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1.
1037例痉挛性脑瘫显微神经外科手术治疗   总被引:14,自引:2,他引:12  
目的探讨显微神经外科手术治疗痉挛性脑瘫的疗效.方法回顾分析2000年3月至2004年3月的显微神经外科手术治疗1 037例痉挛性脑瘫病例.依据病例的不同情况采用相应的选择性周围神经部分切断术,包括:胫神经、坐骨神经、肌皮神经、正中神经、尺神经、颈段和腰骶段脊神经后根.结果全部患者平均随访24.1个月.96.05%患者术后即感痉挛状态缓解,随访期间缓解率为 91.23%.术后 6周内运动功能改善率为 70.74%,随访期间为 87.24%.生活质量提高率在随访期间为89%.术后发生肢体感觉障碍382侧(21.66%),肌无力256侧(14.51%),随访期间均见好转.术后肢体痉挛状态不同程度复发134例(10.58%).结论选择性周围神经部分切断术是治疗痉挛性脑瘫安全有效的手术方法.选择合适的病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效的关键.  相似文献   

2.
选择性周围神经部分切断术治疗脑瘫性肢体痉挛   总被引:1,自引:1,他引:0  
目的观察选择性周围神经部分切断术治疗痉挛性脑瘫的效果。方法采用显微神经外科手术治疗的68例痉挛型脑瘫病例,根据患者肢体痉挛的不同情况采用相应的选择性周围神经部分切断术,包括胫神经、坐骨神经和正中神经,其中选择性胫神经切断术36侧,选择性正中神经切断术28侧,选择性坐骨神经切断术28侧,共计92侧。结果全部患者经3-15个月的随访,术后即刻肢体痉挛状态缓解率为97.8%(90/92),随访期间为94.6%(87/92),随访期间运动功能改善率为76.5%(52/68),术后肢体痉挛状态不同程度复发5侧(5.4%)。结论选择性周围神经部分切断术对降低痉挛性脑瘫患者肌张力、纠正痉挛性畸形近期疗效满意,手术创伤小,治疗效果能够被医患双方同时认可。  相似文献   

3.
非脑瘫病因性痉挛状态的显微神经外科手术治疗   总被引:13,自引:1,他引:12  
目的探讨显微神经外科手术治疗多种(主要为非脑瘫)病因所致痉挛状态的疗效。方法2000年3月至2005年6月我院采用显微神经外科手术治疗多种(主要为非脑瘫)病因所致痉挛状态356例。根据病例的不同情况采用相应的选择性周围神经部分切断术.包括胫神经、坐骨神经、肌皮神经、正中神经、尺神经、闭孔神经、副神经、颈段和腰骶段脊神经前、后根。结果全部患者平均随访28个月。95.2%患者术后即感痉挛状态缓解,随访期间缓解率为90.7%,运动功能改善率为87.6%,生活质量提高率为91.3%。术后肢体感觉障碍发生率23.3%,肌无力发生率19.5%,随访期间均见不同程度好转。术后痉挛状态不同程度复发33例(9.3%)。结论选择性周围神经部分切断术是治疗多种(主要为非脑瘫)病因所致痉挛状态安全有效的手术方法。  相似文献   

4.
1244例痉挛状态的显微神经外科手术治疗   总被引:9,自引:1,他引:8  
目的探讨显微神经外科手术治疗痉挛状态的疗效。方法回顾分析2000年3月至2004年5月实施的1244例显微神经外科手术治疗痉挛状态,根据病例的不同情况采用相应的选择性周围神经部分切断术,包括:胫神经、坐骨神经、肌皮神经、正中神经、尺神经、副神经、颈段和腰骶段脊神经前、后根。结果全部患者平均随访24.3个月。96.26%患者术后立即感痉挛状态缓解,随访期间缓解率为90.68%。术后6周内运动功能改善率为71.63%,随访期间为86.72%。生活质量提高率在随访期间为88.67%。术后发生肢体感觉障碍478侧(23.17%),肌无力378侧(18.32%),随访期间均见好转。术后痉挛状态不同程度复发165例(10.83%)。结论选择性周围神经部分切断术是治疗痉挛状态安全有效的手术方法。选择合适的病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效的关键。  相似文献   

5.
选择性正中神经分支部分切断术治疗脑瘫性腕、指痉挛   总被引:1,自引:0,他引:1  
目的探讨选择性正中神经分支部分切断术治疗脑瘫患儿腕、指部痉挛状态的治疗效果:方法回顾分析2000年3月至2004年3月显微手术治疗的57例脑瘫患儿77侧腕、指部痉挛状态病例。全部病例采用选择性正中神经分支部分切断术治疗。结果全部病人平均随访25个月。100%病人术后立即感腕、指部痉挛状态缓解,随访期间缓解率为88.31%(68/77)。术后6周内运动功能改善率为90.91%(70/77),随访期间为74.03%(57/77)。生活质量提高率在随访期间为89.47%(51/57)。术后发生上肢感觉障碍37侧,肌无力26侧,随访期间均见好转?随访期间痉挛状态复发10侧(12.99%)。结论选择性正中神经分支部分切断术治疗脑瘫患儿腕、指部痉挛状态是安全有效的。  相似文献   

