腰神经后支应用解剖与射频热凝的实验研究

目的 探讨可阻断腰神经后支痛觉传导的射频热凝有效温度。方法 在１５具成人尸体上解剖腰神经后支;用射频热凝机分别为６０℃、７０℃、８０℃、９０℃热凝家兔坐骨神经后,在不同时间内观察神经纤维的超微结构、感觉神经传导速度（ＳＣＶ）及传导痛觉的无髓纤维波形（Ｃ波）的变化。结果 腰神经后支途径的“横突根部”与“横突点”可作为腰神经后支热凝的初步标志,方法刺激可使位确切化;动物实验热凝温度为８０℃时,痛觉传入     

Comparative study of different surgical procedures using sensory nerves or neurons for delaying atrophy of denervated skeletal muscle

To observe the effect of sensory components on muscle atrophy, 4 surgical procedures applying sensory nerves or neurons to the denervated muscle were conducted in a rat model: sensory nerve implantation (group B), sensory motor nerve crossover (group C), dorsal root ganglia implantation (group D), and implantation of preganglionically avulsed sensory nerve (group E). Rats with complete denervation served as controls (group A). The degree of muscle atrophy was evaluated after surgery by fibrillation potential amplitude, muscle wet weight, muscle fiber cross-sectional area, collagen content, and protein content. Compared with group A, the results in groups B, D, and E were superior 1 month after surgery and the results in groups B, C, and E were superior 3 months after surgery. Implantation of normal or preganglionically avulsed sensory nerve delayed atrophy. Dorsal root ganglia implantation only had a short-term trophic influence. In the animal model setting, sensory motor nerve crossover is effective only after it is maintained for at least 3 months.     

不同方法的感觉神经(元)营养失神经骨骼肌实验研究的疗效比较

目的　建立不同方法的感觉神经 (元 )营养失神经骨骼肌的动物模型 ,并比较其延缓失神经肌萎缩的作用。方法　选用 12 0只SD大鼠 ,按术式不同随机分成 5组。按肱二头肌单纯完全失神经支配(A组 )、失神经支配加感觉神经种植 (B组 )、失神经支配加感觉神经寄养 (C组 )、失神经支配加背根神经节剪碎种植 (D组 )及节前撕脱的感觉神经种植 (E组 ) ,共分 5组。按术后取材时间 ( 1个月、3个月 )分为A1、A3、B1、B3、C1、C3、D1、D3、E1、E3组共 10组。测定、比较各组肌肉纤颤电位波幅、肌湿重、肌纤维截面积、胶元纤维含量及总蛋白质含量 ,判断肌萎缩的程度。结果　B1、E1组各项指标均优于A1组 ;D1组除胶元纤维含量外 ,其余各项指标均优于A1组 ;C1组仅有纤颤电位波幅、肌湿重优于A1组 ,而其余指标与A1组相比无差异。B3、C3组各项指标均优于A3组 ;E3组除胶元纤维含量外 ,其余各项指标均优于A3组 ;D3组与A3组各项指标均无差异。结论　正常和节前撕脱的感觉神经种植 ,不论短期还是长期都有延缓失神经肌萎缩的作用。而背根神经节剪碎种植的作用时间短。感觉神经寄养需较长时间才能发挥作用     

腰椎后路不同显露方式对多裂肌影响的实验研究

目的 比较腰椎后路不同显露方式及棘突重建方式对多裂肌的影响.方法 40只健康成年山羊随机分为棘突正中劈开(A组)、棘突切除(B组)、单侧进入棘突切断(C组)及双侧椎旁肌剥离(D组)四组,每组10只.其中C组又分为剥离侧(C1组)和未剥离侧(C2组)两组.以术前腰椎MR扫描图像及另1只山羊L_6多裂肌标本作为正常对照.术后10个月行腰椎MR及手术区多裂肌组织学检查.测量双侧多裂肌面积及肌肉面积萎缩比.结果 四组均出现不同程度的肌肉萎缩,组织学及MRI评分均低于正常对照,面积萎缩比高于正常对照.A组组织学、MRI评分高于B、C1及D组,面积萎缩比较低.B组组织学、MRI评分低于A、C及D组,而面积萎缩比较高.肌肉未剥离组(A组及C2组)各项评分均优于肌肉剥离组(B组、C1组及D组).棘突重建组(C1组及D组)各项评分均优于棘突切除组(B组).术后组织学评分与MRI评分呈正相关,而与面积萎缩比无相关性.结论 棘突切除会导致术后严重肌萎缩.减少肌肉剥离范围及重建后路骨一韧带结构可有效减少术中肌肉损伤、预防术后多裂肌萎缩.棘突正中劈开方式肌肉剥离范围小,在预防多裂肌萎缩方面优于剥离肌肉后单纯重建棘突的手术方式.     

