躯体感觉诱发电位皮节电生理检查在脊神经根损伤中的应用

躯体感觉诱发电位(Somatosensory Evoked Poten-tials,SEP)是特定的刺激作用于感觉系统而在脑区所引起的电位变化,主要通过脊髓后索和内侧丘系上达皮层[1]。SEP可评价传入通路的全长,皮节刺激研究     

选择性脊神经根阻滞治疗腰椎间盘突出症的疗效观察

目的观察选择性脊神经根阻滞(SNRB)治疗腰椎间盘突出症(LDH)的临床疗效。方法选取110例LDH腰腿痛患者,在知情同意基础上按照随机数字表法分为治疗组与对照组各55例,分别给予SNRB与椎旁神经阻滞(PVB),比较2组患者治疗情况及疗效。结果治疗1个疗程后,治疗组总有效率明显高于对照组(P<0.01),治疗2,4周时VAS评分明显优于对照组(P均<0.01),治疗组得宝松、局麻药混合液用量明显少于对照组(P<0.01)。加用镇痛药比例明显低于对照组(P<0.01),治疗组不良反应发生率明显低于对照组(P<0.01)。结论 CT引导下SNRB治疗LDH具有疗效高、安全性高等优点,值得推广应用。     

选择性脊神经后根切断术治疗痉挛型脑瘫的疗效观察

目的：观察选择性神经后根切断术治疗痉挛性脑瘫患者的疗效。方法：对58例诊断明确且符合纳入标准的痉挛性脑瘫采用选择性神经后根切断术治疗,治疗后观察患者术后肌张力改善情况、行走能力、步态改善情况等。结果：58例患者经治疗的肌张力明显下降,与治疗前比较有明显差异（P〈0．05）;58例患者经治疗行走能力明显提高,与治疗前比较有明显差异（P〈0．05）;其中评分≥3分者53例,有效率迭91．38％。结论：选择性神经后根切断术治疗痉挛性脑瘫疗效确切,可显者降低肌张力,提高行走能力。     

腺病毒性关节炎合并脊神经根炎1例

腺病毒性关节炎临床少见 ,合并脊神经根炎尚未见报道。最近我院收治 1例腺病毒性关节炎合并脊神经根炎患者 ,现报道如下。1　病历介绍患者 ,女 ,43岁 ,主因发热 7ｄ、多关节肿痛伴腰部感觉障碍 4ｄ而于 2 0 0 1年 11月 16日入院。患者 7ｄ前无诱因出现鼻塞、咽痛 ,体温最高达 3 9.8℃ ,无发冷寒战。4ｄ前出现全身多关节红肿疼痛伴功能障碍 ,伴头痛、乏力、全身酸痛 ,腰部感觉障碍。既往体健。查体 :急性病容 ,球结膜充血 ,前胸后背均可见充血性斑疹 ,无瘙痒 ,心肺腹无异常 ,双侧掌指关节、近端指间关节及腕、肘、膝等关节均红肿 ,皮温高 ,有…     

选择性脊神经后根切断术治疗痉挛性脑瘫的护理

脑瘫是出生前到出生后1个月内各种原因所致非进行性脑损伤病变，主要表现为中枢性运动障碍及姿势异常，出现下肢肌张力增高、踮足、剪刀步等症状。本院2001年6月-2006年10月1日采用选择性脊神经后根切断术（SPR术）治疗痉挛性脑瘫患者30例，现将护理体会介绍如下。     

高选择性脊神经后根切断术的麻醉方式探讨

目的探讨2种麻醉方式对高选择性脊神经后根术切断术（SPR）围术期生命体征的影响．．方法择期全麻下高选择性脊神经后根切断术的患者355例,随机分为2组：A组180例采用静吸复合全麻;B组175例采用全凭静脉（TC1）麻醉,2组均于术毕缝皮时停药,观察患儿不同时间心率、血压、脉搏血氧饱和度、BIS的变化和苏醒时间等。蛄果2组组间比较心率、血压、血压、脉搏血氧饱和度、BIS、苏醒时间等差异无统计学意义,A组组内比较电刺激时较其他时段有统计学意义（P均〈0．05）,2组在电刺激时及电刺激10min时与麻醉前比较有统计学意。义（P均〈0．05）。蛄论静吸复合全麻与TCI2种麻醉方式均可用于SPR手术,TCI术中生命体征的维持更加平稳。     

