肩胛上神经肩关节支阻滞治疗肩关节周围炎

目的：探讨肩胛上神经肩关节支阻滞治疗肩关节周围炎的效果。方法：肩关节周围炎３８例４１ 肩,于肩胛上神经主干的外侧１．５ｃｍ 处,用利多卡因和醋酸曲安奈德的混合液对肩胛上神经肩关节支进行阻滞,每肩治疗１～２ 个疗程。结果：经６～２４ 个月（平均１１ 个月）的随访,患肩疼痛减轻、日常功能改善、运动范围增加,与治疗前的差异均有非常显著性意义（Ｐ＜ ０．００１）。患肩前屈、上举、外展、内旋与正常参考值间相差均无显著性意义（Ｐ＞ ０．０５）。无明显并发症。结论：肩胛上神经肩关节支阻滞是治疗肩关节周围炎较为安全有效的方法。     

超声引导肩胛上神经阻滞联合盂肱关节类固醇注射治疗粘连性肩关节囊炎

目的观察超声引导肩胛上神经阻滞联合盂肱关节类固醇注射治疗粘连性肩关节囊炎效果。方法将60例粘连性肩关节囊炎患者随机均分为研究组和对照组。对研究组在常规康复治疗基础上予超声引导肩胛上神经阻滞联合盂肱关节类固醇注射,对照组给予常规康复治疗。于治疗前、治疗2周和4周后评估视觉模拟评分(VAS)、Constant肩关节评分(CSS)和肩部活动范围。结果研究组治疗2周和4周后VAS和CSS较治疗前降低(P均0.01),且均低于对照组同期(P均0.01);2周和4周后肩部前屈、外展、内旋和外旋活动范围均较治疗前增加(P均0.01),且除治疗2周后外旋活动范围外均优于对照组(P均0.01)。治疗后3、6个月,研究组疼痛症状复发率均低于对照组(P均0.05)。结论超声引导肩胛上神经阻滞联合盂肱关节类固醇注射可提高粘连性肩关节囊炎康复治疗效果,减少复发。     

肩胛上神经阻滞结合关节腔注射玻璃酸钠治疗肩周炎的疗效

目的 观察肩胛上神经阻滞结合关节腔内注射玻璃酸钠治疗顽固性肩周炎的治疗效果.方法 肩周炎患者208例,经抽签分组为治疗组(n=108)和对照组(n=100).治疗组行肩胛上神经阻滞结合关节腔注射玻璃酸钠治疗,每7天1次,3次为1个疗程;对照组采用痛点注射结合关节腔注射玻璃酸钠治疗,每7天1次.3次为1个疗程.结果 治疗组的痊愈卒和显效率分别为69%和25%,明显高于对照组的61%和20%(P＜0.05).结论 肩胛上神经阻滞结合关节腔注射玻璃酸钠治疗肩周炎,疗效优于常规治疗方法,安全性高,无任何不良反应.     

肩部撞击症合并肩胛上神经卡压综合征诊疗分析

<正>肩部撞击症是一种常见病和多发病,诊断和治疗并无困难[1],但少数病人同时合并有肩胛上神经卡压综合征。因肩部撞击症的症状和体征可能掩盖肩胛上神经卡压综合征的临床表现,故给确切诊断带来一定难度,单纯治疗肩部撞击症使效果不理想。笔者于2001年9月～2009年3月,共收治6例此类患者,取得满意疗效,现报告如下。     

手术治疗创伤致神经源性单纯肩外展功能障碍

 目的 探讨手术治疗肩部创伤致肩胛上神经与腋神经同时损伤的疗效。方法 回顾性分析2003年7月至2011年9月,手术治疗13例男性肩部创伤后诊断为肩胛上神经与腋神经同时损伤的患者资料,年龄8~59岁,平均28 岁;受伤至手术时间为2~7个月,平均3.7个月。其中肩胛颈和锁骨同时骨折2例,浮肩损伤3例,肱骨颈及关节盂骨折1例,锁骨骨折3例,肩峰骨折1例,肩胛骨骨折2例,寰枢椎骨折1例。13例临床检查均示单纯肩外展、外旋功能完全丧失,三角肌及冈上、下肌肌力均为0级。电生理检查示腋神经、肩胛上神经完全失神经支配。肩胛上神经断裂10例,其中6例通过1股腓肠神经移植修复,1例通过1股颈丛浅支移植修复,3例因远端撕脱而放弃神经修复;另3例肩胛上神经仅进行松解。腋神经断裂12例,其中10例采用2~3股腓肠神经移植修复,2例采用正中神经束支移位修复;另1例腋神经于四边孔处进行松解。13例患者中,10例患者的肩胛上神经及腋神经同时断裂。结果 13例患者随访时间36~134个月,平均85个月;7例肩关节上举恢复正常达180°,该7例的三角肌力均为4级,肩外旋40°~70°,平均56°;5例肩外展达30°~50°,平均38°;该5例肩外旋为-40°~30°,平均10°,三角肌肌力4级1例,3级2例,2级2例;另1例无恢复。结论 对于肩部创伤后出现的单纯肩关节外展、外旋功能完全丧失,应考虑肩胛上神经与腋神经同时损伤的可能。此种类型的神经损伤修复后的效果满意,应尽早进行神经移植修复。     

