运动员肘部尺神经牵张性损害的手术治疗(附24例报告)

本文通过对24例运动员肘部尺神经夸张性损害的手术治疗,认为早期施行尺神经前移松解术,将受损的神经置于宽敞、健康、血供良好的神经床上,能收到良好的治疗效果。1980—1990年间,我院共收治肘部慢性牵张性尺神经损害96例,均采用尺神经前移松解术治疗,效果满意。本文对其中与运动性损伤有关的24例进行回顾性分析,认为该术式简单,效果可靠,现结合临床资料,报告如下。     

克氏针固定并皮下神经前置术治疗肱骨髁上骨折疗效分析

目的探讨尺神经皮下前置术在治疗肱骨髁上并尺神经损伤的疗效。方法回顾分析2004～2007年收治的此类患者58例,获得随诊50例,分别行单纯克氏针固定和克氏针固定并尺神经皮下前置术,术后评估优良率,观察尺神经恢复疗效。结果单纯固定组优良率为65%,固定并神经前置组优良率为80%,两组疗效不存在显著差异。结论Ⅰ期行尺神经皮下前置能提高尺神经损伤的恢复率,中重度伴有尺神经损伤的患者神经前置远期恢复更佳;未行神经前置的病例,若后期出现迟发性尺神经炎,可再行探查并皮下前置。     

肘管综合征行高频超声检查的价值

目的探讨高频超声检查技术对肘管综合征(CUTS)的诊断价值。方法选择31例肘管综合征患者的患侧手臂尺神经作为CUTS组,健侧手臂尺神经作为对照组,应用高频超声成像技术观察尺神经的连续性、内部结构、回声、有无局限性膨大及比邻结构关系,取横断面测量所有患者患侧尺神经与健侧尺神经的横截面积(CSA)。结果尺神经受压明显时神经局段变细,变细处回声明显减低,束状结构欠清晰,卡压近端及远端神经增粗;尺神经卡压瘢痕粘连时,神经增粗回声减低,外膜及束膜回声增强,与周围组织界限模糊;个别患者未见明显卡压段,仅见肘管内尺神经全程肿胀。31例肘管综合征患者患侧肘管尺神经与健侧肘管尺神经比较,患侧尺神经横截面积较健侧明显增大并存在统计学差异(P<0.05)。结论高频超声能动态观察尺神经卡压征象及其周围结构损伤情况,对肘管综合征的诊断有着重要的应用价值。     

对51例肘部迟发性尺神经炎治疗分析

对51例肘部迟发性尺神经炎行尺神经松解前移手术,随访7个月～2年,尺神经功能改善,其中优36例,良13例,可2例;疗效满意。     

非神经组织束间移植修复神经缺损

采用静脉束间移植治疗周围神经干缺损。对１０例前臂正中、尺、桡神经外伤性缺损而作一期或二期修复的病例，取１束或多束皮下浅静脉移植于断端相应神经束之间，修复１．５－４．５ｃｍ的神经缺损。随访２－３年，感觉恢复达Ｓ３或以上的为８０．０％，运动恢复达Ｍ４的为７５．０％。讨论了此新术式的理论基础、优点、适应证和操作要点。     

周围神经缺损的修复

周围神经缺损在临床上较为常见,常为神经碾挫伤或陈旧性损伤致神经断端回缩所致。其修复方法较多,临床效果各家报道不一。我院自1993－01～1998－01共收治周围神经缺损 46例,取得了较好的疗效。 1　材料与方法 1．1　一般资料：本组男35例,女11例; 年龄10～54岁,平均28.6岁。致伤原因：切割伤24例,钝器伤6例,碾挫伤14例,电击伤2例。其中桡神经16条,正中神经12条,尺神经7条 ,股神经3条,胫神经5条,腓总神经3条。新鲜损伤27条,陈旧性损伤19条。神经缺损长度3 ～14 cm。 1．2　方法：本组有34例通 过各种方法缩短神经两断端之间的距离达直接缝合,12例行游 离神经移植,均取自体腓肠神经,移植长度为3～8 cm。克服神经缺损的方法有：①充分游 离神经,屈曲关节。如正中神经和尺神经游离后屈曲肘、腕关节可克服4～8 cm的缺损,股 神 经和胫神经游离后屈髋屈膝可克服6～8 cm的缺损,术后石膏固定4～6周,以后逐步练习伸 直;②对伴有骨折者,可适当缩短骨折端;③切除近腓腕骨和腓骨小头;④神经移位。如尺 神经肘部前移可克服2～4 cm的缺损,桡神经自腋部前移可克服2 cm左右的缺损;⑤陈旧性 损伤可分期手术,一期手术屈曲关节,缝合两断端神经瘤,术后逐步伸展关节,使神经延长 ,二期手术切除神经瘤,直接缝合神经。46例病人术后随访1.5～4年,平均2.6年。     

