同侧颈7神经根选择性移位术治疗臂丛上干根性撕脱伤

目的 针对臂丛上干根性撕脱伤合并膈神经损伤病例,采用新的同侧颈_7神经根选择性束组移位方法,并证实其科学性、可行性与实用性,方法 自96年6月～99年2月,运用同侧颈_7神经根选择性束组移位术12例。其中臂丛上干撕脱伤10例,臂丛上干根性撕脱伤合并中干颈_7神经根部分损伤2例。全麻下行同侧选择性颈_7神经根前股前外侧份移位,直接与上干前股显微缝合。术后随访9例,并进行疗效评价。结果 7例颈_7神经根前股外侧份移位至上于前股有明显疗效,术后2月肌电检查证实有移位神经长入;术后4～7月即见肱二头肌恢复屈肘动作,而原颈_7神经根支配肌肉功能均无明显功能障碍。结论 同侧选择性颈_7神经根纤维束组移位不仅不影响颈_7神经根原有支配肌的运动功能,而且提供动力神经源,不失为一种新的切实可行的手术治疗方法。     

同侧颈7神经根选择性移位术后疗臂丛上干根性撕脱伤

目的：针对臂丛上干根性撕脱伤合并膈神经损伤病例,采用新的同侧颈7神经根选择性束组移位方法,并证实其科学性、可行性与实用性。方法：自96年6月－99年2月,运用同侧颈7神经根选择性束组移位术12例。其中臂丛上干撕脱伤10例,臂从上干根性撕脱伤合并中干颈7神经根部分损伤2例。全麻下行同侧选择性颈7神经根前股前外侧份移位,直接与上干前股显微缝合。术后随访9例,并进行疗效评价。结果：7例颈7神经根前段外侧份移位至上干前股有明显疗效,术后2月肌电检查证实有移位神经长入;术后4－7月即见肱二头肌恢复屈肘动作,而原颈7神经根支配肌肉功能均无明显功能障碍。结论：内侧选择性颈7神经根纤维束组移位不仅不影响颈7神经根原有支配肌的运动功能,而且提供动力神经源,不失为一种新的切实可行的手术治疗方法。     

臂丛颈7神经根支配主要代表肌的电生理研究

目的 通过电生理检测分析臂丛颈,神经根的主要代表肌.方法 选择16例臂丛神经根性撕脱伤行健侧颈7神经根移位的患者,术中采用电生理检测,对颈7神经根支配肌的波幅进行分析,确定颈7神经根的主要代表肌.结果 电生理检测表明背阔肌与肱三头肌长头均可较好地代表颈7神经根的功能.尤其是肱三头肌长头在所有16例患者的检测中,刺激颈7神经根所得复合肌肉动作电位(CMAP)波幅值均明显大于其余神经根所得波幅值;而背阔肌有4例(占25.0%),在刺激颈6神经根时所得CMAP波幅值与颈,神经根接近.结论 将肱三头肌长头、背阔肌作为定位颈,神经根的代表肌更具有合理性与科学性.     

肌皮神经肱肌肌支移位术的电生理研究

目的应用电生理技术研究肱肌肌支的神经根来源及探索肱肌肌支移位术的可行性和有效性。方法选择10名臂丛损伤作健侧C7移位术的患者,术中暴露正常的臂丛神经,用Reporter四道程肌电诱发电位仪,刺激C5~T1神经根,在肱肌记录诱发电位并计算其潜伏期及波幅。对1例肩外展、屈肘功能正常而手部无功能的C7脊髓损伤患者,在右侧上肢行肌皮神经肱肌肌支移位术,术中将肱肌肌支移至骨间前神经,以恢复手指屈曲功能。结果10名行健侧C7移位者术中刺激C5~C7均记录到复合肌肉动作电位(compoundmuscleactionpotential,CMAP),而刺激C8T1则无CMAP出现。C5~7CMAP的潜伏期为[(6.32±1.50)ms,x-±s,下同]、(6.51±1.36)ms和(6.99±1.33)ms,波幅为(2.81±3.17)mV、(3.01±3.20)mV和(1.55±1.99)mV。其中以C6的波幅最大,提示C6支配肱肌的纤维数可能最多,但经统计学处理,各神经根间的差异无统计学意义(P>0.05)。1例患者术后第2天检查屈肘功能正常,电生理检测肱二头肌为单纯相。术后1年半随访,术侧拇示指出现屈曲动作。结论肱肌同时接受来自C5~7神经纤维的支配,该肌支移位至C8T1为主支配的正中神经是可行及有效的。     

