单次手法和物理治疗颈型颈椎病：疼痛和关节活动的即刻及短期效果比较

背景：大量研究表明，手法治疗和物理治疗均可显著改善颈型颈椎病患者的疼痛和关节活动度，但两种治疗方式对颈型颈椎病的即刻和短期疗效比较鲜有报道。 目的：比较单次手法治疗和物理治疗对颈型颈椎病患者疼痛和活动的即刻和短期疗效。 方法：颈型颈椎病患者随机分成2组，手法治疗组和物理治疗组，各接受1次治疗。采用疼痛目测类比评分法、压力疼痛阈值和关节活动范围评定患者治疗前、后10 min(即刻疗效)和治疗后第2天(短期疗效)的情况。 结果与结论：手法治疗组患者在单次治疗后的10 min和第2天疼痛目测类比评分较治疗前下降，压力疼痛阈值增加，颈椎各方向关节活动范围均增加(P < 0.05)；物理治疗组患者在单次治疗后的10 min和第2天疼痛目测类比评分较治疗前均下降(P < 0.05)，在治疗后第2天，颈椎左/右侧屈关节活动范围较治疗前增加(P < 0.05)；在治疗后的10 min和第2天，手法治疗组患者的疼痛目测类比评分均低于物理治疗组，压力疼痛阈值均高于物理治疗组，颈椎前屈/后伸，左/右侧屈关节活动范围均大于物理治疗组(P < 0.05)。结果表明单次手法治疗对改善慢性颈痛患者疼痛目测类比评分，压力疼痛阈值和关节活动范围的即刻效果和短期效果均优于物理治疗。 关键词：手法治疗；物理治疗；颈椎病；疼痛；关节活动范围     

伽玛刀放射外科治疗药物难治性三叉神经痛的长期疗效及其影响因素分析

目的探讨伽玛刀放射外科(GKRS)治疗药物难治性三叉神经痛(TN)患者的长期疗效及其相关影响因素。方法回顾性分析2009年1月至2019年9月内蒙古医科大学附属医院头部伽玛刀治疗中心采用GKRS治疗的293例药物难治性TN患者的临床资料。治疗后对所有患者进行临床随访,随访内容包括判断患者的疼痛缓解程度、并发症发生及复发情况。疼痛缓解程度依据巴罗神经学研究所(BNI)疼痛强度量表评级,其中Ⅰ~Ⅲb级为疼痛缓解有效,Ⅳ、Ⅴ级为疼痛缓解无效。采用单因素和多因素logistic回归分析法判断影响患者治疗后疼痛缓解和发生面部麻木的危险因素。结果293例患者的中位随访时间为64个月(6~132个月)。至末次随访,270例患者疼痛缓解有效,另23例无效;疼痛有效缓解率为92.2%(270/293)。293例患者中,术后存在面部麻木伴蚁走感80例(27.3%),单纯蚁走感26例(8.9%),眼角抽搐14例(4.8%),眼睛异物感、干涩等6例(2.0%),耳鸣3例(1.0%),味觉减退或丧失5例(1.7%),咀嚼功能障碍4例(1.4%)。随访期间,17例(5.8%)患者复发;复发的中位时间为24个月(14~81个月)。多因素logistic回归分析结果显示,存在既往治疗史是影响患者治疗后疼痛缓解的危险因素(OR=3.419,95%CI:1.264~9.248,P=0.015),与照射剂量<80 Gy比较,80 Gy的照射剂量对疼痛的缓解效果好(OR=0.252,95%CI:0.071~0.888,P=0.032);存在既往治疗史(OR=2.533,95%CI:1.194~5.373,P=0.015)和血管压迫神经(OR=5.865,95%CI:2.538~13.556,P<0.001)是影响患者治疗后出现面部麻木的危险因素。结论采用GKRS治疗药物难治性TN的疼痛缓解率较高,治疗后并发症以面部麻木最常见。存在既往治疗史的TN患者疼痛缓解较差,术后易出现面部麻木;照射剂量80 Gy的患者疼痛缓解较好;存在血管压迫神经的患者术后易出现面部麻木。     

