神经外科住院医师脊柱亚专业培训的思考

随着神经外科向广度和深度的不断发展,各个亚专业的出现成为必然,除传统的肿瘤外科、创伤外科和血管外科外,一些新的亚专业不断发展壮大,例如血管内神经外科、功能神经外科等.     

加强神经外科脊柱亚专业培训,全面提高脊柱神经外科水平

脊柱神经外科已成为我国神经外科全面发展的主要因素。尽管我国神经外科在椎管内肿瘤、特别是脊髓髓内肿瘤的手术治疗方面取得了很大进展,但是对脊柱的稳定性还认识不足,且脊柱内固定技术掌握     

美国神经外科住院医师培训制度

神经外科医生不但要熟练掌握必需的临床技能,还要熟悉相关的基础、专业知识,所以神经外科医生的培养非常重要。国外的神经外科专业发展较早,已建立了较完善的专科医师培训制度,现将美国的神经外科住院医师培训制度做一综述,以兹参考和借鉴。1 住院医师的申请与选拔美国每所医学院校每年招收1~2名住院医师进行神经外科培训,要求申请者按规定完成4年的医学教育,获得医学博士学位(M.D.),并在医学院校所在地区取得行医资格。选拔过程于每年的1月按照神经外科住院医师选拔计划(Neurosurgery Residency Matching Program,NSMP)进行。申请者…     

加强脊髓脊柱术后不稳与重建研究

随着脊柱神经外科手术的广泛开展、手术病例的不断增加及随访时间的延长,逐渐发现部分病例因术后脊柱不稳(滑脱、侧弯、后凸畸形等)导致脊髓或脊神经受压损伤,部分患者远期疗效欠佳,甚至少数患者术后出现严重性损伤[1～3].手术对脊柱部分结构的破坏及术后生物力学性质的改变是脊柱术后不稳的重要原因之一,已引起广大神经外科医师的高度重视.但是,许多神经外科单位对脊柱术后不稳缺乏有效的应对措施,需要骨科医师来帮助完成,或者直接放弃脊柱稳定性的重建,这对作为脊柱神经外科医师来说是不完美的,神经外科医师应尽快提高及掌握脊柱术后不稳定性的应对策略[4～6].     

我国功能神经外科的过去、现在和未来

中枢神经系统功能性疾病是中枢神经系统生理功能改变或紊乱所致的疾病.功能神经外科是应用各种手术和技术,通过对中枢神经系统的某些结构进行刺激、破坏或重建,实现新的系统平衡.以达到缓解症状、恢复神经功能之目的[1].功能神经外科是随着科学技术的进步和神经外科的发展而逐步发展起来的.     

颅底肿瘤外科发展现状与存在问题

对于解剖关系复杂、治疗困难的颅底肿瘤,需组成多学科诊疗模式(神经外科、耳鼻咽喉头颈外科、口腔颌面外科、眼科、整形外科等),方能达到有效切除肿瘤、改善患者神经功能、提高生活质量的目的;颅底肿瘤外科被视为当今极具挑战性的神经外科亚专科.本文通过对我国颅底肿瘤外科发展现状及存在问题的回顾,展望未来发展方向,以推动我国颅底肿瘤...     

神经外科麻醉:现状与展望

神经外科学自1904年创立至今,经历了从经典神经外科、显微神经外科到微创神经外科3个发展阶段.近年来,神经外科学进入了一个崭新的时代,神经外科手术已经从传统的解剖学模式转变为现代解剖-功能模式,在尽可能切除病灶的同时最大限度地保护脑功能,大大提高了手术质量.神经外科学的发展与神经影像学、神经麻醉学、神经生理学、神经生物学等相关学科的发展密不可分.随着麻醉学的迅速发展,大量过去被认为是禁忌的疑难、危重病患者得到了及时的手术治疗,麻醉期间对生命功能的监测与调控,以及血液保护、手术后镇痛等不断普及,更在无形中推动了神经外科学的发展.麻醉学新药物、新方法、新技术、新理念有效保障了围手术期的正常脑功能,提高了手术治疗效果.     

2009年度国家自然科学基金资助神经外科学基础研究概述

本文概述了2009年度神经外科学领域国家自然科学基金(以下简称科学基金)的受理、评审和资助情况,通过对申请和资助项目的分析,反映神经外科学领域基础研究的现状、发展趋势及存在的问题,并提出建议.谨供从事神经外科学研究的科研工作者在申报科学基金时参考.     

