不同术式神经移位至桡神经疗效观察

目的 比较不同动力神经移位至桡神经不同部位疗效的差异。方法 自1997年至2000年，采用肋间神经或健侧C7神经根移位至不同部位的桡神经术，治疗全臂丛神经损伤36例，平均随访时间42．39个月，用四格表法统计，计算肌力恢复的有效率。结果 本组总有效率为56％（20／36）；在恢复伸肘功能时，以神经移位至桡神经主干组和移位至肱三头肌肌支组的有效率高，分别为5／8、4／4；在恢复伸腕功能时，健侧C7神经根移位至桡神经发出肱三头肌肌支后的沟内段的有效率最高，为75％（9／12）。结论 移位至桡神经主干术和至肱三头肌肌支术的伸肘功能恢复佳；健侧C7神经根移位至桡神经沟内段术的伸腕功能恢复最好；年龄〈30岁和手术间隔时间〈12个月，有利于桡神经功能恢复。     

神经介入放射治疗五例

神经介入放射治疗是一项技术难度较大、器材及设备要求较高的新技术,我院应用IADSA进行超选插管介入治疗5例,现报告如下。 1 一般资料,本组男性4例,女性1例。年龄14～37岁,平均22.8岁。其中脑动静脉畸形3例、脑膜动静脉畸形1例、颈内动脉海绵窦瘘1例。 2 栓塞操作方法:采用神经安定麻醉,肝素化后经     

桡神经深支损伤的治疗

目的探讨桡神经深支损伤的手术治疗方法与疗效。方法５８例桡神经损伤患者，３３例采用显微外科吻合和移植，１９例神经松解，２例神经残端植入，４例肌腱转位。结果神经吻合和移植优良率９３．９％，神经松解优良率８９．５％，４例肌腱转位疗效均满意，２例神经残端植入者疗效均差。结论对已明确的桡神经深支应尽早手术探查修复；对于鱼尾平面的桡神经深支损伤宜采用肌腱转位。     

桡神经移位在肱骨干骨折治疗中的应用

目的探讨避免肱骨干骨折手术治疗中的桡神经医源性损伤。方法在手术中将桡神经向后方移位然后再进行复位内固定。结果本组58例肱骨干骨折的手术未出现桡神经医源性损伤。结论手术中将桡神经向后方移位再进行复位内固定可以有效防止桡神经的医源性损伤。     

带血管腓肠神经移植治疗桡神经损伤

自84年2月我院收治18例桡神经损伤病人,其中3例桡神经完全离断伤。均采用带血管腓肠神经移植修复,报告如下; 典型病例例1,男性,22岁,农民,未婚,84年2月8日因车祸左上臂受伤术后3月入院。查体:左上臂外侧10cm切口疤痕巳愈合,左     

双神经弓式双端侧吻合治疗痛性指固有神经瘤

目的介绍一种治疗痛性指固有神经瘤的手术方法。方法2005年2月-2011年3月,巢湖紫晨手外科医院手外科中心采用双端侧吻合治疗指固有神经瘤11例11指。术中将神经瘤彻底切除直至正常神经束,对远、近端尺桡侧指固有神经分别进行远与远、近与近端一端吻合,形成远、近2条神经弓;测量两神经弓间距,取直径相近的前臂外侧皮神经,平分为两段,分别于神经弓的尺、桡侧开窗式端侧吻合。结果随访24．5—52个月,平均（38±2．5）个月。9例指疼痛完全消失,2年后未见复发;2例指自发性疼痛消失,但仍有轻度触痛,参照Burchiel疗效评定标准：优9指,良2指;优良率100％。感觉测定指标为s3～s4级,两点分辨觉为4．5—6．5mm。结论双神经弓式双端侧吻合的方法可有效治疗痛性指固有神经瘤,消除患指疼痛、恢复指腹灵敏性。     

军事训练致桡神经感觉支嵌压综合征16例

桡神经感觉支在经前臂中下 1/ 3交界处 ,当其穿出肱桡肌和桡侧伸腕长肌的筋膜被牵拉或挤压时即发生嵌压综合征 ,报道不多。 1994年以来 ,作者用局部封闭方法治疗 16例 ,疗效满意。1　临床资料1 1　一般情况　均为男性 ,年龄 18～ 2 0岁。训练中有腕部扭伤史 9例 ,桡侧撞击史 4例。左 2例 ,右14例。病史最长为 7个月 ,最短为 2个月。主要症状为桡侧刺痛、麻木或烧灼感 ,较为弥散 ,不能指出确切的痛点 ,且活动时加剧 ,休息时减轻。手背桡神经感觉分布区过敏或减退 ,桡神经行程Ｔｉｎｅｌ征阳性。叩击桡侧中下 1/ 3交界处有较明显的麻痛点。1 2…     

桡神经各区损伤的诊断与治疗

本文报告了14例桡神经各区的损伤,其中2例骨间背侧神经降支的损伤罕见报道。根据解剖、临床的观察研究,将桡神经分为三区,并对各区损伤的症状、鉴别诊断和处理原则作了阐述。     