胚胎运动神经元移植对失神经肌肉影响的实验研究

目的探讨胚胎运动神经元移植至入肌点前支配神经内对失神经肌肉萎缩的影响.方法取20只健康SD大鼠建立失神经腓肠肌动物模型,随机分移植组和对照组(每组10只);将胚胎14～18d的SD鼠胚脊髓前角运动神经元的活细胞悬液注入移植组切断的胫神经远端,对照组注射等量的生理盐水.手术后第3个月,进行腓肠肌肌力、肌湿重测定,组织和免疫化学检查以及胫神经纤维计数,并作图像分析.结果种植入胫神经内的鼠胚胎运动神经元能够存活.移植组腓肠肌肌力和肌湿重恢复率高于对照组,差异有显著性(P＜0.01);肌纤维横截面积恢复率高于对照组,差异有显著性(P＜0.05),且I型、Ⅱ型纤维面积均优于对照组(P＜0.05);肌动蛋白的相对含量移植组高于对照组,差异有显著性(P＜0.05);移植组运动终板结构清晰,而对照组大部分运动终板崩解,两组运动终板恢复率比较,差异有显著性(P＜0.05);移植组神经纤维再生率为0.661±0.149,高于对照组的0.463±0.109,差异有显著性(P＜0.01).结论胚胎运动神经元移植至外周神经内,便于靶组织获得神经营养,能延缓失神经肌肉的萎缩,并可提高其功能的恢复.     

Experimental study of denervated rat muscle. Part I: Histochemical and electrophysiological observations of denervated rat muscle

Histochemical and electrophysiological observations were carried out on denervated rat muscles, mainly extensor digitorum longus muscle. The myofibrillar ATPase reaction was employed to classify the type of muscle fibers. Type 1 fiber, low ATPase activity, and type 2 fiber, high ATPase activity, were recognized. It is generally believed that denervation causes a preferential atrophy of type 2 fibers and these fibers may be more dependant on neural influence than type 1 fibers. But the result of this investigation revealed that the atrophy of type 1 fiber and the enlargement of type 2 fiber will be caused by denervation. The term of enlargement is not equivalent to hypertrophy. Enlargement means the increasing of diameter of muscle fiber reacting to the denervation in this experiment. It is deduced that type 1 fiber is affected more by neural control than type 2 fiber.     

腰椎术后切口积液的探讨

[目的]分析后侧入路腰椎术后切口积液产生的原因，探讨积液的分型并确定相应的治疗策略。[方法]白2001年6月～2006年6月本院共开展1986例经后侧入路的腰椎手术。使用内固定的手术877例，未使用内固定手术1109例，比较两组间切口积液的发生率。将发生积液的病人分为Ⅲ型：Ⅰ型：病因明确型，共28例；Ⅱ型：感染型，共11例；Ⅲ型：病因不明确型，共14例。Ⅰ型病人给予穿刺抽液，对因治疗，营养疗法。Ⅱ型病人给予穿刺抽液，清创，手术灌洗和按药敏给予抗生菌治疗。Ⅲ型病人给予穿刺和预防应用抗生素。[结果]使用内固定组的切口积液率（4．33％）高于未使用内固定组（1．35％）P〈0．01。平均住院日：Ⅰ型14．7d，Ⅱ型：87．6d。Ⅲ型：15．6d。[结论]伴随手术过程的复杂化切口积液率明显增高。给积液分型有助于确定有效的治疗方案。Ⅰ型病人予以穿刺抽液和对因治疗。Ⅲ型治疗的关键是防止转化为Ⅱ型。Ⅱ型治疗比较困难，积极的手术干预和按药敏给予抗生菌是两个关键的治疗方法。     

