用颈长肌重建预防颈前路植骨块滑脱的临床应用

目的:探讨颈长肌重建对颈椎前路手术并发症的预防作用。方法:将颈椎病确诊病例分为实验组126例和对照组128例。对照组病例采用颈椎前路减压、植骨和/或钢板内固定术。实验组病例在完成上述手术之后,利用两种方法使颈长肌瓣重建植骨块或钢板表面。两组病例术后均获得随访,并将两组术后疗效及手术并发症的随访结果进行统计学分析。结果:两组术后随访0.5~6年,平均3.5年。根据Odom评分标准,对两组术后临床疗效进行评价,经统计学分析,P>0.05,说明两组术后疗效无明显差异。而对两组病例术后并发症的统计学分析,P<0.05,两组有统计学意义,表明颈长肌重建可以减少术后并发症的发生。结论:颈长肌重建是预防颈椎前路手术并发症的一种有效方法。     

A biochemical and pharmacological examination of Rhamphiophis oxyrhynchus (Rufous beaked snake) venom.

The venom of R. oxyrhynchus, a member of the psammophiine subfamily of the colubrid assemblage, was examined for biological activity using biochemical and pharmacological techniques. Venom displayed a high protein content, a complex electrophorectic profile and PLA2 activity but no detectable proteolytic or haematological activities. In the chick biventer cervicis nerve muscle preparation, venom (1-10 microg/ml) displayed postsynaptic neurotoxic activity as evidenced by inhibition of indirect (0.1 Hz, 0.2 ms, supramaximal V) twitches and responses to exogenous acetylcholine (1 mM) and carbachol (20 microM). This inhibitory effect was poorly reversible by washing. Venom (30-50 microg/ml) caused a rapid and readily reversible inhibition of direct (0.1 Hz, 2 ms, supramaximal V) twitches of the chick biventer cervicis nerve muscle preparation without morphological changes to the muscle fibers. Venom (30-100 microg/ml) inhibited electrically-evoked (0.2 Hz, 0.3 ms, 70-100 V) twitches of the prostatic segment of the rat vas deferens. This inhibitory effect was not significantly attenuated by 8-phenyltheophylline (8-PT; 20 microM), idazoxan (1 microM), a combination of ranitidine (0.2 microM) and thioperamide (10 microM) or capsazepine (10 microM). Venom (5 mg/kg) induced hypotension with subsequent cardiovascular collapse in the anaesthetised rat. The cardiovascular collapse was prevented by artificial respiration of the animals prior to venom administration. The biological activities demonstrated by R. oxyrhynchus venom may aid in prey envenomation strategies such as prey immobilisation. This study provides further evidence that colubrid venoms are comprised of multiple components which can display a variety of actions, some of which may be novel, therefore reinforcing the largely untapped potential of colubrid venoms.     

Pharmacological evidence for a presynaptic action of venoms from Bothrops insularis (jararaca ilhoa) and Bothrops neuwiedi (jararaca pintada).

Whereas the presynaptic action of Crotalus durissus terrificus venom is well-established, Bothrops venoms have historically been considered to have only postsynaptic and muscular effects. However, some studies have also suggested a presynaptic action for these venoms. In this work, we used chick biventer cervicis preparations to compare the presynaptic actions of two Bothrops venoms (B. insularis and B. neuwiedi) with that of C. d. terrificus venom. At 10 microg/ml, all venoms produced irreversible blockade of the twitch tension responses, with no reduction in acetylcholine (ACh)-induced contractures and only a slight decrease in potassium induced-contractures. The times (in min) required to produce 50% neuromuscular blockade (C. d. terrificus: 16.3+/-0.7, n = 8; B. insularis: 30.0+/-1.9, n = 5; B. neuwiedi: 42.0+/-2.0, n = 8; mean +/- SEM) were significantly different among the venoms (p < 0.01). Lowering the temperature at which the experiments were done (from 37 to 24 degrees C) prevented neuromuscular blockade by the three venoms, indicating that enzyme activity may be involved in this response. At concentrations capable of causing complete neuromuscular blockade, creatine kinase release remained close to levels seen in control preparations incubated with Krebs solution alone (500-1200 IU/l). Commercial crotalic antivenom, but not bothropic antivenom, protected against the neuromuscular blockade caused by B. insularis and B. neuwiedi venoms. These observations indicate that bothropic venoms may contain components which act presynaptically in a manner similar to C. d. terrificus venom, and that at low venom concentrations a direct action on skeletal muscle does not contribute to this presynaptic neurotoxicity.     

