颈椎硬膜外连续神经阻滞联合银质针治疗颈性眩晕的临床观察

目的：探讨颈性眩晕经颈椎硬膜外连续神经阻滞联合银质针的治疗效果。方法总结收治的60例颈性眩晕患者的临床资料,观察硬膜外连续神经阻滞联合银质针治疗(YYZ)组和星状神经阻滞(XZ)组的临床疗效。结果通过3个月~1年的随访,发现两种治疗方法治疗颈性眩晕均有疗效,但以颈椎硬膜外连续神经阻滞联合银质针治疗疗效好,颈椎硬膜外连续神经阻滞联合银质针治疗的总有效率(84.9%)明显大于星状神经阻滞治疗组(64.2%)。结论颈椎硬膜外连续神经阻滞联合银质针治疗颈性眩晕优于星状神经节阻滞治疗颈性眩晕,不仅疗效确切,而且患者远期疗效好,复发少,颈椎硬膜外连续神经阻滞联合银质针治疗颈性眩晕是临床上较好的治疗方法。     

星状神经节连续阻滞术治疗颈性眩晕的临床研究

目的 研究星状神经节连续阻滞术对颈性眩晕患者的治疗效果及作用机制分析.方法 通过对43例颈性眩晕采用星状神经节连续阻滞术,观察住院及随访中患者的眩晕等症状改善情况.结果 星状神经节连续阻滞术对颈性眩晕患者有效率达88.4%.结论 连续阻滞术药效持久均匀,避免多次穿刺注药造成痛苦,病人易于接受,值得临床推广应用.     

逆行标记法研究颈脊神经节至交感神经节的神经反射通路

目的 分析颈交感神经节和颈脊神经节之间的神经纤维联系,探讨颈性眩晕发病的神经反射基础.方法 48只新西兰兔随机分为颈上交感神经节组和颈下交感神经节组及相应对照组,于颈上或颈下交感神经节内分别注入荧光金溶液或生理盐水,分别于存活4、8d后取出双侧颈脊神经节C2～C8,制备冷冻切片并进行荧光显微镜观察分析.结果 颈上交感神...     

寰枢椎因素致椎动脉供血不足的解剖学机制

颈性眩晕的主要原因是椎动脉供血不足 ,寰枢椎因素在其中起着重要的作用。本文就寰枢椎因素致椎动脉供血不足的解剖学基础及其机制方面的研究作一综述     

股外侧皮神经在髂前上棘附近的解剖学和超声观察

目的 感觉异常性股痛(MP)常由股外侧皮神经(LFCN)的机械嵌压引起,通常发生在股外侧皮神经走行至髂前上棘的部位。MP最佳手术治疗方法有待确定,部分原因是LFCN周围筋膜平面的精细结构尚未阐明。本研究的目的是利用生物塑化和超声确定LFCN在髂前上棘附近的筋膜结构。方法 选择11具尸体（6名女性,5名男性, 38～97岁）制作薄层生物塑化切片。对34名健康志愿者（19名女性,15名男性,20～62岁）进行LFCN超声评估。结果 LFCN在腹内斜肌筋膜纤维和髂筋膜之间出骨盆,然后在缝匠肌表面和位于髂前上棘（ASIS）下方的阔筋膜张肌之间走行。在缝匠肌和阔筋膜张肌之间,LFCN走行在独立封闭的筋膜鞘中。结论 LFCN在髂前上棘处位于腹内斜肌腱膜内。LFCN在缝匠肌表面及外侧走行至大腿前外侧区域。超声定位LFCN有助于外科手术。     

家兔颈上神经节双核神经细胞的实验观察

本文通过组织培养和电子显微镜观察了家兔颈上神经节双核神经细胞在NGF阳激光作用下超微结构的改变。得出:1)在组织培养条件下,交感神经节单、双核神经细胞体的超微结构对NGF的反应相同。2)激光促进交感神经节细胞再生合成代谢形态学改变的生物学效应需要NGF的协助;其促进机理尚须进一步作生理生化研究。     

椎间孔外颈神经卡压的解剖学基础

颈肩痛是临床上十分常见的疾患,近年来其发病率逐年上升,并趋于年轻化.既往多将其归于“颈椎病”范畴,认为多因椎管内因素如：颈椎退变、颈椎间盘突出及椎管狭窄而刺激或压迫颈髓和颈神经根所致,然而相当一部分患者按此对症治疗无效或效果不佳而反复发作.随着对其研究的不断深入,逐渐认识到非椎间盘源性病变即椎间孔外的颈神经卡压亦是引起颈肩痛的重要原因.现结合国内外最新研究,对其病变的解剖基础作综述如下.     

