臭氧盘内配合曲安奈德颈深筋膜间隙注射治疗神经根型颈椎病

目的探讨利用臭氧盘内注射配合曲安奈德颈深筋膜间隙注射治疗神经根型颈椎病的临床效果。方法将收治的60例神经根型颈椎病患者随机分为二组,比较MacNab评价和VAS评分差异。结果通过改良的MacNab疗效评价标准J和VAS评分,联合组在术后7天和3个月治疗效果明显优于臭氧组。结论臭氧盘内注射配合曲安奈德颈深筋膜间隙注射治疗神经根型颈椎病疗效优于单一臭氧治疗,值得临床推广应用。     

Systematic Reviews Published in the April 2013 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The April 2013 issue (2nd DVD for 2013) contains 5484 complete reviews, 2341 protocols for reviews in production, and 22,600 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 692,000 randomized controlled trials, and 15,700 cited papers in the Cochrane methodology register. The health technology assessment database contains some 12,000 citations. Ninety-four new reviews have been published in the previous 3 months, of which four have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided.     

LEVOMEPROMAZINE FOR NAUSEA AND VOMITING IN PALLIATIVE CARE

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The April 2013 issue (2nd DVD for 2013) contains 5484 complete reviews, 2341 protocols for reviews in production, and 22,600 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 692,000 randomized controlled trials, and 15,700 cited papers in the Cochrane methodology register. The health technology assessment database contains some 12,000 citations. Ninety-four new reviews have been published in the previous 3 months, of which four have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided.     

基于“筋骨并重”探讨针药并用、理筋整复手法治疗神经根型颈椎病(气滞血瘀证)的效果及机制

目的:观察针药并用、理筋整复手法治疗神经根型颈椎病(气滞血瘀证)的临床效果,初步对可能的起效机制进行探究。方法:将就诊于我院的118例神经根型颈椎病患者,按照随机数字表法分为对照组(n=59)和观察组(n=59)。对照组患者给予理筋整复手法;观察组患者在对照组基础上加用针灸、中药汤剂进行内外合治。比较两组有效率,测定颈椎活动度,评估颈肩疼痛程度、强度、分级指数,监测血清中肿瘤坏死因子-α(TNF-α)、降钙素基因相关肽(CGRP)、内皮素-1(ET-1)、一氧化氮(NO)水平变化。结果:观察组的有效率高达93.22%(55/59),明显高于对照组的77.97%(46/59),差异有统计学意义(χ~2=0.018,P0.05);与对照组相比,观察组患者治疗后的颈椎活动度改善更明显,颈椎活动相关的右旋、左旋、后伸、前屈、左屈、右屈度明显高于对照组(P0.05);观察组患者治疗后的颈椎疼痛减轻更明显,VAS、PPI、PRI评分显著降低(P0.05);观察组患者炎症状态、血管内皮功能改善优于对照组,血清中TNF-α、CGRP、ET-1水平低于对照组,NO水平高于对照组(P0.05)。结论:针药并用、理筋整复手法利于提高神经根型颈椎病患者的颈椎活动度,缓解颈椎痛感,其机制可能与干预血清中TNF-α、CGRP、ET-1、NO水平以减轻炎症反应、改善血管内皮功能有关,值得进行临床推广。     

筋痹方治疗神经根型颈椎病150例临床观察

目的观察筋痹方治疗神经根型颈椎病的临床疗效。方法对150例神经根型颈椎病病例给予筋痹方加减治疗,疗程28天,观察治疗前、治疗后和停药3个月患者症状、体征情况,并评价临床疗效。结果 150例病例中,痊愈58例,好转80例,无效12例,治愈率为38.67%,总有效率为92.00%。治疗前后比较,颈肩部疼痛与不适、上肢疼痛与麻木、手指麻木、工作和生活能力、椎间孔挤压试验及腱反射各项指标评分差异均有统计学意义(P<0.05,P<0.01);治疗后3个月随访与治疗前比较,各项指标差异均有统计学意义(P<0.05,P<0.01);治疗后3个月随访与治疗后比较,各项指标差异无统计学意义(P>0.05)。结论以内服筋痹方为主的中药治疗神经根型颈椎病具有良好的近期疗效。     

Acute neuropathies after peripheral blood stem cell and bone marrow transplantation

Neuromuscular complications are not uncommon after bone marrow and stem cell transplantation, especially in patients with allogeneic transplantations and graft-versus-host disease. The pathogenesis of these complications remains unclear, but the changes in immune modulation that occur after transplantation are likely to play a key role. We describe 4 patients who developed brachial plexopathy (3 cases) or multiple lumbosacral radiculopathies (1 case) between 5 days and 4 months after autologous peripheral blood stem cell (3 cases) or allogeneic bone marrow transplantation without evidence of graft-versus-host disease (1 case). Infectious, tumor-related, toxic, and metabolic causes were excluded in all cases. Recovery was limited in two cases and nearly complete in the other two patients. Brachial plexopathies and polyradiculopathies are potential complications of peripheral blood stem cell and bone marrow transplantation. It is possible that these disorders may be the result of autoimmune phenomena directed against specific nerve antigens.     