健侧C7 神经根经椎体前移位修复臂丛上干损伤的中期临床随访

目的 观察健侧C7 神经根经椎体前通路移位修复臂丛上干损伤重建肩外展、屈肘功能的中期效果.方法 健侧C7 神经根经椎体前通路移位修复臂丛上干损伤患者15例,男14例,女1例;年龄15～43岁,平均30岁.全臂丛撕脱伤7例,上、中干撕脱伴下干不全损伤6例,上、中干损伤2例.健侧C7 神经根经椎体前通路移位到患侧臂丛上干的距离平均(7.6±1.7)cm,8例同时行副神经或膈神经移位单独修复肩胛上神经.结果 随访36～63个月,平均50个月.健侧上肢用力内收时,12例患者的肱二头肌、三角肌、胸大肌锁骨部、冈上肌肌力(8例来自副神经或膈神经的支配)均达到4级,大脑皮层运动支配中枢发生临床转化;另3例肌力为3级或以下,尚未发生大脑皮层运动支配中枢的临床转化.健侧上肢用力内收时,8例肩胛上神经单独修复者的肩外展角度平均78.0°,另7例平均43.1..结论 健侧C7 神经根经椎体前通路移位可用于修复臂丛上千损伤,桥接神经的距离短,重建肩外展及屈肘功能的效果良好,大脑皮层运动支配中枢可发生临床转化.     

臂丛神经根性撕脱伤的治疗

神经移位术是治疗臂丛根性撕脱伤的主要方法。臂丛丛外移位神经包括肋间神经(Tsuyama1969)、副神经(Kotani1970)、颈丛运动支(Brunelli1977)、膈神经(顾玉东1970)、健侧颈7神经根(顾玉东1986)等。其中，健侧颈7根移位神经纤维数量最多，安全有效，已被国内外广泛应用。近年来，胸腔镜下超长切取膈神经，有效缩短了神经再生时间。对颈5、6根性撕脱伤，改良的Oberlin术式——臂丛丛内部分尺神经或正中神经移位修复肌皮神经肱二头肌支，手术简单，屈肘功能疗效肯定；同侧颈7根移位术有效且能恢复多组肌肉功能。对颈8胸1根性撕脱伤，肌皮神经肱肌肌支移位修复正中神经屈指肌束或骨间前神经以恢复屈指功能。对全臂丛根性撕脱伤，改良的Doi术式——双股薄肌移位联合神经移位较好恢复了手握持功能；肢体短缩，健侧颈7移位直接修复正中、尺神经，能恢复屈拇屈指功能，但手内肌功能仍无恢复。如何重建手内肌仍需作进一步探索。     

经椎体前路移位健侧颈7神经根修复臂丛上中干根性撕脱伤

目的探讨健侧颈7神经根经椎体前路移位，修复臂丛上、中干根性撕脱伤的最短通路及其安全性，并分析其应用指征和临床疗效。方法将颈部双侧前斜角肌切断，经椎体前、食管后间隙构制健侧颈，神经根移位通路，将颈7神经根自锁骨后股束交界处切断，近端游离至椎间孔，通过皮神经桥接或直接缝合修复患侧颈5、6神经根或上干前后股。2005年12月-2007年5月，对8例臂丛上、中干根性撕脱伤伴下干部分损伤，或合并副、膈神经损伤的患者进行修复。结果术后1周内，8例患者在咳嗽、进食时健侧手指有轻度麻木感，2～3周后症状逐步消失；体感诱发电位（豁口）在术后3个月时均能引出，7个月时能引出支配肌复合肌肉动作电位（CMAP）；术后12个月肩、肘功能部分恢复。结论切断双侧前斜角肌不仅可以缩短移植神经的长度，且健侧颈7神经根翻转通路更通畅、安全。直接修复或短段皮神经移植极大地缩短了神经再生的距离，利于患肢肩、肘功能的恢复。术后早期禁食可以减轻食道的组织创伤反应，利于颈7神经根缝合口的愈合。     

同侧颈7神经根移位术的临床应用

目的探讨同侧颈7神经根移位术治疗臂丛上干撕脱伤的有效性与安全性.方法 1998年2月至2000年9月,对4例颈5、6神经根节前损伤患者,采用同侧颈7神经根移位修复上干,其中2例同时将副神经移位至肩胛上神经.结果术后随访1 ～ 2年半,4例肱二肌肌力均恢复至M4.肩外展1例外展15°,1例45°,2例 > 90°.供区神经的支配肌,除短期内肌力下降1级外,均无明显功能障碍.结论臂丛上干损伤采用同侧颈7神经根移位是有效的、安全的手术方法.如系下干不全损伤时,使用该手术必需慎重.     