家兔颈上神经节神经细胞分离培养的形态观察

本文通过神经细胞分离培养技术,观察了家兔颈上神经节神经细胞的形态学特点。指出,细胞分离培养的家兔颈上神经节神经细胞可呈单极、双极和多极性;双核神经细胞除核外,其形态特征与单核神经细胞相同,在新生家兔颈上神经节中存在着与脊神经节中神经母细胞相似的泪滴状神经细胞。双核神经细胞核与泪滴状神经细胞的形态学演变过程尚须进一步研究。     

刃针松解配合传统针刺治疗颈性眩晕的解剖学与经穴关联性分析

目的　观察刃针松解配合传统针刺治疗颈性眩晕的临床疗效。 方法　100例颈性眩晕患者随机分为观察组与对照组,每组各50例。对照组单纯给予刃针松解治疗,观察组在刃针松解治疗的基础上加用传统毫针针刺疗法,分别观察治疗前及治疗2周后两组的视觉模拟评分（VAS评分）及临床显效率。 结果　观察组和对照组治疗后的VAS评分[（2.14±0.83）、（3.78±1.30）]均较治疗前[（7.17±2.83）、（7.25±2.48）]减少,差异有显著性（P＜0.05）;治疗后两组VAS评分比较,差异有显著性（P＜0.05）。观察组与对照组显效率（72%与56%）比较,差异有显著性（P＜0.05）。 结论　刃针松解配合传统针刺治疗颈性眩晕较单纯刃针松解疗效显著,值得临床推广应用。     

寰椎后弓椎动脉沟环与颈性眩晕92例临床X线分析

目的：探讨寰椎后弓椎动脉沟环（下称后环）对颈性眩晕的关系．材料方法：从1000例颈椎摄片中,选出有后环的92例。体征通过转动头颈诱发椎动脉屈曲试验阳性,58例作脑血管多普勒（TCD）检查评估基底动脉供血情况,全部病例在电视下摄取颈椎正侧及双斜位片,分析后环的形态、大小及出现位置．结果：（1）完整环／孔46例。呈椭圆形者39例,近似圆形者7例,双侧着7例,左侧者19例,右侧着20例,不完整环46例。有3种X线变异型：上突骨、下突骨与吻状突骨．有颈椎退变者34例;无颈椎退变者58例．（2）后环与颈性眩晕无颈椎退变X线征象的58例（63％）,TCD均提示基底动脉痉挛或供血不足,其中5例还出现单侧或双侧大脑中动脉血流下降,另8例经转头后才显示基底动脉供血不足。（3）临床主要以椎动脉型颈性眩晕者38例,颈一脑－臂综合症者54例．结论：后环的存在,对头颈的轴向旋转运动,可引起椎动脉V－3段痉挛与狭窄．导致脑底供血不足出现间歇性眩晕有密切关系。     

神经肽Y在兔颈部交感神经节与脊神经节间通路应用研究

目的　通过电刺激兔颈脊神经节,检测颈交感神经节内的神经肽Y （neuropeptide Y,NPY）含量,研究颈交感神经节与颈脊神经节间的通路联系,探讨颈性眩晕发病机制中的神经解剖学基础。 方法　96只新西兰兔随机分为C2、C3、C4、C5、C6、C7组及相应对照组（每组8只）,麻醉后显露相应的脊神经节,给予波宽0.5 ms、频率30 Hz、5 V电刺激,5秒/次,每1 min重复1次,共5次,30 min后,灌注固定,切取双侧颈上、下交感神经节,切片,免疫反应,染色,观察。 结果　电刺激C2、C3脊神经节后,同侧颈上交感神经节内NPY含量升高（P<0.05）;电刺激C4、C5脊神经节后,同侧颈上交感神经节和颈下交感神经节内NPY含量均有明显变化（P<0.05）;电刺激C6、C7脊神经节后,同侧颈下交感神经节内NPY含量升高（P<0.05）。 结论　颈脊神经节和颈交感神经节间存在神经电生理上的通路联系,且具有节段性、同侧性特点,为颈性眩晕的发病机制及临床分型提供了实验依据和理论基础。     