失神经骨骼肌萎缩的研究进展

周围神经损伤的治疗一直是外科研究的热点。 2 0世纪 6 0年代随着显微外科技术的应用 ,大大提高了周围神经损伤修复的水平。然而其临床疗效仍难令人满意 ,许多肢体功能仍不能恢复 ,特别是高位损伤。究其原因是周围神经损伤的实质是细胞损伤 ,是神经元的完整性受到了破坏 ,其胞体联系末梢的轴浆运输中断 ,从而使神经元的胞体和效应器发生了程度不同的变性或死亡。因此其修复涉及相应神经元胞体的保护、轴突再生和效应器的功能保存等环节。其中任何一个环节延缓或发生不可逆性损害均将影响肢体功能的康复 ,从而最终影响疗效。目前对周围神经损…     

An experimental study on denervated muscle atrophy--effect of electrostimulation and comparison with immobilization muscle atrophy

The efficacy of causing muscle atrophy was compared among denervation, arthrodesis and tenotomy in rat anterior tibial muscle. Reduction of wet weight was most pronounced in denervated muscle and least in arthrodesed muscle. Histochemical investigation by ATPase stain revealed that atrophy of Type 1 and Type 2 fiber was more severe in denervated muscle group than in the other two groups. Type 2 fiber atrophy was dominant in denervated muscle and in arthrodesed muscle. Type 1 fiber atrophy was dominant in tenotomized muscle. The effect of electrostimulation on denervated muscle was investigated. Electrostimulation significantly reduced the degree of denervation atrophy. Four weeks after severance of peroneal nerve, tibial nerve-crossing was done and electrostimulation was continued for eight weeks. Recovery of wet weight of re-innervated muscle with electrostimulation was significantly better than that without electrostimulation. Electrostimulation applied to denervated muscle reduced the progress of atrophy and improved the recovery after nerve repair.     

Segmental square spinal instrumentation for posterior lumbar spinal fixation.

The purpose of this study is to evaluate the clinical results of operations using a new spinal instrumentation for posterior fixation, called segmental square spinal (3-S) instrumentation. The 3-S instrument consists of two pairs of hooks to clasp the interarticular portion of the lamina bilaterally, two horizontal bars to connect the hooks on the right and left, and rods to connect the hooks side by side on the top and bottom. Twenty-seven patients who had degenerative lumbar disorders underwent operations with the 3-S instrument. Rigid fixation was obtained in all cases immediately after the operation. Bone union rates were 91% (21/23) with posterolateral fusion. The 3-S instrument seems to be suitable for spinal disorders in which anterior spinal fusion is not necessary, especially for degenerative spinal disorders.     

Acute occlusion of the posterior spinal vein. Experimental study in monkeys.

The posterior spinal vein was occluded with silicone in seven rhesus monkeys, and locally resected in one. There were no neurological findings associated with acute venous obstruction of the cord. Follow-up arteriography revealed diversion of venous outflow into the anterior spinal venous system. Histology revealed gliosis associated with demyelinization confined to the posterior columns.     

去神经骨骼肌退变的T2弛豫时间的实验研究

目的探讨T2弛豫时间(T2值)测定在不同时间段去神经骨骼肌退变中的诊断价值。方法 35只新西兰兔随机分为七组,每组5只,切断右侧坐骨神经建立去神经支配腓肠肌实验模型,于模型制成后1、24、48 h,1、2、4、6周不同时间段行双侧下肢MR扫描,测量不同时间段腓肠肌的T2值,扫描后分别取材进行病理学检查。结果去神经肌肉1及24 h各扫描序列上信号均无异常,去神经侧腓肠肌1~24 h的T2值:(31.76±1.23)ms,假手术侧T2值为:(30.65±1.05)ms,T2值与假手术侧无明显统计学差异(F=3.884,P0.05)。48 h后T2图上可显示去神经支配腓肠肌信号轻度增高,T2值为(40.75±1.02)ms;1~2周时肌肉T2值继续升高,6周达高峰(57.04±1.79)ms,T2值时间曲线呈缓慢上升型。假手术侧T2值与48 h的T2值有明显统计学差异(F=346.903,P0.01);T2值增加与病理上出现肌肉水肿、变性,肌细胞间毛细血管增多,扩张相一致。结论损伤后48 h的T2值测定可早期发现去神经肌肉的异常改变,明显早于肌肉萎缩的形态学改变,T2值随着去神经骨骼肌时间的延长而升高,T2值时间曲线可客观反应去神经后肌肉的退变,可作为检侧去神经肌肉异常的敏感、可靠指标。     