肩胛上神经卡压综合征的后入路手术应用

目的探讨手术治疗肩胛上神经卡压综合征的最佳人路。方法2000年1月～2003年6月．共收治肩胛上神经卡压综合征患者8例。男2例，女6例，年龄21～53岁。病程6个月～3年。均采用后入路切断肩胛上磺韧带松解肩胛上神经的手术方法。观察患者术后症状，肌力、肌肉萎缩的恢复情况。结果8例术后1周颈肩部疼痛均消失，肩外展、外旋及开始30。外展肌力恢复至5级．于术后1、6、12及16个月随访，症状未见复发，但肌肉萎缩无明显改善。结论后入路手术方法简便且不影响外形，肩胛￡神经卡压只局限在肩胛切迹处应选择后入路手术。     

肩胛上神经卡压的手术治疗6例报告

肩胛上神经卡压症是指肩胛上神经在穿越肩胛切迹处受压而引起的一系列症状和体征。本病少见，文献报道不多。临床上又常误诊为肩周炎、颈椎病等。肩肥上神经卡压涉及手术治疗者更少。陈德松［1］在其综述中也仅引用了国外资料，且是在全麻下进行手术。作者采用臂丛阻滞局部浸润麻醉进行神经松解术，6例均取得了良好效果。现报告如下。1临床资料男3例，女3例。年龄23～62岁，平均43岁。于部1例，工人4例，农民1例。右侧患病5例，左侧1例，本组无双侧或相继发病。肩部撞击伤2例，上肢活动过度、长期劳累劳损2例；腕部Smith骨折1例，风寒侵袭1…     

肩胛上神经卡压症肩胛切迹定位封闭的临床研究

目的 探讨肩胛上神经卡压症的肩胛切迹定位封闭的疗效.方法对28例肩胛上神经卡压症采用肩胛切迹测量定位封闭,结合理疗,非甾体药物等治疗.结果26例获随访3～12个月,根据VAS评分:优18例,良4例,可3例,差1例,优良率84.6％.结论肩胛冈上缘及肩峰角走行恒定,部位表浅可作为肩部疾病的诊治定位标志.早期准确封闭可使大...     

肩胛上神经卡压的诊断和治疗

目的　讨论肩胛上神经卡压的诊断和治疗。方法　对近 6年来收治的 2 4例肩胛上神经卡压的病史进行分析 ,发现患者在肩外展起始 30°时 ,冈上、下肌肌力明显下降 ;同时双上肢在伸直位、肩关节前屈 90°位 ,交叉于胸前时可诱发肩胛部疼痛 ;此两点为肩胛上神经卡压的特殊体征。肌电图检查显示肩胛上神经慢性损伤。 2 1例于肩胛切迹处痛点作局部封闭治疗。 3例手术治疗 ,切断肩胛横韧带。结果　保守疗法中 7例失访 ,14例获 6个月以上的随访 ,有效率达 5 7.14 % ,其中 3例因无效后期改行手术治疗。手术治疗 6例 ,术后随访 6个月以上 ,症状完全消失 ,但肌萎缩均无明显改善 ,未发现有复发者。结论　颈肩痛患者系肩胛上神经卡压引起并不罕见 ,一旦确诊 ,可先于肩胛切迹处压痛点处作封闭治疗 ;如无显著效果 ,或出现明显肌萎缩者 ,应采取手术治疗。     