Labelling of schwann and satellite cells by [3H]dexamethasone in a rat sympathetic ganglion and sciatic nerve

Light-microscopic autoradiograms of superior cervical ganglia of adult rats after injection of [³H]dexamethasone showed a preferential accumulation of radioactivity in the nuclei of satellite and Schwann cells. The total radioactivity found in the ganglion at 10 min after injection was high compared to the cerebral cortex of the brain, but declined rapidly. Only Schwann and satellite cell nuclei retained the label for up to 2 h. The labelling was specific for dexamethasone, since it could be prevented by an excess of unlabelled dexamethasone but not by corticosterone. Administration of [³H]corticosterone resulted in only a weak labelling of the ganglion and no specific labelling of Schwann and satellite cells could be observed. As in the ganglion, accumulations of [³H]dexamethasone by Schwann cell nuclei was also observed in the sciatic nerve.It is possible, therefore, that satellite and Schwann cells represent an important target for glucocorticoids in the nervous system.     

Morphological evidence for the maintenance of the cervical sympathetic system in aged rats

Elements of the cervical part of the sympathetic nervous system have been examined quantitavely in four and twenty-four month Wistar rats. The number of unmyelinated axons in the cervical trunk had significantly (P<0.002) increased in the old animals and the number of myelinated axons comprised less than 4% of the total number at both ages. The number of neurons in the superior cervical ganglion and the density of noradrenergic innervation of two of its target organs, the iris and the submandibular gland, were insignificantly different at the two ages. These results are consistent with other evidence which suggests that the cervical sympathetic system is maintained throughout the adult lifespan in rats.     

Connections between the accessory nerve and the posterior root of the first cervical nerve

The aim of this study was to demonstrate the incidence of absence of the posterior root of the first cervical nerve, and the relation between the accessory nerve and the posterior root of the first cervical nerve in Turkish population. Dissections of the accessory nerve and the posterior root of the first cervical nerve were performed in 49 specimens from 27 formalin fixed cadavers (25 male and 2 female). The type of the connections between the accessory nerve and the posterior root of the first cervical nerve was classified into four types. Type III was the most common type in present study (30.6%). There was a connection between the accessory nerve and the posterior root of the first cervical nerve in this type. The connections demonstrated in this study are important in the etiology and surgical treatment of the spasmodic torticollis.     

Differences in sensitivity to nerve growth factor of axon formation and tyrosine hydroxylase induction in cultured sympathetic neurons

Superior cervical ganglia from 2-day-old and 3-week-old rats were maintained in vitro for up to 2 weeks in the presence of a range of concentrations of nerve growth factor up to 100 micrograms/ml. Nerve fibre length and density were measured and tyrosine hydroxylase activity of these cultures assayed after various times. Ganglia were also examined for catecholamines and neuronal numbers using fluorescence histochemistry and histology respectively. In cultures maintained without nerve growth factor, or in those containing low concentrations of nerve growth factor (3 ng/ml), tyrosine hydroxylase decreased to 5-10% of the initial levels by 14 days in vitro. The presence of the high concentration of 1 microgram/ml nerve growth factor in the culture medium or the addition of such a concentration during the culture period did not prevent an initial decrease in tyrosine hydroxylase but subsequently increased the enzyme activity. The maximal effect of nerve growth factor on nerve fibre density was at low concentrations whereas its maximal effect on neuronal survival, tyrosine hydroxylase activity or nerve fibre elongation was at high concentrations. After 2 days in culture, maximum neurite production occurred in cultures containing 10 ng/ml, while maximum nerve fibre elongation and tyrosine hydroxylase activity occurred in cultures containing 100 micrograms/ml nerve growth factor. We conclude that low concentrations of nerve growth factor, as occur in plasma, cause maximum axon formation while high concentrations of nerve growth factor, as occur in effector organs, induce maximum tyrosine hydroxylase activity and cell survival. The former process may be mediated via cell surface receptors and the latter via retrograde axonal transport of nerve growth factor to the cell body, following uptake by the terminal regions of the axons.     