神经端侧吻合治疗尺神经缺损2例

我院自2001年10月以来,采用神经端侧吻合法成功治疗尺神经缺损2例,现报告如下。1临床资料病例1:男,41岁。因车祸致左前臂异位畸形,骨质外露急诊入院。查体:左前臂后内侧中段约12cm×6cm皮肤及肌肉挫伤,尺、桡骨粉碎性骨折,尺动脉无搏动,尺神经支配区感觉丧失,手指收展不能,小指对掌不能。入院后急诊手术:术中见掌长肌,尺侧腕屈肌,指深屈肌大部,尺侧腕深肌,小指伸肌挫灭断裂,尺、桡骨中段粉碎性骨折,尺神经、尺动脉断裂缺失,尺神经在腕上6cm处缺损达8cm。正中神经连续性完好。清除坏死肌肉组织后,恢复骨连续性及断裂肌肉。见尺神经无法直接缝…     

肱骨髁间骨折双锁定钢板内固定尺神经前置的临床效果分析

目的：探讨尺神经前置对双锁定钢板内固定治疗肱骨髁间骨折患者临床疗效的影响。方法将我院骨科2008年2月～2013年2月收治的113例肱骨髁间骨折患者随机分为两组,两组均行双锁定钢板内固定,观察组在此基础上行尺神经前置手术,比较两组的临床疗效。结果观察组手术时间大于对照组,差异有统计学意义（P＜0.01）,住院时间、骨折愈合时间小于对照组,差异有统计学意义（P＜0.01）,两组手术出血量差异无统计学意义（P＞0.05）;观察组肘关节功能恢复情况优于对照组,差异有统计学意义（Z＝－2.177,P＝0.029）;术后两组并发症有切口红肿、皮下血肿、钢板断裂、神经损伤,差异无统计学意义（ P＞0.05）,经对症治疗及综合护理,两组的并发症基本缓解。结论尺神经前置术在双锁定钢板内固定肱骨髁间骨折患者中具有促进临床疗效、改善肘关节功能和减少不良反应等特点。     

尺神经部分转位肌皮神经对臂丛损伤屈肘功能恢复的观察

目的探讨部分尺神经转位肌皮神经二头肌支重建臂丛神经损伤屈肘功能的临床疗效。方法对5例臂丛神经上中干损伤的患者(早期2例,晚期3例)采用部分尺神经转位肌皮神经二头肌支手术,随访6～18月(分别于伤后6、8、12、13、18个月实施手术)。术后持续性进行肱二头肌肌动、肘关节屈曲肌力、手内肌握力、尺神经支配区感觉测试。结果所有病例都恢复了肘关节的屈曲功能(肱二头肌肌力均恢复到3级以上)。2例早期病例术后1周内出现肱二头肌主动收缩,肘关节主动屈曲功能正常恢复时间平均6月,平均肌力恢复4+级。3例晚期病例术后平均3个月出现肱二头肌收缩,肘关节主动屈曲功能正常恢复时间平均10个月,平均肌力恢复3+级。3例术后出现尺神经支配区感觉减退,1月后自动恢复。结论部分尺神经转位肌皮神经二头肌支手术是治疗臂丛神经上中干损伤,快速有效恢复肘关节主动屈曲功能的优良方式。     

卧姿射击训练致尺神经肘管卡压7例报告

我院自1997年2月～2001年2月共收治7例卧姿射击训练致尺神经肘管卡压综合征,现报告如下。1 临床资料1.1 一般资料 本组7例,均为男性新兵,年龄19～21岁,在卧姿训练时肘部疼痛伴前臂内侧放射性麻木疼痛,伤后1～16d就诊。1.2 临床表现 7例中右侧6例,左侧1例,均为单侧发病,握力下降6例,感觉障碍7例,夜间麻醒1例;屈肘试验阳性4例,Tinel试验阳性2例。7例均在肩外展和屈肘时加重,肌电图:尺神经在肘段的运动传导速度(MCV)比前臂段减慢(13.5～30.7)m/s,平均21.6m/s。1.3 治疗方法和结果 7例中单纯保守治疗3例,保守加手术治疗4例,有效6例,完全缓解2例,部分缓解1例;尺神经皮下前置术3例,单纯肘管切开1例。治疗6月后,6例握力下降明显改善,7例感觉障碍,其中感觉明显改善5例,缓解2例,夜间麻醒、屈肘试验阳性、Tinel试验阳性均消失,肌电图显示尺神经在肘段的运动传导速度(MCV)比治疗前提高(9.2～25.7)m/s,平均12.6m/s。     

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.