Experimental study of denervated rat muscle. Part II: The effects of electrical stimulation on the denervated rat muscles

Electrical stimulation has been widely employed for the treatment of peripheral nerve lesion, however, its effects are not well known. Effects of electrical stimulation on denervated muscles were studied by measuring the weight of anterior crural muscles and the diameter of muscle fibers of the extensor digitorum longus muscle of the rat. The muscle fibers were classified by myofibrillar ATPase reaction. The denervated muscle showed loss of weight, a marked decrease in diameter of type 1 fibers and a small increase in diameter of type 2 fibers. Electrical stimulation suppressed weight loss of the denervated muscles. Electrical stimulation with high frequency cycle, like phasic motoneuron discharges, significantly suppressed the increase in diameter of type 2 muscle fibers. Electrical stimulation with low frequency cycle, like tonic motoneuron discharge, significantly suppressed the decrease in diameter of type 1 muscle fibers.     

恒河猴去神经骨骼肌游离移植的研究

目的为临床行去神经肌肉游离移植提供理论依据。方法将恒河猴的双足(足母)、趾短伸肌8块分2组去神经后游离移植于骶棘肌内,定期活检行光镜(HE 染色、银染色、酶染色)及电镜观察肌纤维及神经纤维。结果去神经后肌肉的代谢降低;移植到有正常神经支配的肌肉内12周后有神经长入。结论去神经后促进移植肌肉在缺氧环境下存活、再生,同时与受区正常肌肉接触后,有神经长入或再生神经长入并支配移植肌。本实验去神经肌肉游离移植后的存活为临床手术方法提供理论依据。     

恒河猴去神经骨骼肌游离移植的研究

目的为临床行去神经肌肉游离移植提供理论依据。方法将恒河猴的双足、趾短伸肌８块分２组去神经后游离移植于骶棘肌内，定期活检行光镜（ＨＥ染色、银染色、酶染色）及电镜观察肌纤维及神经纤维。结果去神经后肌肉的代谢降低；移植到有正常神经支配的肌肉内１２周后有神经长入。结论去神经后促进移植肌肉在缺氧环境下存活、再生，同时与受区正常肌肉接触后，有神经长入或再生神经长入并支配移植肌。本实验去神经肌肉游离移植后的存活为临床手术方法提供理论依据     

Intraforaminal repair of plexus spinal nerves by a posterior approach: an experimental study.

Many spinal nerve roots injured due to stretch or other types of lesions are not reparable. Some spinal nerves might be repaired if they could be exposed in their intraforaminal course. A posterior subscapular approach for a more lateral exposure of the brachial plexus was combined with a facetectomy to expose intraforaminal nerves in a series of Macaca rhesus monkeys. This approach exposed a 6- to 10-mm segment of spinal nerve not approachable by a more classic anterior operation. Sural grafts were placed from the dural exit of the spinal nerves to the cord level of the plexus. Nine surviving animals were followed for 36 to 54 months and observed for clinical evidence of return of function. In each animal at least one electromyogram (EMG) was performed. The plexus was then re-exposed and intraoperative nerve action potentials were recorded across graft sites. Evoked muscle action potential and cortical potentials were recorded in six animals. Despite the proximal level of repair, adequate regeneration was shown by clinical, electrical, and histological studies. Functional return was best to the supraspinatus and biceps muscles and to wrist and finger flexors. Clinical recovery was present, but less effective, for deltoid, wrist, and finger extensors and intrinsic muscles of the hand, despite evidence on EMG of reinnervation. Recovery of the infraspinatus muscle was poor. Nerve action potentials could be recorded across each graft site. Reinnervational activity was recorded by EMG and evoked muscle action potential studies in most of the muscles studied, despite the persistence of some denervational changes 3 years or more after injury and repair. Histological studies confirmed the presence of a large number of axons of moderate size and myelination even at the forearm level.