Patterns of reinnervation of denervated cerebral arteries by sympathetic nerve fibers after unilateral ganglionectomy in rats

Summary In order to clarify the manner in which previously denervated cerebral arteries become reinnervated after unilateral excision of the superior cervical ganglion (SCG), we observed directly the reinnervating sympathetic nerve fibers originating in the contralateral SCG by using anterograde labeling with wheat germ aggulutinin-horseradish peroxidase in rats. The nerve fibers sprouted from the nerve fibers in the contralateral anterior cerebral artery and reinnervated the arterial wall of the anterior cerebral artery of the denervated side as early as one week after ganglionectomy. In addition to this sprouting route, three other reinnervating nerve fiber routes were observed in the circle of Willis of the denervated side two weeks after ganglionectomy: the proximal portion of the internal carotid artery, the route passing between bilateral ethmodial arteries, and the posterior communicating artery. Eight weeks after ganglionectomy, these reinnervating nerve fibers formed a fairly dense plexus in a circular pattern in the circle of Willis. However, the reinnervation could not be observed in the arterial branches derived from the circle of Willis (middle cerebral artery and posterior cerebral artery) even 16 weeks after ganglionectomy. The present results clearly demonstrated the time course, distribution pattern and limitation of the reinnervation from the contralateral SCG following unilateral ganglionectomy. The fact that reinnervation could be observed only in the main cerebral arteries of the circle of Willis, in which the nerve plexus appeared to have a circular pattern, suggests a difference between the qualities of sympathetic innervation controlling the cerebral circulation in these arteries and the other arterial branches related to these differences in reinnervation capacity.     

An applied anatomical study of the superior laryngeal nerve loop

The aim of this study was to provide some specific information about the morphology and topography of the superior laryngeal n., its branches, and its anastomoses with the cervical sympathetic chain, as well as its relations with the thyroid gland. Sixty adult cadavers, ie 120 superior laryngeal nn., were dissected and analysed. An anastomotic loop connecting the cervical sympathetic chain and the distal laryngeal n. was present in 111 of the 120 cases. The morphology of this loop made it possible to define 5 different groups. This study supplies information valuable in thyroid surgery.     

人与狗迷走/交感干的比较解剖及其喉上神经外支纤维成分

目的　对人与狗的颈段迷走/交感干进行比较解剖,并鉴定狗的喉上神经外支的纤维成分。方法 随机解剖经福尔马林固定的成年人尸体颈部（n=50）及狗的颈部（n=10）,暴露其颈交感干与喉上神经及其外支间的交通;并取狗的喉上神经外支,甲醛固定,明胶包埋,恒冷切片后用Karnovsky AchE组化方法染色并观察。 结果 狗的迷走神经结状神经节与颈上神经节完全或部分融合,迷走神经干与交感神经干完全或部分融合为迷走-交感干;而人的结状神经节与颈上神经节互相分离;颈上神经节与喉上神经及其分支之间存在交通,其中颈上神经节与喉上神经外支相交通者占86%。AchE染色显示：狗的喉上神经外支含AchE阳性有髓神经纤维、AchE阴性有髓神经纤维和AchE阳性无髓神经纤维。 结论 喉上神经外支呈袢状,而非干式,含躯体运动、交感神经节后及躯体感觉纤维,因此喉上神经外支为一混合神经。     

NOS-positive preganglionic neurons innervate a subpopulation of postganglionic neurons in superior cervical ganglion in rats

To determine the postganglionic targets of NOS-containing preganglionic neurons, we studied the association of NADPH-diaphorase positive preganglionic fibers and retrogradely labeled postganglionic neurons in the superior cervical ganglion (SCG) in rats. Wheat germ agglutinin-horseradish peroxidase solution was applied to the anterior chamber of the eye, middle cerebral artery, subcutaneous layer of the facial skin, or submucosal layer of the inside of the lip. Two days after tracer application, the rats were perfused with fixative solution. Serial sections of the SCG were stained histochemically for NADPH-diaphorase followed by diaminobenzidine reaction. More than 80% of the labeled postganglionic neurons innervating the structures in the subcutaneous or submucosal layer showed close association with NADPH-diaphorase positive preganglionic nerve terminals; approximately one-third of these labeled neurons were encircled by dense baskets of pericellular terminals. On the other hand, most of the postganglionic neurons innervating the iris (69%) or the cerebral artery (90%) did not show a distinct association with NADPH-diaphorase positive terminals. These results suggest that one of the principal roles of the NOS-containing preganglionic neurons may be in controlling the postganglionic neurons which innervate the structures in the subcutaneous or submucosal layer.