肱骨干骨折并桡神经麻痹

本文报导肱骨干骨折并桡神经麻痹57例。除2例来治外，手术探查桡神经33例，发与完全断裂13例，进行吻合，3例神经缺损行游离神经移植。功能优良率为81．6％。保守治疗22例，优良率为68．1％。影响手术效果的因素与本组开放骨折和火器伤比例高（31．1％）有关。     

腋神经、桡神经与肱骨关系的应用解剖

通过解剖 30具 6 0侧成年人上肢标本 ,测量腋神经、桡神经与肱骨骨性标志的关系。认为肱骨上 1/ 5段腋神经及肱骨下 3/ 5段桡神经为易损区域。根据术前、术后的影像检查 ,计算出神经的基本位置 ,可减少或避免神经受损     

额-眶-蝶骨纤维结构不良的经颅视神经减压术

为探讨因额 眶 蝶骨纤维结构不良致视力进行性下降经颅做视神经减压术的临床效果 ,作者对收治的 2 5例次患者进行了回顾性研究。结果显示 ,术后 1周 ,2 1例次患侧眼视力改善和稳定 ,4例次视力减退。视力减退的 4例次中有 3例次患侧眼术前视力接近失明。18例次获得有效随访 ,随访时间 2～2 2年 ,平均 6年 ,视力再减退的仅 3例次。研究结果表明 ,经颅做视神经减压术挽救视力是额 眶 蝶骨纤维结构不良致视力进行性下降的有效的手术治疗方法 ,但术前视力接近失明的患者手术效果不理想     

腕掌侧桡动脉掌浅支游离皮瓣修复手指皮肤缺损并桥接手指动脉

目的：探讨采用腕掌侧桡动脉掌浅支游离皮瓣修复手指皮肤缺损并桥接手指动脉的临床疗效。方法2012年1月～2013年11月对18例手指皮肤缺损合并血运障碍患者,缺损面积为1cm ×2cm～1.5cm ×2.5cm,采用腕掌侧桡动脉掌浅支游离皮瓣修复手指皮肤缺损并桥接指动脉。6例合并指固有神经缺损移植正中神经掌皮支桥接,腕部供区直接缝合。结果18例皮瓣全部成活。术后随访皮瓣质地好,外形及功能满意。无需二次手术皮瓣整形。结论桡动脉掌浅支游离皮瓣是修复手指皮肤缺损合并指动脉断裂缺损的良好方法。     

非体外循环冠状动脉旁路顺行序贯移植术

目的探讨先吻合桥血管近端的顺行序贯非体外循环心脏不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)应用的临床意义。方法62例患者行OPCABG,将桥血管与升主动脉吻合后备用,再行左乳内动脉与前降支吻合,最后进行桥血管与其他靶血管顺行序贯式吻合。结果吻合到左前降支的桥血管:带蒂左乳内动脉57支,桡动脉2支,大隐静脉3支。采用大隐静脉桥血管顺行序贯吻合其他靶血管,3支桥47例,2支桥15例。术后1例因低心排血量综合征死亡。其余61例术后心绞痛症状全部缓解,无围术期急性心肌梗死。经3～36月随访,无新发心绞痛,生活质量提高。结论非体外循环心脏不停跳冠状动脉旁路顺行序贯移植术,可以避免体外循环和心脏停搏心脏停搏的弊端;每完成一个桥血管吻合口,即恢复该部位心肌的血液供应,更早改善心肌缺血缺氧状态,手术安全、有效。     

经桡动脉途径前列腺动脉栓塞术可行性及安全性研究

目的 探讨经桡动脉途径前列腺动脉栓塞术(PAE)治疗前列腺增生的可行性及安全性.方法 回顾性分析18例经左侧或右侧桡动脉行C形臂CT引导下PAE术患者临床资料,观察记录上肢动脉痉挛、损伤和穿刺点出血发生率,术后桡动脉搏动及堵塞情况,手指血供及神经损伤情况,手术成功率,围手术期脑血管并发症发生率,手术时间,射线辐射剂量及临床疗效.结果18例患者中接受经左侧桡动脉、右侧桡动脉途径PAE术分别为14例、4例.16例接受双侧栓塞,2例因前列腺动脉开口扭曲伴狭窄仅完成单侧栓塞.术后1例出现桡动脉搏动减弱,超声提示血流减慢.手术时间96～245 min,患者所受辐射剂量2 435～4 958 mGy,平均(3 342±156) mGy,与同期经股动脉途径PAE术差异无统计学意义(P=0.1167).结论采用经桡动脉途径行PAE术安全、可行.     

Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography.