健侧颈7移位术后的远期功能随访

目的 随访全臂丛根性撕脱伤患者行健侧颈，移位术后远期功能恢复的情况，及该术式对健侧肢体的影响。方法 对28例行健侧颈，移位术的全臂丛损伤患者进行远期随访。其中健侧颈7移位于正中神经20例（一期手术2例，二期手术18例），桡神经3例，肌皮神经2例，同时移位于正中神经和桡神经2例，同时移位于正中神经和肌皮神经1例。随访内容：了解患肢受体神经所支配肌肉的肌力及其支配区域皮肤感觉恢复、电生理表现、双侧肢体协同活动和颈，神经根切断后对健侧肢体功能影响等情况。结果 术后28例患者远期随访发现，健侧肢体功能均无障碍。1．健侧颈7移位于正中神经：屈腕、指肌群电生理呈单纯相或单纯混合相10例（10／20），屈腕肌肌力达M3或以上者12例（12／20），屈指肌肌力达M1或以上者9例（9／20）；感觉恢复达S3或以上者10例（10／20）。2．健侧颈7移位于肌皮神经：屈肘肌群电生理呈单纯相或单纯混合相2例（2／2），屈肘肌肌力均达M3以上；前臂外侧皮肤感觉达S3或以上者l例（1／2）。3．健侧颈7移位于桡神经：伸腕、指肌群电生理呈单纯相或单纯混合相1例（1／3），伸腕肌力达M3或以上者2例（2／3），伸指肌力达M3或以上者1例（1／3）；感觉恢复达S3或以上者2例（2／3）。4．同时移位于正中神经和桡神经：屈腕肌肌力达M3或以上者2例（2／2），屈指肌肌力达M3或以上者1例（1／2）；正中神经支配区感觉均为S2。而桡神经支配区伸腕、指肌力仅为M2和‰，感觉均为S1。5．同时移位于正中神经和肌皮神经1例，其电生理均呈单纯相，屈腕肌和肱二头肌肌力均已达M3。28例中能自主活动患肢者仅为6例（6／28），22例需靠健侧肢体带动以活动患肢。结论 健侧颈，移位术是治疗全臂丛根性撕脱伤的理想术式，分期手术效果更好。如需同时修复2根神经，则应选择相互无拮抗作用的受体神经。     

臂丛损伤后神经移位寄养法预防失神经支配肌萎缩的实验研究

目的研究臂丛损伤后神经移位端侧缝合寄养法是否有预防失神经支配骨骼肌肌萎缩的作用。方法64只SD大鼠随机分成两组。对照组：切断肌皮神经，造成肱二头肌失神经支配。实验组：切断肌皮神经后，胸内侧神经分支移位与肌皮神经远端作端侧缝合寄养失神经支配的肱二头肌。术后2、4、6、8周观察大鼠的行为变化与肱二头肌的萎缩程度，检测肱二头肌肌肉纤颤电位或再生电位、肱二头肌肌肉湿重、肌纤维截面积和Na-K-ATP酶活性。以左侧为实验侧，右侧为自身对照侧，将左侧测量值除以右侧测量值，求各观察值恢复率，比较组间各观察值的恢复率。结果术后对照组随着失神经时间延长，肌肉萎缩程度逐渐加重，屈肘功能不能恢复，纤颤电位波幅逐渐下降，肌肉湿重、肌纤维截面积和酶的活性均逐渐下降；而实验组随着神经寄养时间的延长，肌肉萎缩程度逐渐减轻，屈肘功能逐渐恢复，出现再生电位，肌肉湿重、肌纤维截面积逐渐增加，酶活性逐渐升高，虽不及正常组，但明显不同于肌肉萎缩严重的失神经组。结论神经移位端侧缝合寄养法可以有效地预防失神经支配骨骼肌肌萎缩。     