义齿三维模型构建中海量点云数据模型的精简方法★

背景：义齿三维模型的构建始终是义齿CAD/CAM系统的核心，而构建的三维模型的精度与效率又与对海量的原始点云数据进行精简密切相连。针对义齿的原始数据进行高效的精简成为重要的研究课题。 目的：针对义齿的原始点云数据进行精简，以便以最少的点，实现最有效的表达。 方法：通过三维栅格法对海量的原始离散点云数据进行拓扑重建，并利用弦差法以及八叉树剖分来保留曲率较大处的点云及其曲率和法向量。 结果与结论：结果表明，该算法简单高效，并能保证在模型曲率变化较大处保留细节信息。结果的比较表明，通过3DSS-STD-II型结构光三维扫描仪得到的义齿点云数据在n=0.7，e=0.0003m时的精简效果最好。     

超短波治疗颈椎病24例疗效观察

目的　探讨超短波对颈椎病治疗效果。方法　对 2 4例颈椎病患者进行超短波治疗。结果　超短波配合药物治疗颈椎病总有效率为 83 3 3 %。结论　超短波配合药物治疗颈椎病具有相互促进作用 ,超短波可加强药物吸收 ,使药物充分发挥作用 ,缓解症状与体征 ,解除颈肩臂肌痉挛、酸困感和手指麻木明显减轻 ,改善椎基底动脉循环 ,减轻椎动脉的刺激和压迫 ,使头晕得以缓解     

DT-MRI动态观察无先兆偏头痛患者治疗前后脑白质结构完整性的改变

目的 研究无先兆偏头痛患者脑白质可能存在的微细结构异常,并探讨其在药物治疗前后的动态变化. 方法 选择自2010年7月1日至2011年6月30日在广州医学院第二附属医院神经内科门诊连续就诊的无先兆偏头痛患者(病例组)及年龄、性别相匹配的同期健康体检者(对照组)各32例,于药物治疗前及治疗第6个月、治疗第12个月后进行磁共振弥散张量成像(DT-MRI)检查,分别于胼胝体膝部、体部及压部最厚的部位设置感兴趣区,测取部分各向异性值(FA值)和表观弥散系数值(ADC值). 结果 (1)治疗前,病例组胼胝体膝部、体部及压部FA值均较对照组明显更低,差异有统计学意义(P＜0.05);治疗第6个月后,胼胝体膝部、体部FA值较治疗前明显升高,差异有统计学意义(P＜0.05);治疗第12个月后,胼胝体膝部、体部及压部FA值较治疗前及治疗第6个月均明显升高,差异有统计学意义(P＜0.05).(2)病例组治疗前后各时间点胼胝体膝部、体部及压部ADC值与对照组比较差异均无统计学意义(P＞0.05).(3)治疗前,病例组病程与胼胝体膝部、体部及压部FA值均呈明显负相关(r=-0.850,P=0.000;r=-0.856,P=0.000;r=-0.430,P=0.014);治疗第6个月后,病例组月均头痛次数与胼胝体膝部、体部及压部FA值均呈明显负相关(r=-0.824,P=0.000; r=-0.792,P=0.000;r=-0.425,P=0.015);治疗第12个月后,病例组月均头痛次数与胼胝体膝部、体部FA值均呈明显负相关(r=-0.452,P=0.009;r=-0.440,P=0.012). 结论 无先兆偏头痛患者存在胼胝体神经纤维微细结构完整性的损害,经有效治疗后此种损害是可逆的.DT-MRI可动态观察无先兆偏头痛患者胼胝体神经纤维微细结构完整性的改变,值得临床推广应用.     

