量成像是基于水分子的弥散运动获取不同组织各向异性信息的一种磁共振成像技术,在周围神经损伤修复、微病变识别和神经肿瘤等方面中发挥重要作用。弥散张量成像在周围神经损伤中临床应用尚不广泛,测量参数受技术设置和序列规范等多种因素的影响,测定方案的标准化和不同功能参数的定量仍有待进一步研究。     

高压氧治疗上肢周围神经损伤的疗效观察

目的 观察早期应用高压氧结合常规康复治疗对上肢周围神经损伤术后的疗效.方法 选取上肢周围神经完全损伤术后的患者60例,等量随机分为治疗组、对照组各30例.对照组采用常规药物和系统康复治疗;治疗组在常规药物和系统康复治疗基础上采用高压氧治疗,并在治疗前及治疗后3、6个月时分别做手功能评定及神经传导速度（MCV）和肌电图（EMG）检查.结果 治疗后3、6个月时手功能评定及神经传导速度和肌电图检查结果显示,治疗组疗效优于对照组,差异有显著性（P均〈0.05）.结论 早期系统康复治疗结合高压氧治疗是上肢周围神经损伤术后患者恢复功能的有效治疗措施.     

周围神经损伤后选择性再生的实验动物模型研究

目的:建立并评价周围神经损伤后神经选择性再生的实验动物模型。方法:3周龄SD大鼠12只随机分成4周组和8周组各6只,均行切断右侧L2～L5背根神经节后纤维和右侧股神经横切-吻合手术,分别于术后4周和8周进行荧光逆向示踪,观察脊髓运动神经元再生情况。结果:4周组大鼠长入运动神经、感觉神经和长入2种神经的运动神经元数量分别为(167±21)个、(53±14)个、(36±7)个;8周组分别为(252±14)个、(37±8)个、(21±4)个。结论:该实验动物模型能反映周围神经损伤后运动神经再生的倾向性,重复性好。     

内源性神经营养因子促进冷冻保存大鼠坐骨神经异体移植后神经再生的作用

目的探讨内源性神经营养因子(ENTFs)对冷冻保存大鼠坐骨神经同种异体移植后神经再生的影响。方法 15 mm雌性Sprague-Dawley大鼠坐骨神经置于DMEM溶液中,37℃、5%CO2分别体外预处理1 d、3 d、7 d、14 d和21 d (A组、B组、C组、D组和E组),设置新鲜神经对照组(F组)。Western blotting检测神经的胶质细胞源性神经营养因子(GDNF)、神经生长因子(NGF)、Bcl-2、Bax、Caspase-3、主要组织相容性复合体(MHC)-Ⅰ、MHC-Ⅱ蛋白表达。将上述6组神经置于冷冻保存液中液氮保存4周,Calcein-AM/Propidium Iodide染色、激光共聚焦显微镜观察保存后神经活细胞和死细胞情况。用上述冷冻保存4周的坐骨神经和新鲜坐骨神经(G组),同种异体移植修复雌性Wistar大鼠坐骨神经10 mm缺损(A′组、B′组、C′组、D′组、E′组、F′组和G′组),设置同系移植组(H′组)。移植术后1周,免疫荧光染色观察CD8+T细胞、巨噬细胞入侵移植物情况,ELISA法检测受者血清白细胞介素(IL)-2、干扰素(IFN)-γ、肿瘤坏死因子(TNF)-α水平;移植术后20周,电生理检测肌肉复合动作电位(CMAP)和神经传导速度(NCV),称重计算腓肠肌湿重比,神经丝(NF)200免疫荧光染色、甲苯胺蓝染色和透射电镜观察再生神经组织学。结果与F组相比,C组、D组和E组GDNF、NGF蛋白表达均增加(P <0.05);B^E组Bcl-2蛋白表达降低(P <0.05),Bax和Caspase-3蛋白表达均增加(P <0.05);A组~E组MHC-Ⅰ、MHC-Ⅱ蛋白表达均降低(P <0.05)。坐骨神经冷冻保存4周后,与F组和G组相比,C组、D组和E组活细胞数量降低。同种异体移植术后1周,与F′组和G′组相比,C′组、D′组和E′组移植物CD8+T细胞、巨噬细胞减少,受者血清IL-2、TNF-α水平降低(P <0.05)。移植术后20周,C′组、D′组和E′组CMAP、NCV、腓肠肌湿重比、再生有髓神经纤维数及髓鞘厚度均显著优于F′组和G′组(P <0.05),C′组、D′组和E′组移植神经NF200表达高于F′组和G′组。结论体外预处理大鼠坐骨神经能诱导ENTFs表达,高表达ENTFs的坐骨神经冷冻保存后异体移植能促进受者神经再生和功能恢复。     

