彩色多普勒超声对刀砍伤周围神经损伤的定位诊断

周围神经损伤后,及时发现神经形态结构的异常改变,可以及早确定治疗方案而无须观察等待。我们将超声诊断技术用于检查周围神经损伤的患者,在定位诊断方面为临床提供了有价值的依据。 1资 料与方法 1．1 对象：2009—12～2010—07对5例男性患者刀砍伤所致神经损伤的患者进行了超声检查。男性5例,年龄18～27岁,平均25岁,其中正中神经损伤2例,尺神经损伤1例,坐骨神经损伤2例。     

周围神经损伤修复进展

随着社会的进步与交通事业的发展，周围神经损伤业已成为临床上的常见病、多发病。许多学者经过不断探索，对周围神经损伤的修复机制有了较为深入的研究，主要集中于神经的接触传导、神经趋化及神经营养等方面。目前，对周围神经损伤的修复方法主要包括神经外膜缝合术、神经束膜缝合术、神经松解术、神经移位、神经移植修复术等。笔者拟总结回顾周围神经损伤的主要修复术式，并对其发展前景予以展望。     

医源性周围神经损伤的临床治疗

目的 回顾医源性周围神经损伤患者的临床治疗效果,总结经验和教训. 方法 对2004年-2010年医源性周围神经损伤患者72例进行回顾性分析,治疗方法包括保守治疗24例,手术松解21例,神经吻合27例. 结果 72例患者均获得随访3～24个月,平均10个月.神经恢复标准按中华医学会手外科学会上肢部分功能评定试用标准:优24例,良21例,可16例,差11例,优良率为64％. 结论 加强医源性周围神经损伤的风险意识,特别注意近几年开展的骨折复位微创治疗有增加神经损伤的风险.对于有可能出现医源性损伤的患者,一定要在术前制订详细的手术方案,争取Ⅰ期修复.     

MRI检查在周围神经病变中的应用

周围神经病变是指各种损伤因素造成外周神经损伤引起相应支配区感觉及运动功能障碍。对于如何精确判断周围神经损伤的部位及程度,是临床亟待解决的难题。磁共振成像技术因其较高的组织分辨率、无辐射、可重复操作等优势,其在临床各个领域都有较普遍的应用。随着神经磁共振成像(magnetic resonance neurography, MRN)技术的不断成熟及完善,MRI在周围神经损伤中的应用越来越广泛。本文主要探讨周围神经病变的因素以及MRI各种成像技术在周围神经病变中的应用。     

扩散张量成像在周围神经变性及再生中的研究进展

周围神经损伤后,其远端轴突和髓鞘发生沃勒变性,如何评估轴索再生、残端修复和神经支配区功能重建是临床研究的难题。目前,临床上主要通过神经电生理检查判断神经损伤程度,但对评估神经完全损伤及近端病变缺乏敏感性及特异性。MR扩散张量成像(DTI)能够无创性定量评估周围神经变性及再生过程,联合扩散张量纤维示踪技术(DTT)可追踪神经纤维束的方向、排列、髓鞘脱失等信息。就DTI技术评估周围神经损伤变性及再生的研究进展予以综述。     

周围神经损伤康复治疗研究进展

临床上周围神经损伤极为常见,修复困难,致残严重,是当今临床医疗面临的严重挑战之一。寻找既能促进损伤神经快速修复与生长,又能保证其再生纤维功能的有效治疗方法,一直是神经修复基础与临床研究的热点。本文就周围神经损伤康复治疗研究进展做一综述。     

周围神经枪击震荡伤的病理观察

31只狗在坐骨神经旁作定点手枪枪击(左);并与子弹直径相同的铁杆穿刺伤(右)作对比。采用病理形态学技术观察坐骨神经和伤道周围软组织的改变,以说明枪击震荡效应。枪击损伤坐骨神经的发生率为22.6％,而穿刺伤无坐骨神经损伤,前者对周围软组织的挫伤区范围和程度较后者为广泛和严重。枪击波及坐骨神经损伤的性质,与一般周围神经直接受到机械性损伤的情况基本相同,主要表现为神经纤维的瓦氏退变和神经内衣、束衣的渗出和增殖性反应。对枪击震荡因素和周围神经对机械力损伤的耐受性作了简要的讨论,并强调周围神经在枪击震荡伤中“神经部分损伤”的意义。     

传递神经冲动训练治疗地震挤压伤致周围神经损伤的疗效观察

目的：探讨传递神经冲动训练对地震挤压伤致周围神经损伤的疗效。方法：将56例地震挤压伤致周围神经损伤患者随机分为治疗组（28例）和对照组（28例）进行临床对照研究。两组均进行物理疗法、针灸、支具矫形器等常规治疗,治疗组除常规治疗外还进行传递神经冲动训练。对两组患者在入组时和治疗2个月后结果进行比较,包括对临床症状、肌电图（EMG）和神经传导（NCV）疗效的评价。结果：治疗组治疗后的临床表现、EMG、NCV均明显优于对照组（P〈0．01）。结论：传递神经冲动训练对周围神经损伤是一种有效的治疗方法。     

周围神经损伤89例患者心理分析及护理体会

周围神经损伤给患者造成较大的痛苦。但因其社会地位、文化素养以及生活环境的不同，其心理状态也不相同。现就我院１９８７年１２月以来收治的周围神经损伤８９例伤员心理状态及护理对策报告如下。１　临床资料本组病人８９例，其中８３例９４条为上肢神经干损伤。６例６条为下肢神经干损伤，正中神经损伤３１条，尺神经损伤４２条，桡神经损伤２１条，坐骨神经损伤２条，腓总神经损伤４条。急诊创伤６８例，陈旧性损伤２１例，电锯伤１４例，刀砍伤６６例，骨折合并神经损伤９例。２　心理分析一般急诊患者都有痛苦、恐惧及急切的心理，但…     

应用显微外科手术修复周围神经损伤219例

1976年1月～1986年12月,我们应用显微外科手术治疗周围神经损伤及神经纤维或鞘膜瘤219例(303条神经),采用低-高-低倍的用镜方法,准确地对合神经断端,轻柔操作,取得了满意的效果。同时介绍了镜下操作的有关注意事项及晚期战伤性周围神经损伤术中应用神经刺激器的意义。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.