三叉神经痛伽玛刀放射外科治疗（附43例分析）

目的：评价伽玛刀（γ－刀）放射外科治疗三叉神经痛（TN）43例治疗结果。方法：采用1．5TD磁共振成像（MRI）、GammaPlan治疗计划系统,Leksellγ－刀治疗34例非肿瘤性TN,治疗靶点在三叉神经感觉根桥脑进入区,单个4mm准直器,最大剂量72－90Gy,50％等计量线限定靶点;9例颅底肿瘤的症状性三叉神经痛边缘剂量12－15Gy。结果：随访3－28个月,平均随访期14．8个月,疼痛100％缓解占69．8％,疼痛缓解＞80％占18．6％,疼痛缓解＞50％占46％,总有效率93％,非肿瘤性TN总有效率90l％。缓解疼痛＜50％3例（7．0％）。3例疼痛缓解后分别在5、9和17个月复发。无效和复发病人经再次治疗后疼痛有效缓解。全组病人无任何并发症,无死亡。结论：γ－刀是治疗三叉神经痛安全和有效的治疗方法。     

首发精神分裂症患者氯氮平治疗前后血浆白细胞介素6,13及可溶性白细胞介素6受体水平的变化

目的探讨首发精神分裂症患者氯氮平治疗前后血浆白细胞介素6(IL6)、白细胞介素13(IL13)及可溶性白细胞介素6受体(sIL6R)水平的变化。方法采用双抗体夹心ABC放射免疫吸附法,对30例(男10例,女20例)首发精神分裂症患者(患者组)氯氮平治疗前后及28名(男13名,女15名)健康对照者(对照组)的血浆IL6、IL13及sIL6R水平进行检测。结果(1)患者组治疗前[(202±26)ng/L]后[(217±28)ng/L]血浆IL6水平均明显高于对照组[(181±36)ng/L],差异均有统计学意义(均P<005)。患者组氯氮平治疗后血浆IL6水平高于治疗前(P<005)。(2)患者组治疗第6周末血浆sIL6R水平[(23±20)ng/L]比治疗前[(34±16)ng/L]明显下降,差异有统计学意义(P<005)。(3)患者组治疗前血浆IL13水平[(16±12)ng/L]明显低于对照组[(24±18)ng/L],差异有统计学意义(P<005),治疗第6周末[(22±14)ng/L]比治疗前有所升高。(4)经相关及多元回归分析,患者组治疗第6周末血浆IL6水平的增高幅度与氯氮平治疗剂量呈正相关,差异有统计学意义(r=0722,P=0000);治疗前血浆sIL6R水平与阳性症状分呈正相关(r=0379,P=0020),血浆IL13水平与阴性症状分(r=-0602,P=0000)及阳性和阴性症状量表总分(r=-0334,P=0035)呈负相关;治疗前后IL13的变化幅度与阴性症状分减分率呈正相关(r=0611     

递增强度运动时肌氧的变化

背景：近红外光谱技术的发展，使连续、实时、快捷及无损检测运动骨骼肌氧含量的变化已成为现实。 目的：分析近红外光谱技术检测递增强度运动时肌氧的变化特征及其与个体乳酸阈之间的关系。 设计、时间及地点：对比观察，实验于2005年在武汉体育学院健康科学学院实验中心完成。 对象:以武汉体育学院23 名青年男子中长跑运动员作为实验组，以该校无正规运动训练史的23名男大学生作为对照组，两组平均年龄基本相似[(21±2) , (20±1) 岁, P =0.215]，受试对象对实验知情同意。 方法：受试者在功率自行车上做递增负荷运动，逐级递增,直至力竭。利用近红外光谱技术连续检测受试者右侧股外侧肌氧的变化，同时作呼出气体分析，运动全程遥测心率，分别测定安静时、每级负荷运动后即刻和恢复期第2，5，10 min手指末梢血乳酸浓度测定，采用在血乳酸动力学变化曲线上标定个体乳酸阈的方法寻找受试者个体乳酸阈。 主要观察指标：两组递增负荷运动过程中肌氧的变化及其与个体乳酸阈的相关性。 结果：①在递增负荷运动时，肌氧的变化在一定运动强度范围（对照组50~150 W，实验组50~200 W）只出现轻微改变；运动强度超过一定数值时（对照组为150 W，实验组为200 W）其变化幅度明显加大。实验组受试者的肌氧平均下降幅度较对照组受试者大（P < 0.05）。②肌氧的变化灵敏反映了运动强度的变化，与血乳酸浓度的变化曲线呈高度负相关（r=-0.960，P < 0.01），突然出现大幅度下降的拐点时所对应的运动强度与个体乳酸阈基本一致。 结论：递增负荷运动中，肌氧的变化信号灵敏地反映了运动强度的变化，其突然出现的大幅度下降的拐点所对应的运动强度与个体乳酸阈显著相关。     

