改良选择性腰骶段脊神经后根部分切断术治疗痉挛性截瘫的初步疗效报告

目的 探讨改良选择性腰骶段脊神经后根部分切断术治疗痉挛性截瘫的初步疗效.方法 回顾分析2002年7月至2008年3月显微手术治疗的21例痉挛性截瘫患者下肢痉挛状态,全部采用改良选择性腰骶部脊神经后根部分切断术.结果 平均随访26.3个月.术后即刻痉挛状态缓解率为100%,随访期间痉挛状态缓解率为91%(19/21),步态功能改善率为71%(15/21),生活质量提高率为95%(20/21).24%(5/21)患者存在随访期间未完全缓解的下肢感觉障碍或异常,肌无力者占14%(3/21),术后发生一过性尿潴留1例(5%).随访期间无永久性二便障碍发生.术后下肢痉挛状态不同程度复发5例(24%),其中2例(10%)回复到术前的严重程度.结论 改良选择性腰骶部脊神经后根部分切断术治疗痉挛性截瘫下肢痉挛状态的短期疗效优良,但能否长期缓解痉挛或遏制住该病痉挛进行性加重的发展趋势尚有待于进一步临床观察评估.     

周围神经缩窄术在治疗脑瘫痉挛肢体中的应用

目的探讨周围神经缩窄术在治疗脑瘫痉挛性肢体的应用及手术效果.方法对31例脑瘫患儿的53肢痉挛肢体共行周围神经缩窄术82例.一次手术单神经干缩窄术31例,多神经干组合神经缩窄术22例.共行肌皮神经缩窄11例,正中神经缩窄15例,胫神经缩窄37例,闭孔神经缩窄6例,坐骨神经缩窄11例,腓深神经缩窄2例.结果所有病例随访6个月-1年4个月,平均10.8个月.以Ashworth分值、ROM关节活动度、随意功能改善和患儿家长满意度进行评价.术后肌痉挛缓解率97.6%,随访期间随意运动功能改善88.7%,不同程度痉挛复发4.9%.结论周围神经缩窄术对治疗脑瘫痉挛肢体具有较高的实用价值.     

选择性周围神经部分切断术治疗脑瘫性肢体痉挛

目的观察选择性周围神经部分切断术治疗痉挛性脑瘫的效果。方法采用显微神经外科手术治疗的68例痉挛型脑瘫病例,根据患者肢体痉挛的不同情况采用相应的选择性周围神经部分切断术,包括胫神经、坐骨神经和正中神经,其中选择性胫神经切断术36侧,选择性正中神经切断术28侧,选择性坐骨神经切断术28侧,共计92侧。结果全部患者经3-15个月的随访,术后即刻肢体痉挛状态缓解率为97.8%(90/92),随访期间为94.6%(87/92),随访期间运动功能改善率为76.5%(52/68),术后肢体痉挛状态不同程度复发5侧(5.4%)。结论选择性周围神经部分切断术对降低痉挛性脑瘫患者肌张力、纠正痉挛性畸形近期疗效满意,手术创伤小,治疗效果能够被医患双方同时认可。     

周围神经选择性切断治疗脑瘫性下肢痉挛

目的探讨周围神经选择性切断治疗脑瘫性下肢痉挛的效果。方法对380例脑瘫性下肢痉挛患者,根据痉挛部位不同,选择相应周围神经(包括腰骶段脊神经后根、坐骨神经、闭孔神经和胫神经)部分切断。结果术后痉挛缓解率100%,其中82例患者肌力下降,142例患者出现肢体麻木、感觉减退,随访期间均见好转。术后随访6个月～3年,随访期间痉挛缓解率为95%。95%患者行走步态好转。结论周围神经选择性切断术对治疗脑瘫性下肢痉挛是安全、有效的。     

1037例痉挛性脑瘫显微神经外科手术治疗

目的探讨显微神经外科手术治疗痉挛性脑瘫的疗效.方法回顾分析2000年3月至2004年3月的显微神经外科手术治疗1 037例痉挛性脑瘫病例.依据病例的不同情况采用相应的选择性周围神经部分切断术,包括:胫神经、坐骨神经、肌皮神经、正中神经、尺神经、颈段和腰骶段脊神经后根.结果全部患者平均随访24.1个月.96.05%患者术后即感痉挛状态缓解,随访期间缓解率为 91.23%.术后 6周内运动功能改善率为 70.74%,随访期间为 87.24%.生活质量提高率在随访期间为89%.术后发生肢体感觉障碍382侧(21.66%),肌无力256侧(14.51%),随访期间均见好转.术后肢体痉挛状态不同程度复发134例(10.58%).结论选择性周围神经部分切断术是治疗痉挛性脑瘫安全有效的手术方法.选择合适的病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效的关键.     

