正中神经损伤后手部感觉功能的康复训练

目的 观察正中神经损伤后早期康复训练对手部感觉功能恢复的影响。方法 将70例正中神经损伤患者随机分为康复组及对照组，康复组于术后2周开始康复治疗，并在康复治疗前及治疗过程中，参照国际标准分别评定手的感觉等级及两点辨别觉，对照组仅行一般处理。经过1个疗程(6—8周)治疗后，进行第2次评定，以后每1个疗程评定1次，共4-5次。结果 康复组患者手的感觉功能优良率达88％，有效率达97％。结论 感觉康复训练能够促进正中神经损伤患者手的感觉功能恢复。     

Bloqueo axilar ecoguiado: variaciones anatómicas de la disposición de los 4 nervios terminales del plexo braquial en relación con la arteria humeral

ObjectivesTo describe the distribution of the terminal branches of the brachial plexus at the axillary level and define distribution patterns after ultrasound evaluation.Material and methodFifty volunteers underwent ultrasound bilateral axillary brachial plexus scanning exploration. Nerve distribution around the humeral artery was described and the distance between each nerve and the center of the artery was measured. The distance and relationship between the ulnar nerve and the humeral vein were also recorded.ResultsThe median nerve was located in the anterolateral quadrant (−29 ± 40°) and at a mean distance of 2.1 ± 0.9 mm from the artery (85%). The ulnar nerve was found at 53 ± 26° and at 4.2 ± 2.1 mm from the artery in the anteromedial quadrant (90%), anterolateral to the vein in 46% of cases, and deep to it in 54%. The radial nerve was at 122 ± 38° and at 3.3 ± 1.7 mm from the artery in the posteromedial quadrant (86%). The musculocutaneous nerve was found at −103 ± 22° and 9.3 ± 5.6 mm from the artery in the posterolateral quadrant (90%) and in the anterolateral quadrant (−55 ± 16°) at 4.8 ± 2.7 mm (10%). There were no differences regarding laterality, gender or overweight patients.ConclusionsOur results allow defining four different anatomical patterns, two based in the position of the musculocutaneous nerve and two based on the disposition of the ulnar nerve with respect to the humeral vein. These patterns were not related to laterality, gender or body weight.     

Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review

A three-year-old boy was investigated for inexplicable incessant crying. On examination, his left wrist was mildly swollen (three to four months) and sensitive. Exploration and carpal tunnel decompression of the left wrist with incisional biopsy was performed for the presence of a fusiform swelling intimately associated with the median nerve. Histopathology revealed the presence of enlarged nerve bundles admixed with mature fat cells and diffuse fibroblastic proliferation. Three months later, he underwent urgent contralateral carpal tunnel decompression for a similar presentation. The final diagnosis was bilateral fibrolipomatous hamartoma (FLH) of the median nerves causing acute bilateral compression neuropathy.FLH of the median nerve is an extremely unusual cause of acute bilateral carpal tunnel syndrome in a young child presenting with ‘incessant crying’. A comprehensive review of FLH including epidemiology, etiology, clinical presentation, differential diagnosis, imaging, pathology, treatment and prognosis is discussed.     

Median nerve compression at the fibrous arch of the flexor digitorum superficialis: an anatomic study of the pronator syndrome

Background

Flexor digitorum superficialis (FDS) arch is a site of compression in pronator syndrome yet little is known about its anatomic structure. The purpose of the study is to delineate the surgical anatomy of the FDS arch along with its relationship to the anterior interosseous nerve (AIN) takeoff.

Methods

Thirty-eight cadavers were dissected using a modified Henry’s approach. The FDS arch was identified, and its distance to the antebrachial crease and medial and lateral epicondyle were measured. The FDS arch was divided in a sequential fashion until adequate decompression of the median nerve was achieved. The total length of the release was measured. The takeoff of the AIN was identified in relation to the FDS arch.

Results

Two types of the FDS arch were discovered, a distinct fibrous arch and an indistinct fibrous arch with vertical fibers blending into overlying fascia. Only 42 % of specimens had a distinct FDS arch averaging 1.69 cm in length. The majority of specimens had an indistinct arch, and of those, 77 % had overlying muscle, requiring an average release of 2.6 cm. The AIN branched at or distal to the FDS arch in 74 % of specimens, and only 8 % was found to have an ulnar-sided origin off the median nerve.

Conclusions

A longer surgical release is needed with indistinct FDS arches. Overlying muscle during dissection may be indicative of an indistinct arch. Dissection along the ulnar side of the median nerve can possibly decrease the chance of injury to the AIN during decompression.     

胸部小切口冠状动脉搭桥术66例报告

目的：探讨胸部小切口冠状动脉搭桥术的临床效果。方法2002年1月～2013年1月采用胸部小切口取左乳内动脉（ left internal mammary artery,LIMA）心脏不停跳冠状动脉搭桥术66例。胸骨下段小切口59例,采用全麻、单腔气管插管,平卧位,倒“L”胸骨下段切口;胸骨旁小切口5例,采用全麻、双腔气管插管,平卧位左胸抬高30＆#176;,左前外侧第4或第5肋切口,用特制牵开器（法国圣骑士公司）牵开肋骨,游离乳内动脉,使用冠脉固定器下行冠脉吻合;2例胸腔镜辅助下完成乳内动脉与左前降支的吻合。结果66例均完成左乳内动脉至前降支的吻合,2例追加大隐静脉降主动脉至第一对角支的吻合。无围术期死亡。60例随访0．5～8年,（5．5±2．5）年,心绞痛症状消失42例,明显减轻24例。术后冠状动脉CT检查16例,冠脉造影12例,LIMA与左前降支（ left anterior descending, LAD）吻合口满意率100％,支架内再狭窄1例,大隐静脉桥血管闭塞1例。结论胸部小切口冠状动脉搭桥术主要适用于心脏前壁冠状动脉尤其是前降支的的再血管化,安全可靠,中期疗效好,在合并高危因素或常规冠状动脉搭桥术和经皮冠状动脉介入术效果不满意者中应用更佳。     