脊椎旁刺激法体感诱发电位在脊髓病变中的临床应用

目的 探讨脊椎旁刺激法体感诱发电位（SEPs）在脊髓病变患者中进行脊髓功能判断的临床应用价值，并将诱发电位结果与脊髓MRI结果进行比较，初步探讨该方法在脊髓病变中的生理定位价值。方法 应用脊椎旁刺激、头皮记录的直接SEPs法对脊髓病变患者进行SEPs测定及脊髓传导速度（SCCV）测定。结果 共有96例脊髓病变患者行脊椎旁刺激法SEPs及SCCV测定，男53例，女43例，年龄15-75岁，平均46．78岁。其中脊髓脱髓鞘病36例，脊髓亚急性联合变性26例，脊髓病19例，急性脊髓炎10例，脊髓压迫性疾病5例。96例脊髓病变患者均做脊椎旁刺激法SEPs检查，脊髓诱发电位及SCCV的异常率在各脊髓病变中阳性率均较高，总异常率为81．25％（78／96）。其中脊髓脱髓鞘病异常率75．00％（27／36），脊髓亚急性联合变性异常率88．46％（23／26），脊髓病19例中有15例异常，脊髓炎异常率10例中有8例异常，脊髓压迫症5例均异常。共有68例患者做脊髓MRI检查，其中42例MRI异常，26例MRI正常。42例MRI异常患者中35例诱发电位结果异常，26例MRI正常患者中21例诱发电位结果异常。结论 脊椎旁刺激法SEPs及SCCV的测定客观地记录了脊髓病变的异常电生理改变，其异常电生理改变可能会出现在脊髓结构改变及影像学改变之前，可为脊髓病变患者早期脊髓功能性改变提供比较可靠的客观诊断依据，尤其在脊髓MRI少有阳性所见的营养代谢性脊髓病中意义更大。本方法简单、无创、具有可重复性，可在临床中应用。     

家庭作业式院外康复训练对脊柱结核患者手术效果的影响

目的探讨脊柱结核手术患者出院后康复训练对于保持手术疗效的意义。方法自2007-10以来,对在本院进行脊柱结核病灶清除、减压、植骨、内固定术患者给予出院后以家庭作业式方法进行康复训练督导,包括肢体运动功能训练、正确用药、合理饮食、情绪调控及并发症预防指导等。结果治疗组手术后1 a日常生活活动功能评分(ADL)与手术后2周的评分有明显差异,而对照组差异不明显。结论以院外肢体运动训练为主的综合治疗、护理是影响脊柱结核手术疗效的重要因素。     

A national survey on the impact of the COVID-19 pandemic upon burnout and career satisfaction among neurosurgery residents

The coronavirus disease 2019 (COVID-19) pandemic has posed significant changes to resident education and workflow. However, the impact of the pandemic on U.S. neurosurgery residents has not been well characterized. We investigated the impact of the COVID-19 pandemic on U.S. neurosurgery resident workflow, burnout, and career satisfaction. In 2020, a survey evaluating factors related to career satisfaction and burnout was emailed to 1,374 American Association of Neurological Surgeons (AANS) residents. Bivariate and multivariate (logistic) analyses were performed to characterize predictors of burnout and career satisfaction. 167 survey responses were received, with a response rate (12.2%) comparable to that of similar studies. Exclusion of incomplete responses yielded 111 complete responses. Most respondents were male (65.8%) and White (75.7%). Residents reported fewer work hours (67.6%) and concern that COVID-19 would impair their achievement of surgical milestones (65.8%). Burnout was identified in 29 (26.1%) respondents and career satisfaction in 82 (73.9%) respondents. In multivariate analysis, burnout was significantly associated with alterations in elective rotation/vacation schedules (p = .013) and the decision to not pursue neurosurgery again if given the choice (p < .001). Higher post-graduate year was associated with less burnout (p = .011). Residents displayed greater career satisfaction when focusing their clinical work upon neurosurgical care (p = .065). Factors related to COVID-19 have contributed to workflow changes among U.S. neurosurgery residents. We report a moderate burnout rate and a paradoxically high career satisfaction rate among neurosurgery residents. Understanding modifiable stressors during the COVID-19 pandemic may help to formulate interventions to mitigate burnout and improve career satisfaction among residents.     

大鼠脊髓损伤后轴突病理变化与胶质瘢痕的关系

目的 观察脊髓损伤(SCI)后轴突变化及其与胶质瘢痕的关系.方法 应用Allen's法建立大鼠脊髓损伤模型,通过行为学评分、免疫荧光及神经束路示踪等观察SCI后轴突的病理变化,及其与胶质瘢痕的关系,并测量胶质瘢痕的厚度.结果 SCI后损伤处的轴突呈断裂、扭曲状,SCI后1 周损伤轴突呈再生趋势,2周时再生明显,与此相应动物运动功能逐渐恢复,4周时胶质瘢痕形成,再生的轴突被瘢痕阻挡.头尾侧胶质瘢痕厚度(107.00±20.12)μm大于两侧边厚度(69.92±24.37)μm.结论 SCI后轴突仍具有再生能力,但被胶质瘢痕所阻挡,瘢痕厚度的测量为将来去除胶质瘢痕提供了实验依据.     