周围神经选择性切断治疗脑瘫性下肢痉挛

目的探讨周围神经选择性切断治疗脑瘫性下肢痉挛的疗效。方法回顾2003年1月至2008年3月收治的380例脑瘫患者,根据痉挛部位不同,选择相应周围神经进行部分切断,包括：腰骶段脊神经后根、坐骨神经、闭孔神经和胫神经。结果术后痉挛缓解率100%,其中82例患者肌力下降,142例患者出现肢体麻木、感觉减退,随访期间,均见好转。随访6个月至3年,随访期间痉挛缓解率为95%。95%患者行走步态好转。结论周围神经选择性切断术是治疗脑瘫性下肢痉挛的安全、有效的神经外科方法。     

组合式周围神经选择性显微切断术治疗脑瘫性下肢痉挛

目的 探讨组合式周围神经选择性显微切断术治疗以大腿内收肌和小腿屈肌痉挛为主的脑瘫性下肢痉挛的疗效。方法 对2004年1月至2006年8月52例以大腿内收肌和小腿屈肌痉挛为主的脑瘫性下肢痉挛患者全部采用组合式周围神经选择性显微切断术。结果 术后大腿内收肌和小腿屈肌痉挛缓解率为100％，一周后所有患者行走步态明显改善．平均随访10个月．随访期间痉挛缓解率为94．2％（49／52），术后18例出现不同程度大腿内收肌和小腿屈肌无力，14例出现感觉障碍．随访期间均好转。结论 组合式周围神经选择性显微切断术是治疗以大腿内收肌和小腿屈肌痉挛为主的脑瘫性下肢痉挛的安全有效的手术方法，术后正规长期功能恢复训练有利于提高生活质量。     

内镜下选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛

目的探讨内镜在选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛中的应用.方法回顾分析2002年3月至2003年4月显微手术治疗的53例脑瘫性下肢痉挛,全部采用选择性腰骶段脊神经后根部分切断术,并在术中应用软性神经内窥镜.结果全部患者平均随访 10个月. 100%患者术后立即感痉挛状态缓解,随访期间缓解率为94.3%.术后6周内步态功能改善率为56.6%,随访期间为90.6%.生活质量提高率在随访期间为94.3%.术后发生下肢感觉障碍20例(37.7 %),肌力下降 5例(9.4%),随访期间均见好转.术后无一过性尿失禁及尿潴留发生.随访期间无复发病例.结论选择性腰骶段脊神经后根部分切断术治疗脑瘫性下肢痉挛,术中应用内窥镜有利于提高疗效、减少创伤和降低并发症发生率.     

非脑瘫病因性痉挛状态的显微神经外科手术治疗

目的探讨显微神经外科手术治疗多种(主要为非脑瘫)病因所致痉挛状态的疗效。方法2000年3月至2005年6月我院采用显微神经外科手术治疗多种(主要为非脑瘫)病因所致痉挛状态356例。根据病例的不同情况采用相应的选择性周围神经部分切断术．包括胫神经、坐骨神经、肌皮神经、正中神经、尺神经、闭孔神经、副神经、颈段和腰骶段脊神经前、后根。结果全部患者平均随访28个月。95．2%患者术后即感痉挛状态缓解,随访期间缓解率为90．7%,运动功能改善率为87．6%,生活质量提高率为91．3%。术后肢体感觉障碍发生率23．3%,肌无力发生率19．5%,随访期间均见不同程度好转。术后痉挛状态不同程度复发33例(9．3%)。结论选择性周围神经部分切断术是治疗多种(主要为非脑瘫)病因所致痉挛状态安全有效的手术方法。     

