全厚皮片修复颈颌部瘢痕挛缩恢复仰头及头侧偏功能3例报告

Backgroud：Survivalrateoffullthickskinflapfreegraftingislowerthanthatofpediclegraft，thesurviveoftheformerdependsonreconstructionofsub－dermalvascularnetandtraumasurface＇scapillary．Oneofthemaincausesofskinflapsurvivalistofullycutoffscarandthekeyishemostasis．Objective：Tostudytheeffectoffullthickskinflapsfreegraftingintherepairingofscarcontractureinneckandjaw．Unit：CentralHospitalofChaoyang．Subjects：Case１：male，８yearsold，hospitalizedonApril１９，１９９９．Scarcontractureexistedins…     

CT对23例Wilson患者脑组织变性及脑萎缩的评估价值

Wilsondiseaseisalsocalledliversinusoidnucleardegenera－tion．It＇sakindofautosomerecessivehereditydisease．Butimageanalysisonthesepatientsispoor．WestudiedandanalyzedbrainandliverCTimageof２３Wilsondiseasepatientscomparedwithclinicalmanifestations．１Subjectandmethods１．１SubjectInthese２３patients，１３weremales，１０werefe－males．Agewere９～５８yearsold．８were９～２０yearsold，８were２１～３０yearsold，３were３１～４０yearsold，and４were４１～５８yearsold．Diseasecoursewas１month～１７…     

颈总动脉交感神经网剥脱术治疗脑性瘫痪的探讨

１Subjectsandmethods１．１SubjectsTherewere１２４patientsinthisgroup，５９males，６５females，age１yearand５monthsto２８yearsold，averageage６．５yearsold．１０９patients（childgroup）werebetween１and１３yearsold（８８％），１５patients（non－childgroup）werebetween１４and２８yearsold（１２％）．６６patientswithdifficultlabor，intrauterineasphyxiaandpostnatalasphyxiahistory，１３patientswithinflamma－tionofcerebralpart，２１patientswithhighfever，spasmhistory，３patientswithjaundicehistory，５…     

脑卒中后抑郁状态的相关因素分析

Theconcomitantdepressionafterstrokecaninfluencethestateofillnessandrecoveryoffunctiondisorder．Itsmechanismisnotclearnow．Wetookaclinicalstudyon１２１strokepatientsfromJanuary２００１toDecember２００１，reportedasfollowed．１Subjectsandmethods１．１SubjectsAllthe１２１patientswerein－patientpatientsofdepartmentofneurologyofourhospital，including７４malesand４７females，＜４０yearsold：４cases，４１～５０yearsold：１５cases，５１～６０yearsold：４５cases，６１～７０yearsold：３２cases，７１～…     

Hypoxemia features of sleep of pulmo nary heart disease and practical value of oxygen therapy and positive pressure ventilation with no trauma

１Subjectsandmethod１２patientsofpurepulmonaryheartdisease，１０males，２fe－males，agedform５４～７０yearsold（meanage：６０yearsold）．Amongthesepatients，therewere９caseswithlong－termsmokinghistory，７caseswithchronicbronchitisandpulmonaryemphysema，１casewithremotepulmonarytuberculosis，１casewithchronicbronchiectasis，２caseswithpulmonaryinterstitialfibrosis，１casewithchronicorga－nizedpneumonia．Weighingindex（２１～２４）kg／m２．Sleephypoxencicfollowinternationalsleepmedicaldiagnosis…     

颅骨缺损修补对病人精神心理的影响

Localcranialdeficiencyiscommonafteroperationsoncranialtraumaortumors．Intheearlystageofdisease，itplaysactiveef－fect．Butinrehabilitationstageitcouldcauseseriousofpathologi－calandphysiologicalchanges，andaffectthebodyandmindnega－tively．１Subjectsandmethods１．１Subjects２６patientswithcranialdeficiencyreceivedfromJanuary１９９１toSeptember２００１wereallmales，agedfrom１８to５１yearsold．Decompressionbyboneflapresectionwasperformedbe－causeofintracranialhematomaaftercerebralcontusionandl…     