早期高压氧治疗对慢性压迫性损伤模型大鼠疼痛行为学的影响

目的观察神经病理性疼痛发病早期0.25 MPa高压氧治疗对大鼠疼痛行为学的影响,并探讨早期治疗的作用机制。方法采用左后肢坐骨神经结扎术建立慢性压迫性损伤大鼠模型,术后早期(第1天)即开始进行高压氧(0.25 MPa)治疗(60 min/d),5d后观察大鼠一般情况、自发缩足次数、缩足阈值(PWT)和缩足潜伏期(PWL)等疼痛行为学变化。结果与假手术组相比,模型组大鼠体质量显著下降(t=4.772,P=0.000)、高压氧组大鼠体质量降低幅度小于模型组(t=2.411,P=0.029);模型组大鼠术后即出现缩足潜伏期缩短(t=28.345,P=0.000),第3天开始自发缩足次数增多(t=12.541,P=0.000)、缩足阈值降低(t=4.032,P=0.001)。与模型组相比,高压氧治疗组大鼠术后第3天开始缩足次数减少(t=8.077,P=0.000)、缩足阈值增加(t=2.114,P=0.049)、缩足潜伏期延长(t=7.715,P=0.000)。结论早期施行高压氧(0.25 MPa)治疗可以显著改善神经病理性疼痛大鼠痛敏症状,为临床神经病理性疼痛提供一种新的便捷、经济、有效的治疗方法。     

抗抑郁药引发转相与抑郁症患者气质特征的关系

目的：了解抗抑郁药引发转相过程中气质特征的作用。方法：103例抑郁症患者选用气质量表进行气质评定后接受单一抗抑郁药治疗3个月,于治疗后1周、1个月、2个月和3个月,分别采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）以及Young躁狂量表（YMRS）进行评定,比较转相与未转相患者之间气质特征的差异。结果：在3个月治疗过程中,103例患者中有27例在治疗的不同时期出现了转相,占26.2%;未转相患者粘液质和抑郁质更为明显（t=2.004、3.480,P=0.048、0.001）。进一步相关分析发现,粘液质和抑郁质躁狂评分呈显著负相关（r=-0.201,P=0.039）,与抑郁评分的变化也呈显著负相关（r=-0.201,P=0.041）;转相患者胆汁质与抑郁质亦呈显著正相关（r=0.389,P=0.026）。结论：抑郁症患者的气质特征在抗抑郁药转相过程中可能有一定的作用。     

Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment

A cervical radiculopathy is the most common symptom of cervical degenerative disease and its natural course is generally favorable. With a precise diagnosis using appropriate tools, the majority of patients will respond well to conservative treatment. Cervical radiculopathy with persistent radicular pain after conservative treatment and progressive or profound motor weakness may require surgery. Options for surgical management are extensive. Each technique has strengths and weaknesses, so the choice will depend on the patient''s clinical profile and the surgeon''s judgment.     

Cervical radiculopathy

Cervical radiculopathy is a condition encountered commonly in the evaluation of neck pain that may result in significant discomfort and functional deficits. Although the long-term prognosis of this condition is favorable, a standardized approach to therapy is important to minimize unnecessary tests and identify patients who require more urgent intervention. Patient education, pain control, and physical therapy are the first line of therapy. Patients who have protracted pain or significant functional deficits may require a more thorough evaluation, including imaging, electrodiagnostic testing, and, possibly, surgical referral. This article outlines the basic clinical, diagnostic, and therapy considerations in the evaluation of cervical radiculopathy.     