The effects of aging on spinal neurochemistry in the rat

The purpose of this study was to investigate how the aging process alters the basal levels of serotonin, norepinephrine, dopamine, and their respective metabolites in the spinal cord using high-performance liquid chromatography and electrochemical detection. Young, mature and aged male Fischer 344 rats (5–6, 15–16, and 25–26 months old, respectively) were used in all experiments. Dorsal and ventral halves of the cervical, thoracic, lumbar and sacral vertebral sections of the rat spinal cord were analyzed. The results indicate that as chronological age increases, local spinal levels of serotonin and norepinephrine decrease. These findings are discussed in terms of how age-related changes in the endogenous levels of the biogenic amines may alter the perception of pain in the elderly.     

Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat

BackgroundSpinal cord injury (SCI) is a critical medical condition that causes numerous impairments leading to accompanying disability. Robotic-assisted gait training (RAGT) offers many advantages, including the capability to increase the intensity and total duration of training while maintaining a physiological gait pattern. The effects of the RAGT ‘Lokomat’ on various impairments following SCI remain unclear.ObjectivesThis review was conducted to examine the impacts of the RAGT ‘Lokomat’ on the impairments following SCI.MethodsWe searched PubMed, SCOPUS, PEDro, REHABDATA, MEDLINE, EMBASE, and web of science from inception to January 2021. Experimental studies examining the effects of the Lokomat on the impairments following incomplete SCI were selected. The methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.ResultsSixteen studies were met the inclusion criteria. Thirteen were randomized controlled trials, two were clinical trials, and one was a pilot study. The scores on the PEDro scale ranged from two to eight, with a median score of six. The results showed evidence for the beneficial effects of the Lokomat on many motor impairments following incomplete SCI.ConclusionsThe Lokomat may improve gait speed, walking distance, strength, range of motion, and mobility after incomplete SCI. There is insufficient evidence for the effect of the Lokomat on balance, depression, cardiorespiratory fitness, and quality of life. The effects of the Lokomat on the lower extremity spasticity were limited.     

Update on the global neurosurgery movement: A systematic review of international vernacular,research trends,and authorship

In 2015, key global and neurosurgical organizations increased collaboration to improve neurosurgical care access, delivery, and outcomes, particularly in low- to middle-income countries (LMICs); sparking what has been termed the global neurosurgery movement. The authors sought to assess trends in usage of the term ‘global neurosurgery’ in academic literature with particular focus on author affiliations, world regions most frequently discussed, and topics of research performed. A PubMed search for articles indexed as ‘global neurosurgery’ was completed yielding 277 articles which met inclusion criteria. It was found that over time, use of the term ‘global neurosurgery’ has increased, with increasing growth notable starting in the year 2008 and continuing into October 2019. Statistical comparisons showed authors with affiliated global neurosurgery centers were more likely to publish studies related to the continent of Africa (47.4% vs 15.9%, p < 0.001), and less likely to focus on countries in Asia (2.6% vs 20.9%, p = 0.023). Use of the term ‘global neurosurgery’ in the article abstract/title/keywords was associated with focus on LMICs (18.6% vs. 5.1%, p = 0.006). Use of the term ‘global neurosurgery’ was associated with workforce and capacity as research topics (41.9% vs 22.6%, p = 0.036). While fairly new, the global neurosurgery movement has seen a rapid increase in publications utilizing the term ‘global neurosurgery.’ Articles frequently have focused on collaborative, targeted workforce capacity building in LMICs. We encourage the development of more global neurosurgery academic centers, especially in non-USA countries, to continue this momentum.     

The combined effects of clonidine and cyproheptadine with interactive training on the modulation of locomotion in spinal cord injured subjects

The combined effects of a noradrenergic agonist, clonidine, and a serotonergic antagonist, cyproheptadine, together with an interactive locomotor training program incorporating progressive body weight support and treadmill walking exercise, were investigated in two chronic spinal cord injured subjects. Both subjects had no independent locomotor ability due to severe spasticity. Kinematic, temporal distance and electromyographic (EMG) data were collected during treadmill walking. The EMG activity of the lower limb muscles, initially characterized by tonic discharge and abnormal timing, became more phasic with less clonus following medication, which was related to a change in the kinematic pattern. Further kinematic and functional improvement were gained by training. Previously wheelchair-bound, both patients became functionally ambulatory overground with the aid of Canadian crutches. Thus, a potentially effective strategy for facilitating the expression of the locomotor pattern following spinal cord injury is proposed. This preliminary study showed that such a treatment strategy could possibly lead to a recovery of locomotor function in some chronic, wheelchair-bound spinal cord injured patients who had previously been stabilized on conventional therapies.