6.
选择性胫神经部分显微切断术治疗脑瘫性踝痉挛   总被引:1,自引:0,他引:1  
目的探讨选择性胫神经部分显微切断术治疗脑瘫性踝痉挛的治疗效果。方法对2003年1月至2006年1月收治的108例(179只足)脑瘫性踝痉挛患者采用选择性胫神经部分显微切断术进行治疗。结果术后患者即感踝痉挛缓解,术后2周步态明显改善,随访期间缓解率97%。术后14例发生肌力下降,16例发生小腿、足部感觉障碍,随访期间均见好转。结论选择性胫神经部分显微切断术是治疗脑瘫性踝痉挛安全、有效的显微神经外科手术方法。  相似文献   

7.
目的探讨周围神经选择性切断治疗脑瘫性下肢痉挛的疗效。方法回顾2003年1月至2008年3月收治的380例脑瘫患者,根据痉挛部位不同,选择相应周围神经进行部分切断,包括:腰骶段脊神经后根、坐骨神经、闭孔神经和胫神经。结果术后痉挛缓解率100%,其中82例患者肌力下降,142例患者出现肢体麻木、感觉减退,随访期间,均见好转。随访6个月至3年,随访期间痉挛缓解率为95%。95%患者行走步态好转。结论周围神经选择性切断术是治疗脑瘫性下肢痉挛的安全、有效的神经外科方法。  相似文献   

8.
目的探讨内镜在选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛中的应用.方法回顾分析2002年3月至2003年4月显微手术治疗的53例脑瘫性下肢痉挛,全部采用选择性腰骶段脊神经后根部分切断术,并在术中应用软性神经内窥镜.结果全部患者平均随访 10个月. 100%患者术后立即感痉挛状态缓解,随访期间缓解率为94.3%.术后6周内步态功能改善率为56.6%,随访期间为90.6%.生活质量提高率在随访期间为94.3%.术后发生下肢感觉障碍20例(37.7 %),肌力下降 5例(9.4%),随访期间均见好转.术后无一过性尿失禁及尿潴留发生.随访期间无复发病例.结论选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛,术中应用内窥镜有利于提高疗效、减少创伤和降低并发症发生率.  相似文献   

9.
目的探讨选择性颈段脊神经后根部分切断术治疗脑瘫性上肢痉挛状态的疗效。方法回顾性分析17例脑瘫性上肢痉挛病人的临床资料.均采用选择性颈段脊神经后根部分切断术。平均随访38、7个月。结果94.1%的病人术后即刻痉挛状态缓解.随访期间缓解率为88.2%:术后6周内运动功能改善率为52.9%.随访期间为76.5%:生活质量提高率在随访期间为82.4%。术后发生上肢感觉障碍20侧(58.8%),肌力下降13侧(38.2%),随访期间均见好转。随访期间复发2例(11.8%)。结论选择性颈段脊神经后根部分切断术是治疗脑瘫性上肢肌群广泛痉挛有效的手术方法。选择合适病例.熟悉局部解剖.掌握显微手术技巧和术后坚持长期正规康复训练等.是保证疗效的关键。  相似文献   

10.
周围神经选择性切断治疗脑瘫性下肢痉挛   总被引:1,自引:0,他引:1  
目的探讨周围神经选择性切断治疗脑瘫性下肢痉挛的效果。方法对380例脑瘫性下肢痉挛患者,根据痉挛部位不同,选择相应周围神经(包括腰骶段脊神经后根、坐骨神经、闭孔神经和胫神经)部分切断。结果术后痉挛缓解率100%,其中82例患者肌力下降,142例患者出现肢体麻木、感觉减退,随访期间均见好转。术后随访6个月~3年,随访期间痉挛缓解率为95%。95%患者行走步态好转。结论周围神经选择性切断术对治疗脑瘫性下肢痉挛是安全、有效的。  相似文献   

11.
Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005  相似文献   

12.
BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.  相似文献   

13.
2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。  相似文献   

14.
目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。  相似文献   

15.
《Clinical neurophysiology》2020,131(1):243-258
Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.  相似文献   

16.
目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。  相似文献   

17.
18.
Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.  相似文献   

19.
Introduction: An important consideration in treating acute mania is the promptness with which a chosen therapy can bring symptom amelioration. This article reviews the available published data from controlled, blinded studies regarding the latency of responses to antipsychotics in patients with acute mania.

Methods: Articles for this review were obtained from a search of the Medline database (1966–1999), using the following keywords and phrases: antipsychotic, atypical, bipolar disorder, mania, neuroleptic, typical. The bibliographic sections of articles gleaned from this search were used to direct further inquiries.

Results: Although information regarding the onset of action of antipsychotics is limited, we discovered data for four typical and three atypical antipsychotics. Drugs with the fastest onsets include haloperidol, risperidone, and olanzapine, with onsets appearing in 2–6 days. Chlorpromazine and thiothixene were at the slowest end of the continuum, with onsets of 2 weeks or longer. Data regarding pimozide are mixed, with some studies showing an onset equivalent to that of the 'fast' compounds and others showing one similar to that of the 'slow' compounds.

Conclusions: Choice of therapy should consider not only efficacy and safety, but also onset speed. Atypical antipsychotics appear to offer safer, faster, and more effective therapies.  相似文献   

20.
Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.  相似文献   

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