皮肤来源的前体细胞培养和向神经元分化的观察

目的　研究皮肤来源的前体细胞 (SKPs)的体外培养方法 ,为神经移植提供一种新的细胞来源。方法　分离培养小鼠皮肤组织的细胞 ,在无血清的培养基中培养 ,用机械方法对细胞进行传代 ,免疫细胞化学方法对细胞进行鉴定。结果　从成年和幼年的小鼠皮肤组织中分离培养出SKPs ,这种细胞在体外可以长期增殖和传代 ,体外培养可超过 8代 ,这种细胞大部分表达纤维粘连蛋白 ,约50 %的细胞表达巢蛋白。在有血清的培养基中培养 ,约 5%的细胞分化为神经元样细胞 ,表达神经元特异性烯醇化酶和神经微丝 ,部分细胞分化为脂肪细胞 ,其余的细胞分化为成纤维细胞样细胞。结论　皮肤组织中存在的前体细胞可在体外稳定增殖 ,能够分化为神经细胞、脂肪细胞和成纤维细胞样细胞。这种前体细胞有潜力成为神经移植的一种细胞来源     

局部围刺配合脊神经根阻滞治疗带状疱疹后遗神经痛26例临床观察

目的：观察针刺配合脊神经根阻滞治疗带状疱疹后遗神经痛的临床疗效。方法：将49例带状疱疹后遗神经痛患者分为治疗组26例和对照组23例,对照组口服布洛芬缓释胶囊、阿昔洛韦、维生素B12、维生素B1常规治疗,治疗组在对照组治疗的基础上采用局部围刺配合脊神经根阻滞治疗。结果：总有效率治疗组为92．31％,对照组为82．61％,两组比较,差异有统计学意义（P〈0．05）。结论：局部围刺配合脊神经根阻滞治疗带状疱疹后遗神经痛有较好疗效。     

选择性脊神经后根切断术治疗脑瘫的术后护理

我院自 1996年以来采用选择性脊神经后根切断术( SPR)治疗痉挛性脑瘫 5 6例 ,术后经精心护理 ,顺利康复 ,取得了满意疗效 ,现总结报告如下。1　临床资料1.1　一般资料　本组 5 6例 ,男 40例 ,女 16例。年龄 2 .5～ 31岁 ,平均 10 .5岁。单下肢瘫 2例 ,双下肢瘫 2 9例 ,偏瘫 12例 ,四肢瘫 13例。不能站立者 5例 ,扶物站立行走者 2 0例 ,不扶物痉挛跛行 31例。所有病例均有不同程度肌痉挛肌张力增高 ,按 Ashworth分级为 3～ 5级 ,平均 4级。病因 :早产 15例 ,窒息 2 0例 ,难产 5例 ,脑炎后遗症 6例 ,不详 10例。1.2　手术方法　采取气管插管…     

小儿脑瘫选择性脊神经后根切断术前的智力测定

选择性脊神经后根切断术（SPR）是治疗痉挛性脑瘫（SCP）的有效方法，其选择性表现为需选择智力正常或接近正常者进行手术，以使患儿能配合术后功能训练。因此SPR对智力测定提出了较高要求。笔者应用Wechsler智力量表对准备行SPR手术的患儿进行智力测定，发现其测验方法简单、安全，易被患儿和家长接受，检查结果可靠，现报道如下。     

针刺影响慢性脊髓损伤大鼠脊髓组织神经生长因子及其受体的表达

为探索针刺治疗慢性脊髓损伤的作用机理,采用大鼠后路渐进性脊髓压迫动物模型,然后手术减压,并进行电针治疗.观察联合行为评分(CBS)、体感诱发电位和神经生长因子(NGF)及其受体的免疫组化变化.结果发现脊髓损伤后NGF和TrkA在神经元及胶质细胞表达增强,经过电针治疗后,NGF和TrkA在神经元和胶质细胞的表达下降;体感诱发电位检测和CBS评分显示,电针组明显优于减压组,电针组与减压组比较统计学差异具有显著性(P＜0.05).表明电针治疗促进脊髓损伤大鼠的行为功能恢复是通过内源性神经生长因子及其受体TrkA介导起作用的.     

兔丘脑束旁核痛敏神经元对刺激扣带回前部的反应

<正> 实验是在清醒和肌肉麻痹的家兔上进行,用同心园电极的单个或短串电脉冲刺激扣带回前部(32区),用玻璃微电极在丘脑束旁核(IF)中引导单位放电,为了阐明IF单位放电的增加和减少是与刺激脉冲同步出现的,故采用电子计算机处理的脉冲密度直方图来表明,其结果,在rF59个对痛刺激呈现兴奋反应的单位放电中,能对扣带回刺激呈现拉制效应的有38个,占64%,4个对痛刺激呈现抑制效应的PF单位,也能为刺激扣带回前部而增强抑制,占6.7%,同时还观察到在少数FF痛兴奋和痛抑制的单位放电中,刺激扣带回能增强其放电频率。这再次表明扣带回前部可以通过下行纤维的活动调制痛信息在丘脑水平的传递。     

INFLUENCE OF ACUPUNCTURE ON THE DISCHARGE OF PHA NEURONS IN THE RABBIT

<正> This paper deals with whether the posterior hypothalamus area(PHA) can receive signals from electroacupuncture(EA) at "Neiguan", and whether a relative specificity does exist between acupoints or acupoint and non-acupoint The neuron activity was recorded extracellularly for analyzing the influence of EA at different acupoints and nonacupoint on the discharge of PHA neurons.     