改良颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病

目的:总结保留颈半棘肌肌止、C3椎板切除、C4～C7“锚定”单开门椎管扩大成形术治疗多节段脊髓型颈椎病的临床效果.方法:2009年1月～2011年10月,共对74例多节段脊髓型颈椎病患者采用保留颈半棘肌肌止、C3椎板切除、“锚定法”固定悬吊C4～C7椎板的单开门椎管扩大成形术治疗,其中57例患者获得随访,男31例,女26例,年龄50～71岁,平均63岁.术前JOA评分4～11分,平均8.5±2.0分,颈椎活动度23°～49°,平均37.4°±10.3°,颈椎曲度指数6.0％～22.0％,平均(13.9±7.4)％.观察患者术中和术后并发症发生情况;术后6个月复查颈椎X线片,测量颈椎曲度指数和颈椎活动度,观察颈椎曲度指数和颈椎活动度变化情况;末次随访时对患者神经功能进行JOA评分,计算神经功能改善率 结果:手术均顺利完成,手术时间50～110min,平均70min.术中出血150～600ml,平均230ml.术中无脊髓损伤、脑脊液漏等并发症发生.术后早期41例患者有颈痛,给予消炎镇痛治疗,术后3周内疼痛消失或明显缓解2例出现切口感染,经抗感染治疗并再次清创后切口延时愈合.9例有明显轴性症状,发生率为15.8％;6例出现C5神经根麻痹,给予甲基强的松龙、营养神经药物等治疗后症状明显缓解.随访6～32个月,平均13个月,术后6个月颈椎曲度指数为4.2％～21.1％,平均(11.3±8.1)％,较术前丢失(2.9±2.4)％;颈椎活动度为18°～46°,平均28.2°±10.8°,平均丢失8.2°±5.1°.患者神经功能均不同程度得到改善,末次随访时JOA评分为10～17分,平均13.8±2.3分,较术前明显提高(P＜0.05),神经功能改善率为29.0％～77.3％,平均(57.0±19.7)％.末次随访均未发现“再关门”现象.结论:保留颈半棘肌肌止、C3椎板切除、“锚定法”固定悬吊C4～C7椎板的单开门椎管扩大成形术可明显改善多节段脊髓型颈椎病患者的神经功能,手术操作简单,临床疗效满意.     

子宫颈癌介入治疗的价值初探

目的探讨经导管子宫动脉灌注化疗并栓塞治疗子宫颈癌的临床价值。方法研究对象为40例Ib2-Ⅲa期子宫颈癌患者，化疗药物为DDP30mg、5-Fu0．75g、ADM30mg。采用Seldinger技术穿刺右股动脉，作超选择性子宫动脉灌注化疗并栓塞。结果总有效率为87．5％。28例患者在治疗后进行了子宫根治术＋盆腔淋巴结清扫术。术中出血减少，手术时间缩短。结论经导管子宫动脉灌注化疗并栓塞治疗可为巨块型子宫颈癌及邻近有浸润的不能手术的大部分子宫颈癌患者行子宫根治术创造条件，并降低手术难度。     

金环蛇毒的分离及组分Ⅸ的初步研究

从金环蛇毒中分离到一个神经毒—组分Ⅸ。该组分阻断小鸡颈二腹肌神经肌肉接头传递;阻断标本对乙酰胆碱的反应,标本对直接电刺激以及对高浓度钾离子的反应性仍然存在;组分Ⅸ使蛙缝匠肌终板电位,微终板电位振幅逐渐减小,最后完全消失;但不影响微终板电位的发放频率,也不影响肌纤维的静息膜电位。实验表明组分Ⅸ是作用于突触后膜的神经毒。     

Interaction of verapamil with d-tubocurarine and cholinergic agonists at the avian neuromuscular junction

The effect of verapamil on neuromuscular transmission and muscle contraction was studied in the skeletal muscle of chick in vitro. The interactions of verapamil with d-tubocurarine (d-TC)-induced neuromuscular blockade, acetylcholine (ACh) and tetraethylammonium (TEA)-induced contractures were also studied. The purpose of the present investigation was to see if verapamil: intensified the neuromuscular blockade produced by d-TC; modified the cholinergic responses to ACh, TEA; and inhibited both directly and indirectly elicited twitch contractions. The results showed that verapamil (1-100 micrograms/ml, 2-200 mumol/l) had a neuromuscular blocking activity on its own; i.e. it reduced both directly and indirectly evoked twitch contractions, and intensified the neuromuscular blockade produced by d-TC. In addition, verapamil reduced the contractures produced by ACh and TEA in the chick muscle. The results are in favour of the possibility that verapamil acts by a mixture of pre- and post-junctional effects at the chick neuromuscular junction.     

