选择性腰5、骶1脊神经后根切断术加内收肌切断术治疗下肢痉挛的研究

采用选择性腰 5、骶 1脊神经后根切断术 内收肌切断术治疗成人脑外伤后、脑瘫、脊髓损伤后下肢痉挛 2 9例 ,术前术后进行步态分析。术前 3天进行步态分析 ,术中于大腿内侧将内收肌腱性部分切断松解内收肌 ,将痉挛下肢的腰 5、骶 1的脊神经后根进行分束 ,电刺激仪测阈值后将阈值较低的神经束切断。2 9例随访 3年 ,痉挛解除率 90 %,功能改善率 80 %。术后步态与术前比较有明显改善。说明选择性腰 5、骶 1脊神经后根切断术 内收肌切断术能较有效的治疗成人脑外伤后、脑瘫、脊髓损伤后肢体痉挛。     

SPR治疗脊髓损伤后肢体痉挛及神经根的组织化学研究

探讨选择性脊神经后切断术（SPR）治疗脊髓损伤后肢体痉挛的效果并对其腰骶神经根进行组织学和组织化学研究，采用L2－S1双侧节段开窗式部分椎板切除，保留棘突和棘间，棘上韧带，显露双侧L2－S1神经根出口处，将前后根分开，分束，测定各后根束阈值，阈值较低的后根小束切断，。对切取的神经束进行冰冻切片，染色，固定和组织化学处理，结果发现，临床应用29例，随访3年疗效满意，痉挛解除率为90％，功能改善率为80％，切除的神经后根纤维Ache反应阳性，后根同感觉支传入纤维相混合，说明采用选择性脊神经后根切断术能有效治疗脊髓损伤后肢体痉挛，在选择性脊神经后根切断术中电刺激选择是必要的。     

SPR治疗成人脑外伤后下肢痉挛的步态分析及诱发电位研究(附47例术后6年随访分析)

采用选择性脊神经后根切断术（SPR）治疗成人脑外伤后下肢痉挛16例，并对47例术后6年病人进行随访。16例患者术前3天进行步态分析及诱发电位测定，将痉挛下肢的L2－S1的脊神经后根进行分束，以电刺激仪测定阈值，将阈值较低的神经束切除。结合肌张力、肌力、体重及肌群功能对神经根切断比例进行量比，均小于30％。16例随访4年，痉挛解除率为90％，功能改善率为805。术后步态明显改善（P＜0．01）。手术前后诱发电位测定支持肌张力调节的“大、小环路”理论，47例术后6年随访结果疗效满意。提示选择性脊神经后根切断术能较有效的治疗成人脑外伤后肢体痉挛。     

脊髓损伤后重度肢体痉挛39例

1994～ 1997年 ,我们采用选择性脊神经后根切断术 (ｓｅｌｅｃｔｉｖｅｐｏｓｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙ ,ＳＰＲ) +局部矫形手术治疗脊髓损伤后重度肢体痉挛 39例 ,疗效满意。1　临床资料1 1　一般情况　 39例中 ,男 2 3例 ,女 16例 ;年龄2 3～ 4 7岁 ,平均 2 9 5岁。其中 ,胸椎骨折 2 8例。伤后均行减压固定术 ,脊柱结核后期出现肢体痉挛11例 ,病史均 3年以上。肢体痉挛和肌张力增高(按照Ａｓｈｗｏｒｔｈ 5级法 )均 3级以上 ,痉挛均累及双下肢呈尖足交叉畸形 ,合并骶尾部褥疮 11例 ,泌尿系感染 7例。1 2　手术方法　全麻后行腰2 ～…     

选择性脊神经后根切断术改进探讨

施行选择性脊神经后根切断术（ＳＰＲ），本文应对肢体单一肌肉或肌群进行肌张力分度，并按照分度确定脊神经后根切断比例，达到降低肌张力理想效果，使ＳＰＲ可以应用于混合有肌肉软瘫的痉挛型脑瘫。提出椎板“开关门”式ＳＰＲ，使此手术更符合生理，减少术后并发症。共完成２４例ＳＰＲ，取得了满意疗效。     

高选择性脊髓神经后根切断术治疗大脑瘫初探

文章报道了一种治疗痉挛型大脑瘫的新手术,高选择性脊髓神经后根切断术,并对此手术的基理、疗效进行了分析,提出高选择性脊髓神经后根切断术是痉挛型大脑瘫一切矫形治疗的基础。     

高选择性脊神经后根切断术的护理

<正>高选择性脊神经后根切断术(SPR)是痉挛型大脑瘫矫形治疗的基础手术,是近年来逐渐发展起来的一种新的外科技术.我院自1992年8月以来采用SPR治疗脑瘫后遗肢体痉挛10例,其中上肢3例,下肢7例,术后患者痉孪、姿态、功能有显著改善,护     

痉挛性脑瘫脊神经后根改变与临床研究

目的探讨痉挛性脑瘫的更佳治疗方法。方法对４７例痉挛性脑瘫病人施行高选择性脊神经后根切断术（Ｓｅｌｅｃｔｉｖｅｐｏｓｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙ，ＳＰＲ），采用方波脉冲器测定仪法测定和电镜下观察脊神经后根超微结构。结果电镜观察结果，表明ＳＰＲ手术切断Ｈｚ低组为未受损脊神经后根，而未切断保留的Ｈｚ高组为受损脊神经后根。结论说明ＳＰＲ手术求得受损与未受损脊神经锥体外系神经及肌力均衡，协调了肢体平衡，促进痉挛性脑瘫病人步态恢复正常或基本正常     

运用SPR治疗痉挛性脑瘫效果好

解放军第１１７医院采用选择性脊神经后根切除术（简称ＳＰＲ），已治疗１００多例脑瘫性肢体痉挛患者，取得了满意的疗效。传统手术疗法以纠正肢体畸形为主，无法改进患者肢体功能，而且是一项手术只能解决单一畸形或仅仅为下一项手术作准备。而采用ＳＰＲ，可以借助新的电刺激仪准确地找到引起痉挛的脊神经后根，将其切断后即可解除肢体痉挛，全面改善肢体功能，从而受到患者的欢迎。运用SPR治疗痉挛性脑瘫效果好@卢一生@殷爱成     

脊髓外伤后痉挛性瘫痪的临床研究

 目的 探讨脊髓损伤后的病理生理变化及对所引起痉挛性瘫痪的外科治疗.方法 44例脊髓损伤患者,选择性后根切断术10例(术前肌张力都高),神经干细胞移植4例(术前肌张力都高),脊柱固定或椎管扩大成形术23例.结果 选择性后根切断术患者,术后5例肌痉挛完全缓解,4例部分缓解,1例一过性改善;7例患者Babinskii's sign转为阴性,3例无变化;浅表感觉障碍改善4例,无变化6例;二便障碍改善6例,无变化4例;1例患者有一过性头痛的并发症.干细胞移植患者术后肌张力、二便障碍等均无改善.脊柱固定和椎管扩大成形术患者,术后浅感觉改善7例,肌张力及二便均无变化,2例出现并发症(伤口感染和呼吸障碍).用PEACOCK的方法 分成7级进行总的运动功能的评估,85%显示出行走功能的改善.结论 选择性脊髓后根切断术能有效改善脊髓损伤后痉挛性瘫痪的运动功能、提高患者的生活质量,但也需保证脊柱的稳定性.     

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.