颞骨骨折致面瘫及听力损失的诊治

目的对65例颞骨骨折致面瘫及听力损失的处理进行探讨。方法应用纯音测听、听性脑干反应(ABR)、40Hz听性相关电位(40HzAERP)检测、耳声发射(DPOAE)、声导抗测试、泪分泌试验、面肌电图及颞骨CT对每一例患者进行检测。根据面神经损伤部位,选择不同的手术径路进行处理以及对不同的听力损失进行处理。结果37例面神经损伤患者进行神经减压术。术后随访6个月面神经功能分级在House-Brackmann(H2B)Ⅰ级14例,Ⅱ级17例,Ⅲ级3例,Ⅳ级3例。9例传导性耳聋经听骨链重建术及鼓膜修补术后,其中7例纯音听阈达到应用水平(语频平均30dB),气骨导差减少10dB,2例气骨导差≤15dB。结论颞骨骨折引起的面瘫通过面神经减压基本上可以恢复,大部分患者听力可以得到恢复。     

选择性面神经减压术治疗外伤性周围性面瘫

目的：探讨选择性面神经减压术治疗外伤性周围性面瘫的方法和临床意义。方法：回顾性分析1990-2001年间采用连续性面神经减压术治疗外伤性周围性面瘫103例的临床特点及治疗方法。结果：103例患者中术后随访93例，依据House-Brackmann面神经功能恢复评分标准评定，Ⅰ级恢复71例，Ⅱ级恢复14例，Ⅲ级恢复5例，Ⅳ级恢复2例，Ⅴ级恢复1例，其中Ⅰ－Ⅱ级恢复者占随访人数的91.4%。结论：选择性面神经减压术治疗外伤性周围性面瘫是一种更为简便、有效的手术方法。     

面神经瘤的CT和MRI诊断

目的：研究面神经瘤的CT和MRI表现,提高对其的认识。方法：9例面神经瘤中,8例面神经鞘瘤,1例面神经纤维瘤。7例行颞骨高分辨CT扫描,2例常规扫描;6例行MRI检查,其中5例做了增强扫描。结果：本组发生在右侧5例,左侧4例;内听道1例,迷路段4例,膝状神经节6例,鼓突段（降段）6例,茎乳孔5例,腮腺3例。CT表现：面神经管扩大,膝状窝骨壁膨胀,面神经径路上有条索状或结节样软组织影。MRI表现：面神经呈结节样或条索状增粗,呈跨节段性分布,T1WI为等信号,T2WI为等或高信号;有明显强化。结论：面神经径路上出现实质性节段性肿块是面神经瘤的影像特点。MR增强扫描是一种有效的检查手段。     

面神经管骨折的CT诊断：附25例报告

目的：分析２５例面神经管骨折高分辨率ＣＴ所见，探讨各类型骨折与面神经管各段损伤的关系。材料与方法：对２５例面神经管骨折患者均采用高分辨率ＣＴ横断面及冠状面扫描，２例除横断及冠状面扫描外并行直接矢状面ＣＴ扫描。结果：面神经管迷路段损伤６例，占１３．８％；鼓室段损伤１４例，占４８．３％；乳突段损伤１１例，占３７．９％。结论：高分辨率ＣＴ可为外伤性面瘫提供可靠的诊断依据，对临床手术及估计预后有重要价值。     

颞骨骨折及其并发症的临床研究

为探讨颞骨骨折及其并发症的特点及救治方法，作者对1989年1月－1999年11月收治的48例颞骨骨折临床资料进行了回顾性分析。结果显示，48例颞骨骨折患者中交通事故所致的占66．7％，存活43例（89．6％），死亡5例（10．4％）；中、内耳或颅脑损伤占77．1％，听力下降或耳鸣占48％；纵行骨折的脑脊液耳漏占36．7％，面瘫占3％；横行骨折的面瘫占37．5％，脑脊液耳漏则占25％。研究结果表明，交通事故伤是造成颞骨骨折的首要高危因素，其严重并发症为颅脑损伤，合并多脏器伤常是致死性并发症；其常用并发症为听力下降或耳鸣等中、内耳损伤；纵行骨折以脑脊液耳漏多见，横行骨折易造成面瘫。     

外伤性面瘫的多层螺旋CT研究

目的探讨多层螺旋CT(MSCT)在外伤性面瘫中的应用价值。方法用MSCT对41例外伤性面瘫的颞骨行高分辨率轴面扫描。用Ph ilipsMx8000MSCT工作站,行岩锥感兴趣区的多平面重建(MPR)及面神经管的曲面重建(CPR)。观察骨折类型,骨折线的走行,中耳腔、乳突积血及外耳、中耳、内耳和面神经管的受累情况。结果41例患者中,39例颞骨有不同部位、不同类型的骨折,其中岩骨纵行骨折34例,横行骨折2例,混合型2例,1例岩骨无骨折,但颞骨鳞部骨折,2例未发现骨折。其中2例为双侧岩骨骨折。面神经管的CPR及MPR显示21例患者面神经管受累,9例可见骨碎片。结论MSCT扫描及重建技术能清晰显示面神经管的全貌及其损伤,对外伤性面瘫的诊断有重要意义。     