He-Ne激光重复照射抑制培养增生性瘢痕成纤维细胞胶原合成的实验研究

Hypertrophicscar（HS），atypeoffibrosisdiseaseofskinwhichischaracterizedbyhyperproductionanddepositionofcolla－genmatrix．So，inhibitionofcollagensynthesisanddepositionofcollageninfibroblastsareimportantforpreventionofHS犤１犦．Inthecurrentstudy，He－NelaserofvariouspowerdensitywasusedtoirradiateculturedfibroblastsderivedfromHStostudythepre－ventingeffectsofHe－NelaseronHS．１Materialsandmethod１．１Cellcultureandgrouping５casesofHSwereincludedinthisstudyaged１２～３１yearsold（２males，…     

Clinical value of X-ray and DSA examination for malignant tumors underwent inactivating replant surgery

Wecarriedoutlimbssalvageoperationin８casesofmalignantbonetumorsusingpartialtumors－incisionandalcoholinactivationsurgery．Theeffectsweresatisfying．Inthisstudy，weretrospec－tivelyanalyzedfindingsofX－rayandDSAexaminationandin－vestigatedtheirclinicalvalues．１Subjectsandmethods８subjectswereincludedinthisstudy（５men，３women）agedfrom９yearsoldto７１yearsold．Allpatientssufferedfrommalig－nantbonetumorsincluding６casesofosteosarcoma，１Ewing＇ssarcomaand１chondrosarcoma．５tumorswerelocate…     

Repair of residualupper limb dysfunction following burn:2cases report

１MaterialsCase１：Female，１６yearsold，peasantwasadmittedtoourhospitalduetoupperlimbsdysfunction１yearafterleftarmpitburn．Physicalexaminationshowedgoodstatus，contracturedhardscar（１４cm×１８cm）withirregularsurfaceinleftarmpit．Movementrangeofshoulderjointis１０degreesunderfor－wardflexionposition，５degreesunderbackwardextensionposition，５degreesinoutwardextension．PreoperativeX－rayshowednoab－normalchangesinbonematrixofleftshoulderjoint．Scarwasex－cisedunderpamplegiaduringselectiv…     

Analysis of bony density of 3100 outpatients

Detectingofbonydensity，chooseandevaluationofthee－quipmentswereinitiallyreportedtheseyears．Quantitativeultra－soundskeletondensity（QUS）wascertifiedasafemethodwithnoradianinjuryindiagnosisofosteoporosis．３１００outpatientsweredetectedwithQUSfromNovemberof１９９８toJuneof２００１．１Subjectsandmethods１．１SubjectsOutpatientsofvarieddepartmentswhowerevol－unteersintroducedbydoctors．８２５malesand２２７５femalesweredividedinto６groupsaccordingtotheages：２０～２９yearsold，１８０；３０…     

耳大神经移植治疗腮腺内面神经鞘瘤2例临床分析并文献复习

目的 探讨耳大神经移植在腮腺内面神经鞘瘸治疗中的意义.方法 分析面神经鞘瘤切除并取耳大神经移植的2例患者的临床资料.结果 术后面神经功能恢复较快,并发症少.结论 耳大神经移植结合显微外科技术以及血供丰富的软组织移植床对面神经缺损修复至关重要,且切取耳大神经后无严重后遗症.应用耳大神经移植修复面神经较为理想,值得临床推广应用.     

桥小脑肿瘤术中神经功能监测判定面神经的预后

目的使用多导监护仪进行桥脑小脑角肿瘤的多组颅神经术中监测,以监测面神经为主。方法总结60例桥小脑角肿瘤术中监测的经验,其中听神经瘤为47例。使用Viking-IV型多导监护仪,监测自发和诱发的面肌、咬肌和斜方肌肌电图。诱发肌电图使用单极恒压电刺激。结果单极恒压电刺激诱发肌电图可以精确判断面神经的位置,损伤较机械刺激小。刺激量由大到小,距离由远及近,定位准确、及时,并可判断面神经预后。本组结果提示术毕在面神经出脑干端刺激时,刺激量在1V,0.1ms时,术后2周面肌功能在H-B分级的I级。术中监测后面神经保留率为93.6%。其他运动性颅神经均解剖保留。结论术中面神经功能监测是提高肿瘤全切率和面神经保留率的理想方法,并可提供面神经术后康复的依据。     

Single session of brief electrical stimulation immediately following crush injury enhances functional recovery of rat facial nerve