切开复位钢板螺钉内固定治疗移位肩胛盂骨折18例

目的总结切开复位钢板螺钉内固定治疗移位肩胛盂骨折的手术方法及疗效。方法自2010-01—2014-06采用切开复位钢板螺钉内固定治疗移位肩胛盂骨折18例,11例选择前入路,7例选择后入路。结果 18例均获得随访6~24个月,平均16个月。骨折愈合时间6~8个月,无畸形愈合。末次随访时疗效按Neer肩关节功能评分标准评定:优6例,良9例,可2例,差1例,优良率83.3%。无废用性肌萎缩、创伤性关节炎、肩峰撞击征、冻结肩等术后并发症。结论根据肩胛盂损伤的不同类型选择合适的手术入路和内固定方法。解剖复位、坚强内固定、术后早期功能锻炼能最大限度地恢复肩关节功能,明显缓解肩关节的疼痛,防止废用性肌萎缩,减少创伤性关节炎及肩关节功能障碍等并发症的发生。     

Repair and reconstruction of peripheral nerve injuries

Axonal regeneration after transection is a complex biological process. It is not merely a process of tissue repair, but rather of cellular repair of a large number of nerve cells. Regeneration involves restoration of the original morphology of each single cell, rather than proliferation. Techniques in microneurosurgical reconstruction of peripheral nerve injuries have improved over the last two decades, with subsequent improvement in functional results. Nerve autografts are now routinely used to guide the regrowth of the proximal nerves to distal nerve segments. However, the limited source of expendable cutaneous nerves restricts the use of nerve grafting techniques and is associated with significant morbidity. With extensive injuries there is an insufficient quantity of nerve autograft material to facilitate optimal repair. In future, the use of artificial conduits or nerve allografts could provide a limitless source of material to reconstruct otherwise irreparable traumatic nerve injuries. Establishment of appropriate strategies to suppress host-immune reaction or donor antigenicity would facilitate clinical allogeneic nerve transplantation. Guest lecture presented at the 69th Annual Meeting of the Japanese Orthopaedic Association in Tokyo on April 13, 1996.     

Repair of peripheral nerve defect with direct gradual lengthening of the proximal nerve stump in rats.

We investigated the effect of direct gradual lengthening on the proximal nerve stump and subsequent nerve regeneration in rats. A 10-mm-long nerve segment was resected from the sciatic nerve of each rat. The proximal nerve stump was directly lengthened at a rate of 1 mm/day using an original external nerve distraction device. Experiment I: After distraction periods of 10, 15, and 20 days, the length of each nerve was evaluated, and the lengthened nerve stump was also examined by immunohistochemical analysis. Experiment II: After a distraction period of 20 days, both nerve stumps were refreshed and direct end-to-end neurorrhaphy was performed. For control, 10-mm nerve grafting was immediately performed after nerve resection. Nerve regeneration was evaluated electrophysiologically and histologically 7, 9, and 15 weeks after nerve resection in both groups. The whole proximal nerve stump, including the endoneurium and the axon, could be lengthened in proportion to the distraction period. There were no significant differences in motor nerve conduction velocity and tetanic muscle contraction force between both groups. Histologically, the total number of myelinated fibers was significantly greater in the nerve lengthening group than in the autografting group. This study demonstrated that the whole proximal nerve stump including the endoneurium and the axon could be lengthened by direct gradual distraction, and that this method might have potential application in the repair of peripheral nerve defects.     

Comparison of assessment tools to score recovery of function after repair of traumatic lesions of the median nerve

In this paper the recovery after repair of the median nerve has been used to compare different assessment tools for evaluation of peripheral nerve function: touch (moving 2-point discrimination (2PD); Semmes-Weinstein (SW) monofilament, motor (Medical Research Council (MRC) scale), combined motor and sensory (Dellon modification of the Moberg pick up test; Moberg Recognition test), and pain (visual analogue scale; pinprick-test). The mean (SD) age of our 28 patients was 28 (12) years. The mean (SD) follow-up period was 5 years, 2 months (2 years, 8 months). On the operated side three patients (11%) had a moving 2PD of less than 4 mm. The results of the moving 2PD were compared with those of the SW monofilaments, but with a poor correlation. The MRC score correlated well with opposition movement of the thumb and muscle wasting (p<0.01). We recommend a number of tests to evaluate (the chronological return of) peripheral nerve function.     