Changes in flow in the subclavian artery and vein resulting from the use of a hyperabduction maneuver during Doppler sonography in 20 volunteers were compared with retrospective findings in 16 patients clinically suspected of having thoracic outlet syndrome. Significant compression of the subclavian artery showed in the Doppler waveform as at least a doubling of peak systolic velocity or complete cessation of flow with hyperabduction; significant compression of the subclavian vein was diagnosed by complete cessation of blood flow or loss of atrial and respiratory dynamics in the waveform of the subclavian vein with hyperabduction. In volunteers, asymptomatic compression of the subclavian vein with arm abduction was seen in two (10%) and asymptomatic compression of the subclavian artery was seen in four (20%). Of the 16 patients, thrombosis of the subclavian vein was found in seven, compression of the subclavian vein with hyperabduction was found in six, and diagnoses other than thoracic outlet syndrome were established as the cause of pain in three. When duplex sonography was compared with venography, which was performed in 10 patients, one false-negative case was found because a subclavian vein thrombus had not been detected. The subclavian artery was examined in five of the six patients with positional compression of the subclavian vein; compression of the subclavian artery was found in three. The clinical significance of compression of the subclavian artery cannot be determined from our data because of the small number of patients involved. When the sonographic criteria of subclavian vein clot or compression resulting in a complete loss of normal venous phasicity with arm abduction and the clinical criterion of subsequent improvement in symptoms after curative surgery are used, color Doppler sonography is 92% sensitive and 95% specific for the diagnosis of thoracic outlet syndrome. This preliminary study shows that Doppler sonography has potential in the evaluation of thoracic outlet syndrome.     

Variations of the superior cerebellar artery: MR angiographic demonstration

PURPOSE: The purpose of this study was to describe variations of the proximal segments of the superior cerebellar artery (SCA) detected by magnetic resonance (MR) angiography. MATERIALS AND METHODS: We reviewed 145 consecutive MR angiograms. All patients were studied with a 1.5-Tesla imager using the three-dimensional time-of-flight technique. RESULTS: There were 16 duplicated SCAs in 13 patients, seven SCAs originating from the posterior cerebral arteries in six patients, four early bifurcations of the SCAs in four patients, and one SCA arising from the internal carotid artery. Because the SCA is small in caliber, the bilateral SCAs in nine patients could not be identified on MR angiograms owing to patient movement. In two patients with duplicated SCA, one of the duplicated trunks compressed the trigeminal nerve at the root entry zone, resulting in trigeminal neuralgia. CONCLUSION: Although most of these SCA variations have no clinical significance, preoperative identification of SCA variations is important for avoiding complications during surgery and/or for interventional procedures of the distal basilar artery.     

颅底血管与三叉神经根位置关系的应用解剖

目的　研究颅底血管与三叉神经根背侧或腹侧的位置关系,为临床诊治三叉神经痛提供解剖学依据。方法　在手术显微镜下解剖经甲醛固定的成人头部标本 25例,对颅底血管与三叉神经根背侧或腹侧的位置关系进行观测。结果　 (1 )行经三叉神经根背侧并对其产生压迫的颅底血管主要有小脑上动脉 (SCA)占 4. 0%;小脑前下动脉 (AICA)占 2. 0%;基底动脉脑桥支占 2. 0%;岩静脉占 4. 0%;岩静脉及SCA占 2. 0%;岩静脉及AICA占 2. 0%。 (2 )行经三叉神经根腹侧并对其产生压迫的颅底血管主要有SCA占 4. 0%;AICA占 4. 0%。结论　SCA,AICA可在三叉神经根背侧或腹侧产生压迫;基底动脉脑桥支、岩静脉、岩静脉及SCA、岩静脉及AICA,仅对三叉神经根背侧产生压迫。     

Ultrasound anatomy of the brachial plexus nerves in the neurovascular bundle at the axilla in patients undergoing upper-extremity block anesthesia

Purpose

Familiarity with the localization of the nerves in the neurovascular bundle that constitutes the axillary segment of the brachial plexus (BP) is important when applying ultrasound (US)-guided block anesthesia. Therefore in this study we aimed to delineate the anatomy of the median, radial, and ulnar nerves of the BP at the axilla with US and electrical stimulation.

Materials and methods

The study included 60 patients who were scheduled to undergo upper-arm surgery with axillary block anesthesia. Prior to anesthesia, ulnar, radial, and median nerves were localized with US using a 12-h quadrant identification system that placed the axillary artery (AA) in the middle. The nerves were then functionally tested using a neurostimulator.

Results

The radial nerve was mainly located in the 4–6 o’clock arc (posterior and posteromedial to AA) in 50 (83 %) of patients. Ulnar nerve was mainly at the 12–3 o’clock arc (anteromedial to AA) in 51 (85 %) of patients. Ulnar nerve showed a second peak at 9–10 o’clock quadrant (anterolateral to AA) in 11 % (7) of patients. Median nerve location was most common in the 12 and 9 o’clock arc (anterior and anterolateral to AA) in 53 (88 %) of the patients.

Conclusions

Ultrasound is a useful tool for depicting BP anatomy in the axillary fossa prior to block anesthesia. Median, ulnar, and radial nerves form a highly consistent triangular pattern around the axillary artery that is easily recognizable with US.     

含血运的神经外膜管桥接神经缺损的实验研究与临床应用

用含有血运的神经外膜管桥接兔坐骨神经缺损4cm,术后6个月神经纤维沿着外膜管生长良好,神经纤维排列规则,其复合运动电位、传导速度、波伏、横径平均值与自体神经移植者无差异。临床应用48例获得较好效果。