Peripheral nerve injuries lead to a variety of pathological conditions, including paresis or paralysis when the injury involves motor axons. We have been studying ways to enhance the regeneration of peripheral nerves using daily electrical stimulation (ES) following a facial nerve crush injury. In our previous studies, ES was not initiated until 24 h after injury. The current experiment tested whether ES administered immediately following the crush injury would further decrease the time for complete recovery from facial paralysis. Rats received a unilateral facial nerve crush injury and an electrode was positioned on the nerve proximal to the crush site. Animals received daily 30 min sessions of ES for 1 d (day of injury only), 2 d, 4 d, 7 d, or daily until complete functional recovery. Untreated animals received no ES. Animals were observed daily for the return of facial function. Our findings demonstrated that one session of ES was as effective as daily stimulation at enhancing the recovery of most functional parameters. Therefore, the use of a single 30 min session of ES as a possible treatment strategy should be studied in human patients with paralysis as a result of acute nerve injuries.     

Clinical and experimental correlations in temporal bone fracture: the facial nerve

In this review of 50 patients with fracture of the temporal bone, 11 patients had ipsilateral facial paralysis, three of immediate and eight of delayed onset. Eight patients with complete paralysis of the facial nerve had facial nerve decompression; six of these had incomplete return of function. Only one patient with a delayed complete facial paralysis had complete return of function. The poor functional results in patients with delayed complete facial paralysis due to temporal bone fracture encourage facial nerve decompression in all stable patients with the complete facial paralysis of temporal bone fracture.     

美容切口在腮腺良性肿瘤切除术中的应用

目的评价腮腺美容切口在腮腺良性肿瘤切除术中应用的临床价值。方法收集12例腮腺良性肿瘤患者,采用由面部除皱切口改良而来的腮腺美容切口入路,进行保留面神经和耳大神经的腮腺切除术治疗腮腺良性肿瘤。随访观察该切口的美观程度及临床疗效。结果所有患者均达临床I期愈合,无涎瘘发生。1例患者术后出现暂时性面瘫,2个月后恢复。所有患者术后均出现不同程度的耳垂麻木,于术后2个月完全恢复。患者对该切口的美观程度十分满意。结论腮腺美容切口入路隐蔽,美容效果好,腮腺任何部位的良性肿瘤都可以采用此术式。     

音乐节拍按摩法对听神经瘤术后面神经麻痹患者康复治疗依从性的影响

目的探讨音乐节拍按摩法对听神经瘤术后面神经麻痹患者康复治疗依从性的影响,为听神经瘤术后面神经麻痹患者提供简便易学、便于操作的手法按摩方法,提高患者训练的依从性。方法采用前瞻性随机对照的方法,将行乙状窦后入路听神经瘤切除术的92例患者分为观察组45例和对照组47例,两组患者均从术后24h开始进行手法按摩,每日3次,每次15min。对照组仅采用手法按摩,观察组在采用手法按摩时配以音乐节拍。两组患者于术后24h及术后1个月均采用House—Braekmann面神经功能评定法进行面神经麻痹等级评定,采用治疗依从性量表于术后1个月进行依从性评分。结果观察组治疗依从性好者18例,部分依从者22例,依从性差者5例;对照组依从性好者11例;部分依从者20例,依从性差者16例,观察组康复治疗依从性明显高于对照组,两组比较,差异具有统计学意义（x^2=7．5069,P〈0．05）。在面神经麻痹康复治疗效果方面,观察组痊愈12例,显效23例,好转7例,无效3例;对照组痊愈9例,显效14例,好转16例,无效8例,经等级资料两样本比较,观察组疗效优于对照组,差异具有统计学意义（U=2．372,P〈0．05）。结论音乐节拍按摩法可以规范按摩手法,在音乐节拍的引导下使康复训练定时、定量、定位,提高患者治疗的依从性、准确性,确保康复训练效果。     

重症肌无力的重复神经刺激技术研究

目的研究重复神经刺激技术(RNS)对重症肌无力(MG)疾病的诊断价值。方法对36例MG患者的面神经,腋神经及尺神经分别进行RNS检查,共检查108条神经。结果108条神经中RNS阳性率为60.2％(65条),其中以腋神经对应的三角肌阳性率最高77.8％(28/36),尺神经对应的小指展肌阳性率最低41.7％(15/36)。同一患者有一条或多条神经RNS阳性的病例数为总例数的86.1％(31/36).所有RNS阳性的MG患者在低频刺激即可获得阳性结果,最佳刺激频率为3～5Hz。结论对MG患者同时进行腋神经,面神经和尺神经的重频刺激,可提高RNS的阳性率。     