不同上肢体位对正常人和青少年特发性脊柱侧凸患者站立位脊柱矢状面形态的影响

目的 探讨不同上肢体位时,脊柱侧位片上脊柱区域和整体的形态变化,并确定上肢何种体位能更正确地反映脊柱的矢状位形态.方法 研究对象包括特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)胸弯患者21例和正常青少年志愿者13名.均摄站立位脊柱全长正位X线片及上肢平举及上肢抱胸两种体位的侧位X线片.侧位X线片上测量的参数指标包括:(1)线性距离指标.T1与C-铅垂线(C7 plumb line,C7PL)的距离、胸椎后凸顶点与C7PL的距离、L1与C7PL的距离、腰椎前凸顶点与C7PL的距离、骶骨后上缘与C7PL的距离(SVA);(2)区域前凸及后凸角度的指标.T2～5、T5～12、T10～L2、T1～12、L1～S1、上胸椎后凸(T1上缘与水平线的夹角)、下胸椎后凸(T12下缘与水平线的夹角)、上腰椎前凸(L1上缘与水平线的夹角)、下腰椎前凸(S1上缘与水平线的夹角);(3)骨盆的形态参数:骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、骨盆投射角(pelvic incidence,PI).分别对AIS组及正常组就不同上肢体位时参数的测量结果进行配对t检验.结果 当上肢平举时,AIS组及正常组的腰椎前凸顶点与C7PL的距离、SVA及上胸椎后凸角度均小于上肢抱胸时的测量结果,下胸椎后凸角度及上腰椎前凸角度大于上肢抱胸时的测量结果;另外当上肢平举时,AIS组的腰椎前凸(L1-S1)较上肢抱胸时增大,胸椎后凸顶点与C7PL的距离、L1与C7PL的距离较上肢抱胸减小.结论 双上肢抱胸体位可以更好地反映生理状况下脊柱的矢状面形态.     

C7 sagittal vertical axis is the determinant of the C5–C7 angle in cervical sagittal alignment

Background Context

Previous studies have indicated that the T1 slope correlates with cervical lordosis. In contrast, the specific impact of the C7 sagittal vertical axis (C7SVA) on cervical lordosis remains unknown.

人工心脏瓣膜替换术后瓣周漏18例

人工心脏瓣膜替换术后瓣周漏是一种严重并发症。我们报告２２９２例植入２５７５枚人工心脏瓣膜，发生瓣周漏者１３例，发生率为０．５１％（１３／２５７５）。外院术后瓣周漏转入我院者５例。１５例中再次手术，单纯修补５例，重新换瓣１０例。本组死亡５例。另３例瓣周漏因心功能尚好，暂未手术。     

Biomechanical comparison of single- and two-level cervical arthroplasty versus arthrodesis: effect on adjacent-level spinal kinematics