侧前方减压植骨内固定术治疗陈旧性胸腰段脊柱骨折伴截瘫

目的评价侧前方减压植骨内固定术治疗陈旧性胸腰段脊柱骨折伴截瘫的效果。方法采用侧前方减压植骨内固定术治疗胸腰段脊柱陈旧性骨折伴截瘫共26例,对临床资料进行回顾性分析。结果随访时间为术后6个月～2.5年。后凸角术前为23°,术后为6°。神经功能恢复按Frankel分级,术前A级2例,B级3例,C级5例,D级7例,E级9例;术后A级1例,B级3例,C级4例,D级6例,E级12例。结论对于因前方压迫造成神经损伤的陈旧性胸腰段脊柱骨折患者,尤其对于仅由中柱的骨折移位而致脊髓损伤者,侧前方减压、植骨加内固定是首选的方法。     

中耳乳突手术致面神经损伤17例报告

面神经损伤是中耳乳突手术常见而又严重的并发症,现将我科1975～1995年间进行中耳乳突手术发生面神经损伤的病例分析介绍如下。 1　临床资料 　　20年间进行中耳乳突手术289例,发生面神经损伤17例,占5.88％。损伤部位,水平段6例, 占35.29％;垂直段11例,占64.70％。损伤原因：面神经骨管鼓室段先天性缺裂11例,占64 .70％,其中3例面神经走向有异常,术中损伤面神经骨管5例,占24.41％,牵拉鼓索神经致 伤1例,占5.88％。17例中面神经均为刺激、牵拉伤。16例当即进行面神经骨管部分减压术 ,术后面神经功能恢复理想,1例未行减压术,面神经功能未恢复,面神经损伤的治愈率达 到94.11％。 　　面神经部分减压术的具体方法：继续在局麻下用6倍手术显微镜将面神经损伤部位探查清楚 ,用切削钻头将受损部位及两端骨管骨质切削磨薄,再用小剥离器将已磨薄之骨片向外挑起 取出,范围为骨管两端各约5 mm,彻底开放面神经受损两端骨管,达到充分减压目的,一般 不切开面神经鞘膜。     

颞骨内面神经病变的影像学表现

目的总结分析面神经病变的影像学检查方法和表现,提高诊断准确性。资料与方法回顾性分析31例经手术病理或临床跟踪随访证实的面神经病变的CT和MRI表现,31例行MR扫描,其中28例行平扫和增强扫描,3例仅行平扫;19例行CT扫描。结果（1）面神经损伤13例,8例行CT扫描,6例显示面神经管骨折,2例表现正常;13例MRI扫描均表现为面神经增粗,其中10例增强扫描显示面神经明显强化。（2）面神经炎14例,7例行CT扫描,1例因岩尖胆脂瘤致面神经管迷路段、前膝部、鼓室段前部骨质破坏,6例面神经管未见异常;14例MRI增强扫描显示面神经节段性异常强化。（3）面神经鞘瘤4例,CT表现为受累面神经管骨质破坏和软组织肿块;MRI表现为面神经节段性增粗,呈长T1、长T2信号,信号不均匀,增强后不均匀强化。经统计学处理,MRI显示颞骨内面神经病变明显优于CT（P＜0．01）。结论HRCT可显示面神经管的异常,MRI尤其是MR增强扫描可显示面神经病变的形态、部位、范围及强化表现,有助于病变的诊断和鉴别诊断。     

MR增强扫描在Bell面瘫患者复查中的应用

目的 纵向观察Bell面瘫患者面神经的MR强化特征变化与预后的关系。方法 本研究为纵向观察性研究，前瞻性连续纳入本院神经内科住院的26例临床诊断为单侧Bell面瘫的患者为研究对象，分别于发病3天内、1个月、3个月三次MR面神经增强扫描，根据3个月后患者面瘫恢复情况分为完全恢复组和不完全恢复组。每次MR检查对患者进行轴位T₁WI三维磁化强度预备梯度回波序列(T₁-3D-MP RAGE)增强扫描，把面神经分为用于评估强化程度的五个节段，并对各节段面神经强化程度进行1～3级的分级标识。结果 完全恢复组21例，不完全恢复组5例。发病3个月后不完全恢复组的内听道底段、迷路段、膝状神经节及鼓室段强化程度均高于完全恢复组，差异有统计学意义(P<0.05),而发病3天内和1个月后的内听道底段、迷路段、膝状神经节、鼓室段、乳突段及发病3个月后的乳突段强化程度均没有统计学差异(P>0.05)。结论 患侧面神经早期异常强化程度与患者最终预后无直接相关性，但是3个月后仍有多节段异常强化提示患者3月后甚至更远期的预后不良。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.