手术治疗上肢周围神经卡压综合征71例

目的探讨手术治疗上肢周围神经卡压综合征的临床疗效。方法1995年1月～2008年6月,对94例上肢周围神经卡压综合征患者通过手术神经松解,对肘管综合征的患者同时行尺神经肌内前置术。根据英国医学研究院颁布的感觉、运动分级标准评定疗效。结果本组71例获随访,随访时间6个月-4年,优31例,良25例,中10例,差5例。结论周围神经卡压综合征诊断明确后,若保守治疗无效,即应早期手术探查,彻底松解受压神经,术后效果满意。     

Neurolysis for megalgia paresthetica

Objective

Meralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue.

Methods

During the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted.

Results

Twelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported.

Conclusion

Neurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.     

神经松解减压术治疗上肢神经损伤

目的 :报告采用神经松解压术治疗上肢神经损伤的效果。方法 :采用显微外科技术对 6例 48条上肢神经分别行神经外膜松解、外膜加束膜松解及神经前置治疗。结果 :48条神经中疗效优的 18条 ,良 2 4条 ,可 5条 ,差 1条 ,总优良率 87.5 %。结论 :对上肢神经损伤患者 ,应尽早选用神经探查松解减压术 ,可望获得满意效果。     

神经根管松解术治疗腰椎间盘突出症临床研究

目的观察小针刀神经根管松解术治疗腰椎间盘突出症临床疗效及安全性。方法40例腰椎间盘突出症患者随机分为2组。治疗组20例给予小针刀神经根管松解术、牵引、针灸、推拿及中药辨证施治内服;对照组20例给予小针刀神经根管假松解术,其他治疗与治疗组完全相同。以疼痛、麻木等根性症状完全消失或退出试验为观察终点,试验中每天观察疗效及治疗反应,记录试验第7天及半月时主症缓解情况,并随访半年。结果治疗组总有效率与对照组无显著差异(P>0.05),显效率明显优于对照组(P<0.01);治疗组显效时间明显缩短(P<0.001);同时,治疗组发生沿神经分布的串麻感明显多于对照组,未见神经损害发生,且串麻感沿受压神经支配区的出现与疗效有正相关关系。结论小针刀神经根管松解术治疗腰椎间盘突出症具有显效快、疗效好、操作简便、痛苦少且潜在风险低的优势。     

术中超强电刺激在产瘫治疗中的应用

目的 探讨术中超强电刺激对不完全产瘫的治疗价值. 方法 2008年7月至2011年9月,对9例产瘫在进行神经松解后,术中给予超强肌电刺激,分别测定超强电刺激前后复合肌肉动作电位的潜伏期、波幅,并比较其改善程度. 结果 9例中7例潜伏期改善,8例波幅改善.经神经超强电刺激前、后其潜伏期缩短差异百分比为1.06％ ～ 39.77％,平均为8.02％;波幅提高差异百分比为2.70％～400.00％,平均为185.97％.术后2周内随访,8例患儿受刺激神经根干所支配相应肌肉有可见的功能改善. 结论 超强电刺激可作为一种提高产瘫松解手术疗效的辅助治疗方法.     

Decompression of the Sciatic Nerve Entrapment Caused by Post-Inflammatory Scarring

A rare case of chronic pain of entrapment neuropathy of the sciatic nerve successfully relieved by surgical decompression is presented. A 71-year-old male suffered a chronic right buttock pain of duration of 7 years which radiating to the right distal leg and foot. His pain developed gradually over one year after underwenting drainage for the gluteal abscess seven years ago. A cramping buttock and intermittently radiating pain to his right foot on sitting, walking, and voiding did not respond to conventional treatment. An MRI suggested a post-inflammatory adhesion encroaching the proximal course of the sciatic nerve beneath the piriformis as it emerges from the sciatic notch. Upon exploration of the sciatic nerve, a fibrotic tendinous scar beneath the piriformis was found and released proximally to the sciatic notch. His chronic intractable pain was completely relieved within days after the decompression. However, thigh weakness and hypesthesia of the foot did not improve. This case suggest a need for of more prompt investigation and decompression of the chronic sciatic entrapment neuropathy which does not improve clinically or electrically over several months.     