‘SCALD-ED’ Block: Superficial Cutaneous Anesthesia in a Lateral Leg Distribution within the Emergency Department – A Case Series

Background

In the midst of a nationwide opioid epidemic, focus has been placed on identifying and utilizing safe, effective opioid-free analgesic alternatives. Lower-extremity peripheral nerve blockades are common and often involve both motor and sensory anesthesia, resulting in leg weakness and ambulatory difficulty. The aim of this case report is to describe an ultrasound-guided peripheral nerve block technique (superficial cutaneous anesthesia in a lateral (leg) distribution within the emergency department [‘SCALD-ED’ block]) that provides motor-sparing, purely sensory anesthesia after a superficial injury to the lateral leg in patients presenting to the emergency department.

滑车神经行经小脑幕侧方区域的应用解剖学研究

目的：通过对滑车神经行经小脑幕侧方区域的应用解剖学研究,寻找小脑幕侧方区域手术时避免损伤滑车神经的临床解剖标志。方法：对15例（男10例,女5例）防腐固定无畸形、无病变的成人头颅标本用红色乳胶灌注后,10倍手术显微镜下观察滑车神经在小脑幕侧方区域的行径,及其与周围重要神经、血管结构的毗邻关系,测量滑车神经长度、宽度、厚度及其与周围标志点的距离,并对所得结果进行统计学分析。结果：滑车神经在小脑上动脉和大脑后动脉之间向前行,进入小脑幕侧方区域,在动眼神经三角的后部穿越游离缘硬膜,其长度为（6．78±1．87）mm,宽度为（1．09±0．21）mm,厚度为（0．78±0．11）mm。滑车神经进入小脑幕侧方区域的人口处位于前床突、颈内动脉床突上段起始部、动眼神经人口后方,位于后床突后外方;距离前床突（23．24±3．18）mm、颈内动脉床突上段起始部（17．57±3．26）mm、动眼神经人口（11．42±3．32）mm;距离后床突（14．21±3．25）mm。结论：行小脑幕侧方区域手术时,为避免损伤滑车神经,前床突：后床突、颈内动脉床突上段起始部和动眼神经人口可以作为寻找滑车神经人口的重要标志,同时注意区分小脑上动脉和大脑后动脉。     

桡神经损伤的康复效果

目的探讨康复治疗对桡神经损伤的治疗作用及预后。方法20例不同原因所致桡神经损伤患者,采用NMR-神经肌肉康复仪治疗,同时进行康复训练。随访12～30个月。结果未手术15例评分16分（优）,恢复正常的时间3.5～18个月。行神经探察及松解术3例,1例16分（优）,2例15分（优）。行神经吻合术1例,术后6个月评分6分（可）。行桡神经移植术1例,术后12个月评分4分（差）。结论运动疗法及神经肌肉电治疗是桡神经损伤后有效的康复方法。     

Abdominal Pain in Primary Care

Abdominal pain is among the top 20 - reasons for primary care office visits. Causes of abdominal pain range from self-limiting to life-threatening. Complaints of abdominal pain present providers with a number of potential differential diagnoses and options for evaluation and management because the source of abdominal pain may include respiratory, gastrointestinal, genitourinary, gynecologic, or musculoskeletal causes. Because the physical examination may be normal despite the underlying pathology, it is important for providers to carefully review the history of the complaint. This case study presents a middle-aged man presenting with abdominal pain for several months that warranted a comprehensive approach to differential diagnosis.     

注射性神经伤的实验形态学研究

对16只家兔坐骨神经进行了青霉素注射性神经伤的实验形态学研究。左后肢为实验侧，右后肢为对照例。实验侧坐骨神经内和对照侧坐骨神经周围分别注入青霉素20万U，注射后每侧分别于2h、4h、72h和7天各取4例坐骨神经，作光镜和电镜观察。组织学发现，实验侧从2h至7天依次出现神经纤维肿胀，髓鞘板层出现微隙，部分髓鞘溃变，轴突结构改变，最后髓鞘和轴突均明显溃变，神经束内或束膜间结缔组织增生。对照侧出现神经周围水肿、充血，神经外膜增生，靠近外膜处神经纤维出现不同程度病理改变。讨论了注射性神经伤的病理改变机理和防治措施。