Current concepts in diagnosis and management of common upper limb nerve injuries in children

Peripheral nerve injuries (PNI) of the upper limb are a common event in the paediatric population, following both fractures and soft tissues injuries. Open injuries should in theory be easier to identify and the repair of injured structures performed as soon as possible in order to obtain a satisfying outcome. Conversely, due to the reduced compliance of younger children during clinical assessment, the diagnosis of a closed nerve injury may sometimes be delayed. As the compliance of patients is influenced by pain, anxiety and stress, the execution of the clinical manoeuvres intended to identify a loss of motor function or sensibility, can be impaired. Although the majority of PNI are neuroapraxias resulting in spontaneous recovery, there are open questions regarding certain aspects of closed PNI, e.g. when to ask for electrophysiological exams, when and how long to wait for a spontaneous recovery and when a surgical approach becomes mandatory. The aim of the article is therefore to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.     

Indication,technique and results of facial nerve reconstruction

Summary 160 patients with various intraor extracranial pathologies were treated by microsurgical facial nerve reconstruction at Nordstadt Neurosurgical Clinic between 1978 and 1993. Facial nerve reconstruction was accomplished along the anatomical course of the facial nerve from its origin at the brainstem, within the mastoid, at the stylomastoid foramen and within the face. Mostly, reconstruction was indicated because of nerve discontinuity (n=61), whereas facial nerve reanimation with a donor nerve such as the contralateral facial nerve or the ipsilateral hypoglossal nerve was indicated in 99 cases of loss of a proximal nerve stump. Depending on the site of the lesion reinnervation started at 5 to 15 months postoperatively lasting for 2 to 3 years with overall satisfactory results. 69% of all the patients regained good symmetry on rest, complete eye closure equivalent to House-Brackmann-Score III: Patients with complete failures either suffered of non-related diseases such as cancer leading to death before the estimated time of recovery or were exposed to radiation or received facial nerve reconstruction after long-standing facial deficit and marked muscular atrophy. The indication of the adequate method depends on the clinical course with or without preexisting facial paresis, on considering the intraoperative state of the facial nerve, the identification and microsurgical preparation of adequate nerve stumps, as well as on the adaptation techniques and the postoperative guidance of the patient. We conclude that facial nerve reconstruction by transplantation at either site of the nerve course or by reanimation with a donor nerve are effective and reliable procedures of treatment leading to satisfactory functional and cosmetic results.     

Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique

A comprehensive analysis of 187 patients (78 median, 86 ulnar, and 23 radial nerve lesions) treated by an interfascicular autogenous nerve grafting technique is presented. After a follow-up of at least 18 months good motor recovery was achieved in 72% of median nerve lesions, 77% of ulnar nerve lesions, and 57% of radial nerve lesions. Good functional sensory recovery was found in 36% of median, 45% of ulnar, and 48% of radial nerve lesions. It appears by multivariate analysis that the results obtained generally were better in younger patients, in patients with a shorter preoperative delay, and in cases with a shorter transplant.     

Anatomie fonctionnelle du nerf trijumeau

The cranial nerve (CN) V is a mixed nerve that consists primarily of sensory neurons. It exits the brain on the lateral surface of the pons, entering the trigeminal ganglion within a few millimeters. Three major branches emerge from the trigeminal ganglion. The first division (V1, the ophthalmic nerve) exits the cranium through the superior orbital fissure, entering the orbit to innervate the globe and skin in the area above the eye and forehead. The second division (V2, the maxillary nerve) exits through a round hole, the foramen rotundum, into a space posterior to the orbit, the pterygopalatine fossa. It then re-enters a canal running inferior to the orbit, the infraorbital canal, and exits through a small hole, the infraorbital foramen, to innervate the skin below the eye and above the mouth. The third division (V3, the mandibular nerve) exits the cranium through an oval hole, the foramen ovale. The third division also has an additional motor component, which may run in a separate fascial compartment. Most fibers travel directly to their target tissues. Sensory axons innervate skin on the lateral side of the head, the tongue, and the mucosal wall of the oral cavity. Motor fibers innervate the muscles that are attached to the mandible. Some sensory axons enter in the mandible to innervate the teeth and emerge from the mental foramen to innervate the skin of the lower jaw.     

双神经卡压综合征

目的：研究双神经卡压征的病因及手术治疗方法。方法：分析了自１９８８年以来同时诊断为腕管综合征和肘管综合征２６例３４侧的临床资料。全部患者均作两处神经松解术，平均随访１７个月。疗效评定标准，根据术后症状、体征的改善程度分优、良、可和无效四级。结果：２５侧术后疗效优良，占７３．６％（２５／３４）。结论：双神经卡压征手术治疗效果较好。当双神经卡压同时合并颈部神经卡压时，建议优先考虑远端的神经减压。当远端神经减压后未能改善近端神经卡压症状时，才考虑近端神经减压