Solving the 'Brown snake paradox': in vitro characterisation of Australasian snake presynaptic neurotoxin activity

Pseudonaja textilis (Eastern Brown snake) and Oxyuranus scutellatus scutellatus (Coastal taipan) are clinically important Australian elapid snakes, whose potent venoms contain the presynaptic (β) neurotoxins, textilotoxin and taipoxin, respectively, and a number of postsynaptic neurotoxins. However, while taipan envenoming frequently results in neurotoxicity, Brown snake envenoming causes an isolated coagulopathy and neurotoxicity is rare. This phenomenon is called the 'Brown snake paradox'. This study compared the pharmacology of both venoms and their respective presynaptic neurotoxins to investigate this phenomenon. From size-exclusion high performance liquid chromatography (HPLC) analysis textilotoxin represents a significantly smaller proportion (5.7%) of P. textilis venom compared to taipoxin in O. s. scutellatus venom (20.4%). In the chick biventer cervicis nerve-muscle (CBCNM) preparation both venoms caused concentration-dependent neurotoxicity, with P. textilis venom being significantly more potent than O. s. scutellatus venom. Conversely, taipoxin was significantly more potent than textilotoxin when compared at the same concentration. Textilotoxin only partially contributed to the overall neurotoxicity of P. textilis venom, while taipoxin accounted for the majority of the neurotoxicity of O. s. scutellatus venom in the CBCNM preparation. Compared with taipoxin, textilotoxin is less potent and constitutes a smaller proportion of the venom. This is likely to be the reason for the absence of neurotoxicity in envenomed humans thus explaining the 'Brown snake paradox'.     

The effects of lignocaine on actions of the venom from the yellow scorpion “Leiurus quinquestriatus” in vivo and in vitro

Fatani, A.J., Harvey, A.L., Furman, B.L., and Rowan, E.G. The effects of lignocaine on actions of the venom from the yellow scorpion, Leiurus quinquestriatus, in vivo and in vitro. Toxicon, 19. Many toxins from scorpion venoms activate sodium channels, thereby enhancing neurotransmitter release. The aim of the present work was to determine if the in vivo and in vitro effects of Leiurus quinquestriatus venom (LQQ) could be ameliorated by lignocaine, a sodium channel blocker. In urethane anaesthetised rabbits, LQQ venom (0.5 mg kg⁻¹, i.v.) caused initial hypotension and bradycardia followed by hypertension, pulmonary oedema, electrocardiographic changes indicating conduction defects, ischaemia, infarction, and then hypotension and death. Lignocaine (1 mg kg⁻¹ i.v. bolus initially, followed by i.v. infusion of 50 μg kg⁻¹ min⁻¹) significantly attenuated the majority of the venom-evoked effects and reduced mortality. Addition of LQQ venom (1, 3 and 10 μg ml⁻¹) to chick biventer cervicis, guinea pig ileum, and rat vas deferens preparations, increased the height of electrically-induced twitches, elevated resting tension, and caused autorhythmic oscillations. Lignocaine (3 × 10⁻⁴–1.2 × 10⁻³ M) greatly attenuated these venom-evoked actions in the three preparations. Antagonists of appropriate neurotransmitters were also tested to determine the contribution of released transmitters to LQQ effects. Atropine significantly decreased the venom-elicited effects on guinea pig ileum preparations, while prazosin and guanethidine significantly reduced the venom’s actions on rat vas deferens. In chick biventer cervicis preparations, tubocurarine and hexamethonium significantly attenuated the venom-induced effects. This study supports the hypothesis that many effects of LQQ venom involve the release of neurotransmitters and may be ameliorated by treatment with lignocaine.     

Study of the mandibulo-stylohyoid ligament

The mandibulo-stylohyoid ligament is a consistent large ligament that extends from the angle of the mandible to the stylohyoid ligament, with prolongations in the direction of the stylohyoid, posterior belly of the digastric and sternocleidomastoid muscles. The ligament partly separates the submandibular from the parotid gland. It is believed that this ligament should be included in anatomy textbooks, as it is important in both the clinical and surgical anatomic fields.