图像滤波技术在B型超声诊断仪中的应用研究

目的：依据医学超声图像固有特点,对B型超声医学图像滤波技术进行研究,以达到大幅度提高图像质量的目的。方法：通过Matlab等工具实现B型超声诊断仪图像的均值滤波、中值滤波、自适应中值滤波、小波变换以及各向异性扩散方程滤波。结果：对常见的B型超声诊断仪滤波算法进行了比较与研究。结论：所有的滤波方法对图像信号均有一定程度的增强,对噪声亦有抑制。均方误差反映了滤波图像在抑制噪声的同时,对细节的保持情况和超声医学图像两者之间达到一个最佳的平衡。     

Assessing the complications and effectiveness of open carpal tunnel release in a tertiary care centre in a developing country

INTRODUCTION

Open surgical release for carpal tunnel syndrome is not devoid of complications and its quantitative assessment with the Boston questionnaire in a developing country had not been conducted, where, lack of facilities and surgical technique can influence the outcome.

PRESENTATION OF CASE

This was a prospective study in which all cases of carpal tunnel syndrome undergoing open release between June 2007 and June 2012 and who returned for follow up were included. Each patient was requested to fill out the Boston questionnaire twice both pre and post op at 3 months. All complications were recorded as well as bio-data of patients and co morbidities. Follow up was at 2 weeks and at 3 months. Those reporting complications at 3 months were further followed up until 6 months. 373 patients were included in the study. Twenty four patients developed complications. Of these, 12 experienced pain resulting from reflex sympathetic dystrophy. Three patients developed wound dehiscence, 2 cases acquired infections, 4 patients developed immediate post-operative haemorrhage and in 3 patients there was late recurrence of median nerve compression. The symptom severity score pre-operatively was 3.30 (±0.60) and it improved to 1.65 (±0.75) post-operatively indicating a significant change (p < 0.0001). The preoperative functional status score was 2.58 (±0.75) and post-op it became 1.60 (±0.80) again implying a good improvement with an effect size of 1.3.

DISCUSSION

All of the complications produced were well managed. The complication incidence was low. The open release procedure produced good improvement in hand function and in decreasing the symptom severity.

CONCLUSION

Conducting open release for carpal tunnel syndrome in a tertiary referral centre in a developing country offers a good outcome.     

基于高频中值滤波的小波滤波在脑动脉色素浓度谱特征信号提取中的应用

近年来,近红外光谱技术(mear infrared spectrometry,NIRS)在脑科学研究领域倍受青睐。为了更好地满足参数的后续使用并提取出有效特征信号,前期尝试了多种常用滤波方法,为了解决滤后信号易失真以及不能有效滤除低频或者高频噪声的问题,提出了基于高频中值滤波的小波滤波,并采用高度还原真实信号特点的仿真信号以及利用脑血流动力学参数采集系统获得的真实光电容积脉搏波(photoplethysmography,PPG)信号,基于中值滤波的小波滤波进行分析。将实验测试数据与其他滤波方法的特征信号提取效果进行对比,并对处理数据进行信噪比和频谱分析。结果表明,采用中值滤波与小波滤波相结合的滤波方式,对脑动脉色素浓度谱特征信号进行滤波处理,能获得有效、精准的脑血流动力学参数,为后续的测量精度打下基础。该方法有效结合了中值滤波能够剔除粗差的特性和小波滤波在光电容积脉搏波中有效滤除高斯信号的特性,改善了采用单一方式的局限性,提供了一种新的PPG滤波的思路,对比传统方法更加优化。     

Étude anatomique concernant le transfert du nerf interosseux antérieur innervant le pronator quadratus sur le rameau profond du nerf ulnaire et sur la branche motrice thénarienne du nerf médian par anastomose termino-latérale

Proximal or middle lesions of median or ulnar nerves are responsible for a great loss of hand motor function. Neurotization of either deep ulnar branch of ulnar nerve (DBUN) or recurrent (thenar) branch of median nerve (RBMN) with the nerve to quadratus pronator (NPQ) from the anterior interosseous nerve (AION) could reduce length of axonal growth and therefore the reinnervation lead-time of hand intrinsic muscles. We studied the anatomy of these three nerves, to help surgeon choosing his (her) technique and approach. Twenty-three cadaver forearms were dissected. End-to-side sutures were performed to mimic these neurotizations. Distances between nerve sutures and ulnar styloid process (USP) or trapeziometacarpal joint (TM) were measured. All the sutures but one RBMN could be done. On average sutures were distant from USP by 44 ± 17 mm (neurotization of DBUN), from TM by 62 ± 15 mm (neurotization of RBMN). Knowledge of average distance to perform these neurotizations should allow choosing the best reduced approach of RBMN and DBUN. Neurotizations of DBNU and RBMN with NPQ were feasible for lesions located at 6.1 cm upstream USP and 7.7 cm upstream TM, respectively. End-to-side sutures remain to be clinically evaluated.