显微神经外科手术治疗痉挛型脑瘫738例临床观察

目的探讨显微神经外科手术治疗痉挛型脑瘫的疗效。方法回顾分析2000年3月至2003年3月显微神经外科手术治疗的738例痉挛型脑瘫病例,根据病例的不同情况采用相应的选择性周围神经部分切断术,包括:胫神经、坐骨神经、肌皮神经、正中神经、颈段和腰骶段脊神经后根。结果全部病人平均随访19个月。98.6%病人术后立即感痉挛状态缓解,随访期间缓解率为89.5%。术后6周内运动功能改善率为75.0%,随访期间为87%。生活质量提高率在随访期间为90.2%。术后发生肢体感觉障碍199侧(21.7%),肌无力123侧(13.4%),随访期间均见好转。术后肢体痉挛状态不同程度复发83例(9.1%)。结论选择性周围神经部分切断术是治疗痉挛型脑瘫安全有效的手术方法。选择合适的病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效的关键。     

Spinophilin的表达与垂体腺瘤侵袭性的关系

目的 探讨垂体腺瘤（PA）组织Spinophilin（SPN）的表达及其与腺瘤侵袭性的关系。方法 选取2018年8月至2021年6月手术切除并经术后病理确诊的PA组织98例和瘤旁组织64例，用免疫组化染色检测SPN蛋白表达水平，应用PCR检查PA组织SPN mRNA表达水平。根据Knosp分类法评估肿瘤侵袭性。结果 98例中，侵袭性46例，非侵袭性52例。PA组织SPN阳性表达率（21.43%，21/98）明显低于瘤旁组织（71.87%，46/64；P<0.05）。侵袭性PA组织SPN阳性表达率（13.04%，6/46）明显低于非侵袭性PA组织（28.85%，15/52；P<0.05）。PA组织SPN mRNA相对表达量（1.21±0.37）明显低于瘤旁组织（2.89±0.75；P<0.05）。SPN阴性表达（OR=2.876；95%CI 1.003~5.121；P<0.001）是PA侵袭性的独立危险因素。ROC曲线分析显示，SPN mRNA预测PA侵袭性的AUC为0.830（95%CI 0.813~0.916；P<0.001），诊断临界值为0.84，灵敏度和特异度分别为95.23%和83.12%。结论 侵袭性PA组织SPN呈低表达，检测SPN表达水平对PA侵袭性有一定评估作用。     

腓浅神经与腓骨短肌联合活体组织检查的诊断意义初探及15例临床病理报告

目的 开展单一切口下的腓浅神经与腓骨短肌联合活体组织检查,通过回顾相关病例的临床和病理资料,分析联合活体组织检查的诊断意义.方法 共15例患者,女性7例,男性8例,年龄14 ～72岁,其中亚急性6例、慢性9例,均患有周围神经病,3例临床上合并肌肉病.周围神经病的临床类型包括对称性感觉和运动性神经病7例、多发性单神经病5例、对称性感觉性神经病3例.在外踝前上方纵切口,取材腓浅神经与腓骨短肌.神经和肌肉病理结论的意义评价分为3级:(1)具有确诊意义;(2)对诊断有帮助:(3)对诊断无帮助.结果 活体组织检查病理结论有确诊意义者7例,包括血管炎5例、炎性脱髓鞘性周围神经病1例和淀粉样变性1例.有帮助者5例:病理改变分别为:慢性髓鞘性神经病伴洋葱球样肥大纤维;小血管病变伴轻度炎性反应;轻度间质炎性反应;脂褐素沉积等.无帮助者3例.最终12例通过活体组织检查得以确诊.结论 联合活体组织检查的诊断阳性率较高,血管炎周围神经病和淀粉样变性等适用联合活体组织检查.     

Peripheral neuropathy in ART-experienced patients: prevalence and risk factors

Peripheral neuropathy (PN) is a common neurological complication of HIV infection that has debilitating effects on quality of life. While there has been a comprehensive evaluation of the prevalence of neuropathic signs/symptoms and risk factors (RFs) for PN or symptomatic PN (SPN) with initiation of combination antiretroviral therapy (cART) in ART-naïve patients, similar evaluation in ART-experienced patients is limited. This study investigated the prevalence and RFs for PN/SPN in ART-experienced patients enrolled in clinical salvage therapy studies. Between February 2000 and June 2007, 522 ART-experienced participants who experienced virologic failure with a prior regimen and started new regimens were followed longitudinally and annually screened for signs and symptoms of PN. Rates of PN/SPN at 3 years since parent study entry were 52.8 and 24.0 %, respectively. Aging, taller height, protease inhibitor use, and female sex were significant RFs for PN/SPN. The use of statin drugs was significantly associated with lower odds of SPN, and it may prevent progression from no SPN to SPN.     