Medical cervical facetectomy for radiculopathy due to foraminal stenosis: 71 personal consecutive cases

Medial cervical facetectomy performed on patients using a high speed drill and microscope represents an effective way for treatment of patients with radiculopathy due to multi-level, either uni- or bilateral, foraminal stenosis. The author presents the results of medial cervical facetectomy performed in 71 cases during a 4 year period. Medial cervical facetectomy appears to provide significant benefits to patients with radiculopathy secondary to foraminal stenosis. The procedure also appears to be superior to complete foraminotomy for relief of radiculopathy as the lateral third to half of the facet joint is still preserved and there is no instability problem.     

Somatosensory conduction times and peripheral, cervical and cortical evoked potentials in patients with cervical spondylosis.

Peripheral, cervical and cortical somatosensory evoked potentials after median or ulnar nerve stimulation were recorded in 21 patients with cervical spondylosis with radiculopathy or myelopathy. The test was normal when pain and paraesthesias were the only symptoms, while pathological in radiculopathy with objective neurological signs. The results varied in patients with cervical myelopathy.     

Simultaneous MR neurography and apparent T2 mapping of cervical nerve roots before microendoscopic surgery to treat patient with radiculopathy due to cervical disc herniation: Preliminary results

There is no imaging modality to quantitatively evaluate compressed cervical nerve roots in cervical radiculopathy. Here we sought to evaluate the usefulness of simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation-enhancement imaging (SHINKEI-Quant) to evaluate compressed nerves quantitatively in patients with cervical radiculopathy due to cervical disc hernia before microendoscopic surgery.One patient with cervical radiculopathy due to cervical disc hernia before microendoscopic surgery and 5 healthy subjects underwent simultaneous apparent T2 mapping and neurography with SHINKEI-Quant. The patient was a 49-year-old man with severe right upper arm pain and numbness. Based on MRI images, we suspected right C7 radiculopathy due to C6-7 cervical disc hernia. The T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus bilaterally at C5–C8 were measured.We observed no significant differences in T2 relaxation times between the nerve roots on the left and right at each spinal level with values in healthy subjects. In our patient, neurography revealed swelling of the right C7 nerve, and a prolonged T2 relaxation time compared with that of the contralateral, unaffected C7 nerve. We performed microendoscopic surgery and the symptoms improved.We were able to evaluate the injured nerve root quantitatively in a patient with cervical radiculopathy using the SHINKEI-Quant technique, being the first study to our knowledge to show the usefulness of this technique to evaluate cervical radiculopathy quantitatively before microendoscopic surgery.     

Quantitative evaluation for cervical foraminal bony stenosis based on angled sagittal slices along a nerve root on computed tomography

Cervical foraminal canal stenosis is a common disease, but any relationships between the measurement values of cervical foraminal canals and clinical symptoms have yet to be explored. We aim to determine a numerical cutoff point of cervical foraminal bony canal size that does not lead to radiculopathy so as to establish criteria for the surgical indication. We reconstructed angled sagittal slices along a nerve root on computed tomography (CT) on a workstation from pre-operative CT data and measured 1152 cervical foraminal canals (144 patients) from Cervical (C) 4/5 to C7/Thoracic (Th) 1. We evaluated the relationship between the size of foraminal canals and clinical manifestations. Receiver operating characteristic (ROC) analysis was used to calculate cutoff points of each foraminal canal size with positive neurologic manifestations. Of the 144 patients’ 1152 nerve roots, 286 nerve roots (24.8%) were diagnosed as radiculopathy by neurological examinations. The mean measured value of all foraminal canals on angled sagittal CT imagery was 3.39 ± 1.37 mm. The cutoff point of foraminal canal sizes without radiculopathy was 2.7 mm (sensitivity 0.680, specificity 0.591) overall. A cutoff point ascertained by quantitative evaluation of cervical foraminal canal size is useful for making diagnosis of cervical foraminal canal bony stenosis.     