62例神经根型颈椎病临床表现与发病部位分析

目的:探讨神经根型颈椎病症状体征的发病基础。方法:回顾性分析62例神经根型颈椎病患者的临床症状、体征;比较临床表现与X线、MRI检查所示病变部位的关系。结果:88.7%患者表现为多组神经根支配区损害特征,MRI分析分别有61.3%和21.0%患者存在椎管外侧份和偏中央狭窄,MRI表现神经根在其骨性通道受压者仅占总病例17.7%。结论:椎间孔狭窄可能并非神经根型颈椎病唯一发病基础,椎管旁中央狭窄导致脊髓外侧份受压可能引发根性症状。     

犬腰骶神经根慢性压迫模型的建立及分子生物学分析

目的:制作犬腰骶神经根压迫的动物模型,进一步探讨神经根压迫造成的根性疼痛及麻木的治疗方法.方法:18只成年杂种犬,均为雄性,随机分成3组:7d组、14d组和28d组,每组6只.应用长5mm、直径3～4mm的硅胶管植入右侧L6、L7及S1神经根下面,造成压迫模型,左侧作为自身对照侧.结果:通过对压迫神经根及神经根节大体观、组织病理学和免疫组织化学的光学显微镜的动态观察,可见神经根压迫后其有髓神经纤维数目减少和超微结构的改变,如神经膜细胞胞质肿胀和细胞水肿、华勒变性、神经轴突脱髓鞘变等.结论:神经根超微结构的改变是神经根失功能的病理形态学基础,此模型更接近于腰椎间盘突出和椎间管狭窄对神经根的压迫,为临床神经根性疼痛及麻木治疗的研究建立了可供参考的动物模型.     

Nerve injury proximal or distal to the DRG induces similar spinal glial activation and selective cytokine expression but differential behavioral responses to pharmacologic treatment

The specific mechanisms by which nervous system injury becomes a chronic pain state remain undetermined. Historically, it has been believed that injuries proximal or distal to the dorsal root ganglion (DRG) produce distinct pathologies that manifest in different severity of symptoms. This study investigated the role of injury site relative to the DRG in (1) eliciting behavioral responses, (2) inducing spinal neuroimmune activation, and (3) responding to pharmacologic interventions. Rats received either an L5 spinal nerve transection distal to the DRG or an L5 nerve root injury proximal to the DRG. Comparative studies assessed behavioral nociceptive responses, spinal cytokine mRNA and protein expression, and glial activation after injury. In separate studies, intrathecal pharmacologic interventions by using selective cytokine antagonists (interleukin-1 [IL-1] receptor antagonist and soluble tumor necrosis factor [TNF] receptor) and a global immunosuppressant (leflunomide) were performed to determine their relative effectiveness in these injury paradigms. Behavioral responses assessed by mechanical allodynia and thermal hyperalgesia were almost identical in the two models of persistent pain, suggesting that behavioral testing may not be a sensitive measure of injury. Spinal IL-1beta, IL-6, IL-10, and TNF mRNA and IL-6 protein were significantly elevated in both injuries. The overall magnitude of expression and temporal patterns were similar in both models of injury. The degree of microglial and astrocytic activation in the L5 spinal cord was also similar for both injuries. In contrast, the pharmacologic treatments were more effective in alleviating mechanical allodynia for peripheral nerve injury than nerve root injury, suggesting that nerve root injury elicits a more robust, centrally mediated response than peripheral nerve injury. Overall, these data implicate alternate nociceptive mechanisms in these anatomically different injuries that are not distinguished by behavioral testing or the neuroimmune markers used in this study.     

Fibrillation potentials in paraspinal muscles in chronic lumbosacral radiculopathy

To assess the rate of fibrillation and/or positive sharp waves (FPSW) in the paraspinal muscles (PM) of patients with chronic lumbosacral radiculopathy, PM and leg muscles of 179 patients, 111 men and 68 women, aged 24-68 years (mean 49.0 +/- 9.3), were tested. Illness duration ranged from 8 months to 40 years (9.4 +/- 7.5 years). FPSW were detected in 38 patients (21.2%). In 28 of them (15.6%), FPSW were present in the limb muscles only, in eight (4.5%) in both PM and limb muscles, and in two (1.1%) solely in the PM. FPSW were accompanied in all the above patients by chronic neurogenic changes of motor unit potentials. Logistic regression analysis did not show any significant difference between: (i) the patients with and without fibrillations in leg and/or PM muscles, and (ii) between those with FPSW in both the PM and leg muscles and those with FPSW in the leg muscles only, when the effect of age and duration of illness were considered. These suggest that the paucity of FPSW in the PM is rather genuine and does not depend on the timing of the examination. In consequence, PM electromyography seems to be not as valuable in chronic radiculopathy as it is in the acute stage.