Distinct subpopulations of cyclic guanosine monophosphate (cGMP) and neuronal nitric oxide synthase (nNOS) containing sympathetic preganglionic neurons in spontaneously hypertensive and Wistar-Kyoto rats

The sympathetic preganglionic neurons (SPN) of the intermediolateral cell column (IML) play a critical role in the maintenance of vascular tone. We undertook a comparative neuroanatomical analysis of neuronal nitric oxide synthase (nNOS) expression in the SPN of the mature normotensive Wistar Kyoto (WKY) and spontaneously hypertensive rat (SHR). The anatomical relationship between nNOS and the NO signaling molecule cyclic guanosine monophosphate (cGMP) was also determined. All animals were male, age > 6 months. Fluorogold (FG) retrograde labeling of SPN (detected with immunohistochemistry) was combined with NADPH-diaphorase histochemistry for NOS in the thoracic spinal cord (T1-11, n = 5 WKY, 5 SHR). There was no difference in the total number of FG-labeled SPN (WKY 6,542 +/- 828, SHR 6,091 +/- 820), but the proportion of FG-labeled cells expressing NOS was significantly less in the SHR (WKY 64.4 +/- 5.1 vs. SHR 55.6 +/- 2.1, P < 0.05). Fluorescence immunohistochemistry for nNOS/cGMP (n = 4 WKY, 4 SHR) was also performed. Confocal microscopy revealed that all nNOS-positive SPN contain cGMP and confirmed a strain-specific anatomical arrangement of SPN cell clusters. A novel subpopulation of cGMP-only cells were also identified. Double labeling for cGMP and choline acetyltransferase (n = 3 WKY, 3 SHR), confirmed these cells as SPN in both WKY and SHR. These results suggest that cGMP is a key signaling molecule in SPN, and that a reduced number of NOS neurons in the SHR may play a role in the increase in sympathetic tone associated with hypertension in these animals.     

A Unique Approach to Neurostimulation in Patients With Previous Two‐Segment Spine Surgery and Obstruction of Epidural Access for Spinal Cord Stimulation: A Case Series

Introduction: Patients with extensive surgery in the lumbar and thoracic spine are often not considered for neurostimulation due to the inability to perform a conventional spinal cord stimulation (SCS) trial. We are presenting six such patients in which spinal‐peripheral neurostimulation (SPN) was used via a caudal approach. Methods: Six patients with intractable low back and leg pain following extensive lumbar and thoracic surgeries, up to at least the T10 level, underwent a stimulation trial with one caudal lead and one subcutaneous lead in order to achieve SPN. Results: In five cases, the trial was successful with coverage of the pain area and at least satisfactory pain relief. All six patients were implanted with a paddle lead(s) and a subcutaneous lead using SPN with good pain control. Conclusion: SPN with a caudal lead appears to be a viable option for SCS trial in patients with no possibilities for conventional trial lead placement.     

Neurochemistry of nerve fibers apposing sympathetic preganglionic neurons activated by sustained hypotension

Sympathetic preganglionic neurons (SPN) in rat spinal cord were activated by the reflex stimulation of bulbospinal sympathetic neuronal pathways after a nitroprusside-induced hypotension. Hypotension-sensitive SPN, identified by immunoreactivity (IR) to the product of the immediate early gene c-fos and to choline acetyltransferase, were localized in the intermediolateral cell column of thoracic and upper lumbar cord, particularly middle to lower thoracic cord. Putative neurotransmitters, or their markers, in varicose fiber networks around SPN were identified. Nearly all hypotension-sensitive (Fos-IR) SPN were apposed by varicose fibers immunoreactive for tyrosine hydroxylase, serotonin, substance P, or enkephalin. Neuropeptide Y (NPY)- or phenylethanolamine-N-methyl transferase (PNMT)-IR varicose fibers apposed Fos-IR SPN in the upper and middle thoracic spinal cord, but in lower thoracic segments some Fos-IR SPN lacked these appositions. In thoracic segment 12, 51% +/- 5% of Fos-IR SPN (n = 9 rats) lacked PNMT contacts and 25% +/- 3% of Fos-IR SPN (n = 8 rats) lacked NPY contacts. In contrast to other chemically defined afferents, galanin-IR varicose fibers apposed fewer than half of the Fos-IR SPN in the middle to lower thoracic cord. Neurotransmitters/neuromodulators that might influence the activity of SPN acting in the baroreflex-mediated control of blood pressure have been identified. Uniformity in the neurochemistry of some fibers making connections with Fos-IR SPN, regardless of their segmental origin, suggests that common sets of neurons provide convergent inputs to all hypotension-sensitive SPN. Other fibers show topographic differences in their contacts with Fos-IR SPN, suggesting that subgroups of hypotension-sensitive SPN are targeted by particular neuron groups.     