Background ContextThe use of motion-preserving spinal implants versus conventional arthrodesis instrumentation systems, which stabilize operative segments, necessitates improved understanding of their effect on spinal kinematics and the biomechanically optimal method for surgical reconstruction.PurposeThe primary objective of this study was to measure operative- and adjacent-level kinematics after single- and two-level cervical arthroplasty and compare them with those after anterior cervical arthrodesis. A secondary objective was to locate the centers of intervertebral rotation at the operative and adjacent levels after arthroplasty and compare them to those after arthrodesis.Study DesignThis biomechanical study used an in vitro human cadaveric model to compare the multidirectional flexibility kinematics of single- versus two-level cervical disc arthroplasty reconstructions.MethodsEight cadaveric cervical spines (C2–T2) were biomechanically evaluated between Levels C4 and T1 in the intact condition and under the following reconstructions: single-level arthroplasty (C6–C7) using porous coated motion (PCM) device; single-level arthrodesis (C6–C7) using interbody cage with anterior plate; two-level arthroplasty (C5–C7) using PCM devices; two-level hybrid treatment of arthroplasty (C5–C6) using PCM device and arthrodesis (C6–C7) using cage/plate; and two-level arthrodesis (C5–C7) using cage/plate. Multidirectional flexibility testing used the Panjabi hybrid testing protocol, including pure moments for the intact condition with overall spinal motion replicated under displacement control for subsequent reconstructions. Unconstrained intact moments of ±3.0 Nm were used for axial rotation, flexion-extension, and lateral bending testing with quantification of the operative- and adjacent-level range of motion (ROM) and neutral zone. The calculated centers of intervertebral rotation were compared for all intervertebral levels under flexion-extension conditions.ResultsAxial rotation loading demonstrated a significant decrease in the C6–C7 ROM for the single-level arthrodesis group compared with the intact spine and the single-level arthroplasty group (p<.05). No differences were observed between the intact and single-level arthroplasty groups (p>.05). For the two-level hybrid treatment group, the C5–C6 ROM significantly increased compared with the intact, single-level arthroplasty, and two-level arthrodesis groups (p<.05). Moreover, a significant increase was observed in the adjacent-level (C7–T1) ROM for the two-level arthrodesis group compared with all other treatment groups (p<.05). Under flexion-extension, no differences were observed in C6–C7 ROM between the intact spine and single-level arthroplasty groups (p>.05). However, as expected, the single-level arthrodesis and two-level hybrid treatment groups demonstrated a decreased ROM at C6–C7 versus the intact spine and arthroplasty treatments (p<.05). In terms of adjacent-level effects, two-level arthrodesis (C5–C7) led to increased ROM in the inferior level (C7–T1) in axial rotation and flexion-extension compared with the intact spine and all other treatment groups (p<0.05). Lateral bending loading conditions demonstrated no significant difference among the treatment groups (p>.05). In flexion-extension, the centers of intervertebral rotation for the intact spine and single-level arthroplasty groups were localized in the central to posterior one-third of the inferior vertebral body for each motion segment: C5–C6, C6–C7, and C7–T1. The single-level arthrodesis group produced more diffuse centers of rotation, particularly at the operative (C6–C7) and inferior adjacent levels (C7–T1).ConclusionsThis study highlights the biomechanical effects of single- and two-level cervical arthroplasty versus single- and two-level arthrodesis on four functional spinal levels (C4–T1). Operative-level ROM was preserved with single- and two-level arthroplasty under all loading modes. The distal adjacent level (C7–T1) demonstrated the greatest increase among the four levels in ROM compared with the intact condition after two-level arthrodesis. These kinematic findings were corroborated by changes in the adjacent-level centers of rotation after arthrodesis and may suggest a biomechanical cause of adjacent-level disease secondary to cervical arthrodesis.     

Constituent ratio of motor fibers from the C5-C7 spinal nerves in the radial nerve is greater in pup rats than in adult rats

Clinically, injuries of C5-C7 of the brachial plexus cause falling of the wrist and fingers in infants but not in adults unless 4 consecutive spinal nerves are injured. The purpose of this study was to compare the constituent difference of spinal nerves in the radial nerve between pup and adult rats.A group of 16 pup rats and a group of 16 adult rats were each divided into 2 groups of 8 (P1 and A1 groups, C5-C6 were divided; P2 and A2 groups, C5-C7 were divided]). A nerve conduction study and histological examination were performed to evaluate radial nerve innervation to the extensor digitorum communis muscle after dividing the spinal nerves. Retrograde tracing with 5% cholera toxin B for anterior horn motoneurons of the spinal cord innervating the radial nerve was performed in 8 pup rats and 8 adult rats. Results showed that the division of C5-C7 caused more significant damage to radial nerve innervation to the extensor digitorum communis in pups than in adults, although the division of C5-C6 did not. In pups, the percentages (median with interquartile) of anterior horn motoneurons of the spinal cord innervating the radial nerve were 36.4 (28.3-38.5) in C5-C6, 28.1 (24.5-32.5) in C7, and 37.5 (36.5-39.3) in C8-T1. In adults, they were 24.2 (23.6-27.8) in C5-C6, 21.8 (19.5-26.3) in C7, and 50.7 (48.7-55.5) C8-T1.This study implies that C7 innervation in the radial nerve in humans may be more critical to the function of this nerve in infants than in adults.     

Induction of specific unresponsiveness (tolerance) to skin allografts by intrathymic donor-specific splenocyte injection in antilymphocyte serum-treated mice.