Electrophysiologic evaluation of the facial nerve in Bell's palsy. A review

Facial nerve paralysis is the most common mononeuropathy and idiopathic facial paralysis (Bell's palsy) the most common seventh nerve disease electromyographers may be asked to evaluate. The electrophysiologic method of choice to assess the facial nerve is side-to-side evoked amplitude comparison with the affected side expressed as a percentage of the nonaffected side. This examination should be performed on days 3, 5, 7, 9, 11 and 13 after onset of paralysis. If the percentage of surviving axons falls below 10% within the first 14 days, an incomplete recovery is suggested. Electromyography may assist in prognosticating a functional return, determining neural conduction across the site of injury and following reinervation in the recovery period. The persistence or early return of an absent R1 component of the blink reflex may qualitatively suggest a satisfactory functional outcome in facial paralysis. Supramaximally exciting the facial nerve at the stylomastoid foramen and comparing the clinical response on the affected and nonaffected side, maximum stimulation test, can also predict eventual seventh nerve return. Observing a minimal twitch, utilizing the nerve excitability test or measuring the facial nerve latency have yielded poor correlations with functional return and are of limited usefulness in the prognostication of acute facial palsies. Trigeminal somatosensory evoked potentials can be employed to evaluate the status of the trigeminal nerve as approximately 50% of patients with Bell's palsy also have lesions involving the fifth nerve. Side-to-side amplitude comparison and electromyography are the two most valuable electrophysiologic methods of assessing facial nerve functioning.     

PLGA artificial nerve conduits with dental pulp cells promote facial nerve regeneration

A number of recent studies have shown the effectiveness of tubulation, using neural progenitor cells or Schwann cells, for promoting nerve regeneration. However, the use of neural cells from other neural donor tissues has potentially serious clinical complications. Therefore, we focused on dental pulp as a new cell source for use in such artificial conditions. Previously, we showed that silicone tubes filled with dental pulp cells (DPCs) promoted facial nerve regeneration in rats. However, the use of silicone tubes requires a secondary removal operation because they may give rise to chronic inflammation and pain. Therefore, to avoid this procedure, a new artificial device was prepared from a degradable poly-DL-lactide-co-glycolide (PLGA) tube containing DPCs, and its effectiveness for repairing gaps in the facial nerves of rats was investigated. A PLGA tube containing rat DPCs embedded in a collagen gel was transplanted into a gap in a rat facial nerve. Five days after transplantation, the facial nerves connected by the PLGA tubes containing DPCs were repaired more quickly than the control nerves. The PLGA tubes were resorbed in vivo and nerve regeneration was observed 2 months after the transplantation. Immunostaining showed that Tuj1-positive axons were present in the regenerated nerves 2 months after transplantation, and osmium-toluidine blue staining showed no mineralization of the regenerated nerves in those tubes containing myelinated fibres after 9 weeks. PLGA tubes filled with DPCs promoted nerve regeneration and were readily resorbed in vivo.     

感觉神经端侧吻合后再生纤维的功能

目的:应用两种电生理技术,评价感觉神经端侧吻合后再生神经的功能。方法:取兔(新西兰兔15只,雌雄不拘,随机分为实验组、对照组和正常组,每组5只)耳大神经移植体作为受神经,与对侧耳大神经端侧吻合并植入皮瓣。用神经单纤维放电引导电生理技术检测皮瓣内再生放电纤维数量、分布、感觉类型。同时以免(新西兰兔16只,雌雄不拘,随机分为10,20,30周实验组和正常对照组,每组4只)2条耳大神经作端侧吻合模型,用RM-6280多道智能生理记录及分析处理系统测定再生纤维动作电位幅值恢复率和神经传导速度。结果:植入皮瓣的受神经在术后4个月可再生触、压、痛、温冷觉末梢,使皮瓣初步建立神经再支配。受神经内再生纤维的动作电位幅值恢复率10,20,30周时分别为(53.0±3.7)%,(66.8±5.5)%,(88.8±2.3)%;神经传导速度10,20,30周时分别为(42.4±1.6),(55.6±1.2),(57.2±1.6)m/s,随时间延长逐步增加。术后30周受神经近端再生纤维幅值恢复率和传导速度分别达到正常的88.8%和94.38%。结论:感觉神经端侧吻合后能再生有功能的神经纤维,再生速度稍慢。