腓总神经嵌压综合征

报告腓总神经嵌压综合征９例，用保守疗法治疗３例，手术治疗６例，获满意疗效。该症的发生与腓总神经在窝至腓骨颈的解剖特点密切相关。主要病因为膝关节急剧屈曲下蹲位劳动使腓总神经反复损伤和局部赘生物压迫。临床表现为胫前肌、腓骨长肌、长伸肌、趾长伸肌等肌力减退或麻痹，小腿外侧及足背皮肤麻木或感觉缺失。电生理检查对诊断有一定价值。早期可保守治疗，３个月无效者，即应手术探查。局部赘生物嵌压者，应将其切除，进行彻底的神经松解术。     

上臂桡神经损伤的手术治疗

目的　探讨上臂桡神经损伤的机制、手术时机、手术方法及其预后。方法　对 1986 0 7～ 2 0 0 1 0 6作者经治的 6 0例上臂桡神经损伤进行回顾性研究。结果　 6 0例中男 42例 ,女 18例 ;年龄 12～ 5 5岁 ,平均 33 5岁。桡骨干骨折合并桡神经损伤 44例 ,锐器伤 12例 ,医源性损伤 4例。 6 0例患者中 47例获得随访 ,随访时间 6个月～ 15年 ,平均 5年 6个月 ,优 36例 (76 6 %) ,良 7例(14 9%) ,差 4例 ,优良率 91 5 %。结论　上臂桡神经损伤的最常见原因为肱骨干骨折所致 ,以挫伤多见 ,早期治疗、术中根据不同情况选择不同显微外科治疗是提高疗效的关键。     

中医综合治疗根性疼痛100例随访研究

目的观察两种中医综合治疗方案治疗根性疼痛的远期疗效,总结根性疼痛的转归规律。方法按分层随机双盲对照法将根型颈椎病及腰突症各50例纳入试验,治疗组予小针刀神经根管松解术加中医综合治疗方案,对照组予小针刀神经根管假松解术加相同中医综合治疗。以无效、疗效不佳而要求结束试验为观察终点．试验中进行症状体征积分及MPQ量表评定、不良事件调查并记录,于试验结束后第1、3、6个月,分别从症状体征积分及疗效评估两方面随访并记录。结果对于两类根性疼痛,完成试验后有症状体征者中,选择继续治疗者及终止治疗者,在各自的两组比较中,症状体征积分均无显著性差异（P〉0．05）;选择终止与继续治疗的病例间相比,对于根型颈椎病,其症状体征积分无显著性差异（P〉0．05）,而于腰突症却有显著性差异（P〈0．05）,两类根性疼痛病例合并统计后仍有显著性差异（P〈0．05）。少数患者症状体征积分仍高,但还是因对疗效满意而停止治疗,转归良好。因无效退出试验的病例中有选择手术治疗者,也有选择激素、脱水剂及神经阻滞等治疗者。转归均较好。同时,对照组因无效退出的病例,采用治疗组的方案仍然有效。结论根性疼痛患者选择治疗与否取决于症状体征的轻重程度,但也与患者的家庭与社会环境、心理与行为特征、对疾病的认知能力与情绪的波动、医生的引导等多种因素密切相关。各种对根性疼痛有效的干预方法,各有特色优势,应根据病情轻重缓急、患者接受度合理选择,综合应用。根性疼痛的干预应适度,症状体征积分减轻至（2．87±1．72）分时可停止治疗,加强健康教育。     

A Review of Interventional Radiology Treatments for Chronic Pain

Interventional radiology procedures are being increasingly used to mitigate chronic pain. In addition to established therapies such as thermal bone lesion ablation, kyphoplasty, and chemical neurolysis, ongoing research has shown promising results for the use of embolization in treatment of osteoarthritic knee pain and chronic pain secondary to adhesive shoulder capsulitis. This review will highlight some of the most common interventional radiology pain procedures, as well as provide insight into future pain-relieving embolization.