Although chronic immunosuppression has been extremely successful in clinical organ transplantation, it is associated with severe complications such as opportunistic infections, spontaneous neoplasms, drug toxicities, metabolic complications, and the inability to control rejection. We therefore have investigated the ability of allogeneic donor lymphoid cells to produce specific tolerance following intrathymic (IT) injection into allograft recipients. Groups of B6AF1 mice received ALS on days -1 and +2 relative to C3H/He skin grafts on day 0; experimental groups received 1, 5, or 10 x 10(7) syngeneic (B6AF1) or allogeneic (C3H) spleen cells (SPCs) by IT injection on day +7. IT injection of C3H splenocytes significantly prolonged allograft survival at all cell doses tested when compared with ALS controls. The best survival was obtained following IT injection of 5 x 10(7) C3H cells (median survival time [MST] = 132 days; ALS controls = 21.5 days), with 8 of 13 skin grafts surviving longer than 100 days. IT injection of syngeneic splenocytes or third-party DBA/2 splenocytes did not prolong allograft survival beyond that observed in ALS controls. C3H spleen cells injected IT into ALS treated mice on day 0 relative to grafting of C3H skin also produced significant allograft survival (1, 5, or 10 x 10(7) SPCs = MSTs of 75, 47, and 35, respectively) but the results were inferior to those obtained by 5 x 10(7) SPCs IT on day +7. Spleen cells (1 or 5 x 10(7)) injected intraperitoneally or intravenously prolonged allograft survival beyond that seen in ALS controls but were inferior to IT injection at all doses and times studied. Bone marrow, thymocytes, or lymph node cells (5 x 10(7) cells) were substituted for SPCs for IT injection. IT injection of BM, LN or thymocytes all significantly prolonged graft survival over ALS controls. However none of these cell types was as effective as IT splenocytes. Eight B6Af1 recipients of IT splenocytes bearing C3H skin grafts for > 100 days received a second C3H skin graft as well as a simultaneous third-party B10.AKM skin graft. All rejected third-party grafts in normal first-set fashion. Three tolerated both 1st and 2nd C3H grafts without any sign of rejection; 1 rejected the 2nd C3H graft while tolerating the 1st graft; and 4 rejected the 2nd C3H graft in an attenuated fashion but also rejected the 1st graft at the same pace.(ABSTRACT TRUNCATED AT 400 WORDS)     

大鼠窒息性心跳停止复苏后脑缺血损伤模型的建立

目的建立稳定的窒息性心跳停止复苏后脑缺血损伤大鼠模型。方法 72只健康雄性SD大鼠随机均分为六组:假手术组(S组)和窒息组(C5、C6、C7、C8和C9组)。C5、C6、C7、C8、C9组分别在窒息5、6、7、8、9min后进行心肺复苏。记录各窒息组窒息到停循环时间、循环停止时间、自主循环恢复时间、复苏成功率、复苏后生命体征变化、神经功能缺损评分。复苏后第9天,观察海马CA1区神经元存活情况。结果窒息组均发生了循环停止,随着窒息时间延长,循环停止时间与自主循环恢复时间逐渐延长;C5组大鼠全部存活,C6、C7、C8和C9组大鼠复苏成功率分别为91.7%、83.3%、75.0%和33.3%,C9组复苏成功率低于其他各组(P<0.05);C5、C6、C7组复苏后各时点神经功能缺损评分高于C8和C9组(P<0.05)。复苏后第9天,与S组比较,C5、C6组海马CA1区神经元损伤不明显,C7组有少量神经元坏死,C8组和C9组大量神经元坏死(P<0.01)。结论窒息8min后进行心肺复苏能够建立稳定的脑损伤模型。     

Effectiveness of multiple-level decompression in laminoplasty and simultaneous C1 laminectomy for patients with cervical myelopathy