The effects of background noise on brain activity using speech stimuli on healthy young adults

Everyday spoken language processing does not occur in a novel acoustic environment, but rather in the presence of the interfering background noise. In the present study, brain activation associated with speech perception (SP) processing in quiet (SPQ) and SP processing in 5-dB SNR noise (SPN) was examined in 15 healthy young adults using functional MRI. The behavioral performance shows no significant difference between SPN and SPQ, suggesting that background noise does not always impair spoken language comprehension in young healthy participants. The fMRI results indicate that both the superior temporal gyrus (STG) and middle temporal gyrus (MTG) were significantly activated during both the SPQ and SPN. This is attributed to the use of verbal stimuli in this study. Further activation for both SPQ and SPN was also found in other temporal areas and the cerebellum. However interestingly, specific comparisons between SPQ and SPN revealed significant increases in brain activation in the left STG, left MTG and bilateral cerebellum during SPN compared to SPQ. We suggest that the higher processing demands due to the presence of background noise are associated with compensatory strategies to allow the cognitive system to overcome noise-related interference, particularly implicating involvement of the left STG, left MTG and bilateral cerebellum. Findings are discussed in the context of corroborating evidence of such compensation.     

血清YKL-40水平与胶质瘤病理分级及预后的相关性研究

目的探讨血清YKL-40水平与胶质瘤病理分级及预后的相关性。方法选取诊断为脑胶质细胞瘤并行手术治疗的成年病例68例为胶质瘤组,20例健康体检病人作为对照组,根据术后病理学分级,低度恶性Ⅰ级2例、Ⅱ级17例,高度恶性Ⅲ级15例、Ⅳ级34例。观察生存时间及复发时间,生存时间〈12个月15例,12～24个月15例,〉24个月38例。复发前死亡10例,复发时间〈12个月14例,12～24个月15例,〉24个月未复发29例。术前均抽取静脉血采用酶联免疫吸附试验（ELISA）测定血清YKL-40水平。结果低级别（I级、Ⅱ级）胶质瘤病人血清YKL-40水平与对照组无显著差异（P〉0.05）,Ⅳ级胶质瘤病人血清YKL-40水平显著高于其他组（P〈0.05）。生存时间〈12个月和12～24个月的病人血清YKL-40水平显著高于生存时间〉24个月的病人（P〈0.05）。复发病人血清YKL-40水平显著高于未复发者（P〈0.05）,12个月内复发的病人血清YKL-40水平显著高于12～24个月复发的病人（P〈0.05）。结论血清YKL-40水平与胶质瘤的病理学分级及预后密切相关,可作为恶性程度及预后的判断指标。     

选择性周围神经切断术治疗痉挛性斜颈的疗效分析

目的研究术前颈部CT及肌电图检查对痉挛性斜颈行选择性周围神经切断手术疗效的影响。方法回顾性分析26例痉挛性斜颈病人的临床资料,术前均评估TWSTRS评分,行颈部薄层CT检查15例,肌电图检查19例。根据术前检查及临床表现情况行选择性周围神经切断手术,术后电话随访评估TWSTRS评分以判断手术效果。结果根据TWSTRS评分．治疗有效21例,疗效差5例;手术前后TWSTRS评分差异有统计学意义（P〈0．01）。本组无严重并发症或死亡病例。术前行CT检查与未行CT检查病人的手术疗效有显著性差异（P=0．02）;术前同时行CT和肌电图检查与未行两项检查的病人手术疗效有显著性差异（P=0．047）;而术前是否行肌电图检查及肉毒毒素注射对手术效果无明显影响（P肌电图=0．08,P肉毒素=0．33）。结论选择性周围神经切断术能有效治疗痉挛性斜颈,根据术前颈部薄层CT检查结果设计个体化手术方案能有效提高手术疗效。