Spinal manifestations of vertebral artery dissection

Among 111 patients with vertebral artery dissection (VAD), two presented with spinal manifestations: one with a C5-C6 radiculopathy and the other with a cervical myelopathy. Of 13 previously reported cases of spinal manifestations of VAD (mean age 37 years), ischemic cervical myelopathy was noted in seven; cervical radiculopathy, often at C5-C6 and primarily motor, in five; and hemorrhagic complications in one, with chest pain being part of the presentation.     

Posterior Cervical Inclinatory Foraminotomy for Spondylotic Radiculopathy Preliminary

Posterior cervical foraminotomy is an attractive therapeutic option in selected cases of cervical radiculopathy that maintains cervical range of motion and minimize adjacent-segment degeneration. The focus of this procedure is to preserve as much of the facet as possible with decompression. Posterior cervical inclinatory foraminotomy (PCIF) is a new technique developed to offer excellent results by inclinatory decompression with minimal facet resection. The highlight of our PCIF technique is the use of inclinatory drilling out for preserving more of facet joint. The operative indications are radiculopathy from cervical foraminal stenosis (single or multilevel) with persistent or recurrent root symptoms. The PCIFs were performed between April 2007 and December 2009 on 26 male and 8 female patients with a total of 55 spinal levels. Complete and partial improvement in radiculopathic pain were seen in 26 patients (76%), and 8 patients (24%), respectively, with preserving more of facet joint. We believe that PCIF allows for preserving more of the facet joint and capsule when decompressing cervical foraminal stenosis due to spondylosis. We suggest that our PCIF technique can be an effective alternative surgical approach in the management of cervical spondylotic radiculopathy.     

颈后旁正中小切口显微神经根减压治疗神经根型颈椎病

目的总结颈后旁正中小切口神经根减压治疗神经根型颈椎病的经验。方法回顾性分析34例神经根型颈椎病病人的手术经验。术前JOA评分11。14分,平均（12．5±0．9）分。采用半坐位33例,健侧卧位1例;经颈后旁正中小切口,显微镜下采用磨钻行神经根管扩大成形术。结果术后无并发症发生,病人3d出院;疼痛消失30例,明显减轻4例。对32例随访3～14个月,平均6．5个月：22例上肢肌力减退病人中,上肢肌力改善19例。术后3个月JOA评分15～17分,平均（15．9±0．8）分;与术前比较,t=-17．951,P〈0．05。结论采用颈后旁正中小切口神经根减压术可有效治疗神经根型颈椎病,避免因广泛剥离颈后部肌肉导致的术后颈肩部轴性疼痛,及颈椎前路手术进行椎体融合引起的并发症。     

Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis?

Cervical stenosis (CS) and multiple sclerosis (MS) are two common conditions with distinctive pathophysiology but overlapping clinical manifestations. The uncertainty involved in attributing worsening symptoms to CS in patients with MS due to extremely high prevalence of asymptomatic radiological CS makes treatment decisions challenging. A retrospective review was performed analyzing the medical records of all patients with confirmed diagnosis of MS who had coexistent CS and underwent surgery for cervical radiculopathy/myeloradiculopathy. Eighteen patients with coexistent CS and MS who had undergone cervical spine decompression and fusion were identified. There were six men and 12 women with an average age of 52.7 years (range 40–72 years). Pre-operative symptoms included progressive myelopathy (14 patients), neck pain (seven patients), radiculopathy (five patients), and bladder dysfunction (seven patients). Thirteen of the 14 patients (92.9%) with myelopathy showed either improvement (4/14, 28.6%) or stabilization (9/14, 64.3%) in their symptoms with neck pain and radiculopathy improving in 100% and 80% of patients, respectively. None of the seven patients with urinary dysfunction had improvement in urinary symptoms after surgery. To conclude, cervical spine decompression and fusion can improve or stabilize myelopathy, and significantly relieve neck pain and radiculopathy in the majority of patients with coexistent CS and MS. Urinary dysfunctions appear unlikely to improve after surgery. The low rate of surgical complications in our cohort demonstrates that cervical spine surgery can be safely performed in carefully selected patients with concomitant CS and MS with a good clinical outcome and also eliminate CS as a confounding factor in the long-term management of MS patients.