A retrospective study to investigate the relationship between the surgical levels and decompression effects was performed in patients with cervical myelopathy who had undergone Tension-band laminoplasty (TBL) with/without simultaneous C1 laminectomy. One hundred and sixty-eight patients (115 males, 53 females; age: 31–80 years, average 58.9 years; follow-up period: 12–120 months, average 20 months) were divided into three groups according to the range of the surgical levels: seventy-two patients in group A underwent TBL at the C2–C7 levels with C1 laminectomy; 60 patients in group B underwent TBL at the C2–C7 levels; 36 patients in group C underwent TBL at the C3–C7 levels. Neurological evaluation was performed by using the Japanese Orthopedic Association (JOA) scoring system. The alignment changes of the spinal column and the spinal cord were analyzed using pre- and post-operative roentgenograms and MRIs. The differences in the pre- and post-operative anterior subarachnoid spaces (D-ASAS), the spinal cord diameters (D-CORD), and the dural sleeve diameters (D-DURA) at the C1–C7 levels were also analyzed by using MRIs. The JOA scores improved in all groups. As for the spinal alignment, neither significant changes between pre- and post-operation in any group nor significant differences among the three groups were found. The lordosis of the cervical spinal cord was decreased in all groups. D-ASAS of group A was larger than that of group B at the C1–C5 levels (P<0.05), as were those of D-CORD and D-DURA at the C1–C2 and C4–C5 levels (P<0.05). D-ASAS of group A was larger than that of group C at the C1–C4 levels (P<0.05), as were those of D-CORD and D-DURA at the C1–C5 levels (P<0.05). In conclusion, laminoplasty including the C2–C7 levels with simultaneous C1 laminectomy was proven to allow the most posterior shift of the spinal cord within the widened dural sleeve at C5 or higher levels without significantly changing the spinal alignment.     

Advantages of cyclosporin A using 2-h levels in pediatric kidney transplantation

Clinical trials in adult liver and heart recipients have shown that management of cyclosporine (CsA) dose with 2-h levels (C2) leads to lower rejection rates and serum creatinine levels compared with C0 monitoring. Therefore, we investigated whether C2 monitoring might also improve late graft survival after kidney transplantation in children. To date, no results in adult renal transplantation and in pediatric transplantation have been published. Forty-nine stable pediatric kidney recipients with a minimum time of 1 year after transplantation (mean=7±5 years) entered the study. None of the patients had experienced an acute rejection up to 6 months before entering the study. CsA dosing was based on C0 monitoring for the first 6 months and then based on C2 monitoring for the following 6 months. C0 and C2 levels were measured at 4-weekly intervals. Percentage decline in glomerular filtration rate (GFR) and mean coefficients of variation of CsA levels (C_var) were calculated and compared during the 6-months periods. At the beginning of the study, the mean calculated GFR was 53±15 ml/min per 1.73 m². During the 6 months of C0 monitoring, the mean GFR decreased to 49±12 m/min per 1.73 m² (P=0.001, paired t-test). Six months after switching to C2 monitoring, the mean GFR remained stable, at 49±15 ml/min per 1.73 m² (P=0.3 paired t-test). The largest increase in GFR (3.9±7.9%) was found in patients with a decrease of their CsA dose of more than 5% under C2 monitoring. C_var was significantly lower under C2 than under C0 monitoring (0.24±0.10 vs. 0.30±0.15, P=0.02, unpaired t-test). We conclude that the switch to C2 monitoring helped to identify patients with CsA overdosing as well as to reduce variation in CsA level, which resulted in a halt in GFR decline.     

臂丛神经根对手指感觉的支配

目的探讨臂丛神经根对手指感觉的支配,为临床诊断臂丛神经根损伤提供依据。方法2003年6月～2005年1月,收治全臂丛神经根性撕脱伤患者10例,男8例,女2例;年龄18～47岁。受伤至就诊时间为2～8个月。均行健侧C7神经根移位术,术中行电生理检查。指环电极置于手指,依次在颈部各臂丛神经根记录,测定感觉动作电位潜伏期和波幅。结果刺激拇、食指,臂丛各神经根均可引出感觉动作电位,C5-7神经根引出的感觉动作电位潜伏期短于C8、T1神经根,波幅大于C8、T1神经根,差异有统计学意义（P〈0.05）;刺激中指,C7、8、T1神经根可引出感觉动作电位,C7神经根引出的感觉动作电位潜伏期短于C8、T1神经根,波幅大于C8、T1神经根,差异有统计学意义（P〈0.01）;刺激环指,C8、T1神经根引出的感觉动作电位潜伏期短于C7神经根,波幅大于C7神经根,差异有统计学意义（P〈0.01）;刺激小指,T1神经根引出的感觉动作电位潜伏期短于C7、8神经根,波幅大于C7、8神经根,差异有统计学意义（P〈0.01）。结论臂丛神经根对手指感觉的支配存在交叉,拇、食指主要由C5-7神经根支配;中指的感觉支配较多来自C7神经根;环指的感觉支配主要来自C8、T1神经根;小指的感觉支配主要来自T1神经根。