隐性循经感传线下皮肤中神经分布特点的初步观察

<正> 先前的研究表明,正常人或患者都普遍存在着纵向分布于体表的线,这些线的各点对机械或电刺激有较明显的敏感现象,而且线的循行位置同古典的经络线基本符合。而且只有当线上的各点受刺激时才产生有传导性的感觉,故定名为隐性循经感传线Latent Propagated Sensation alongChannel(LPSC)。近年的工作又证明,LPSC不仅是一种感觉线,而且可以用多种生物物理方法加以验证,因此,推测LPSC或许与线下皮肤中某些结构的分布有一定的关系。本文对LPSC下皮肤中的神经分布进行了初步的观察。     

OBSERVATION OF THE CLINICAL EFFECTS OF ELECTROACUPUNCTURE COMPOSITE REHABILITATION TRAINING ON THE MOTION FUNCTION OF PATIENTS WITH INCOMPLETE SPINAL CORD INJURY

Objective: To testify the effectiveness of electroacupuncture treatment by observing the improved situation of motion function in patients with incomplete spinal cord injury treated by elec troacupuncture composite rehabilitation training, and to provide a new method for the patients with incomplete spinal cord injury Methods: Randomized, double-blind and blank-contro method was used.Thirty-two patients with incomplete spina cord injury were assigned into the observation group, in which acupuncture with the electric pulse stimulation was applied to the motor points of the key muscles of the lower extremities, and the control group, in which electroacupuncture was applied a Biguan, Yinshi, Futu, Liangqiu, Fenglong, Chongyang, and Jiexie In each group, treatment was given once a day; one-month treat ment made a session.Three sessions were required totally with two-day rest between each session.Before and after each session the American Spinal Injury Association(ASIA) impairmen scale, ASIA motor score, modified Barthel index(MBI), and integrated electromyography tests were adapted to the subjects.The differences in the efficacy on the motion function were compared with the results before and after treatment.Results: The changes of ASIA impairment scale were not statisti cally different(P0.05) at 1 h, 2 and 3 months after treatment While the changes of ASIA motor score, MBI, and integrated electromyography were statistically different when tested afte treatment for 1, 2 and 3 months.That meant the motion function of the subjects was improved in both groups.The ASIA motoscore, MBI, and integrated electromyography changes were of no statistical significance(P0.05) at 1 and 2 months after treatment, while were of statistical difference at 3 months.The effect of the treatment group was better.Conclusion: Both the electroacupuncture and traditional body acupuncture could improve the motion function of patients with incomplete spinal cord injury.However, concerning in the long term, the electroacupuncture composite rehabilitation training achieves better result, and is more safe and effective.     

下丘脑室周核神经元对电针的反应和初步分析

<正> 国内外有关针刺、电刺激脑及吗啡镇痛的研究都指出第Ⅲ脑室尾端侧壁灰质及导水管周围灰质(PAG)是镇痛的有效部位。关于 PAG 已有深入的研究,而第Ⅲ脑室尾端侧壁灰质方面报道较少,迄今未见电生理研究的资料。本工作直接观察电针过程中第Ⅲ脑室尾端侧壁灰质(下丘脑室周核,hpv)神经元活动的变化,与其紧邻下丘脑后核(hp)的反应相比较,并初步分析其机制.     

针灸肝俞、脾俞、粱门、期门各穴抑制胆色素结石的神经解剖学机理探讨

<正> 胆石症为临床常见病及多发病之一。据统计约有10％的成年人患有此病。《针灸学简编》一书曾谓肝俞穴有舒肝利胆之作用,脾俞穴则治黄疸等症。而梁门穴有缝脾胃助运化的作用。期门穴有疏肝理气之功能。此外,有关肝俞、脾俞、期门、梁     

THE ROLE OF P_1-PURINERGIC RECEPTORS IN THE SPINAL MECHANISMS OF ACUPUNCTURE ANALGESIA

It has been extensively proved that electro-acupuncture elicit analgesia in bothextensive areas and local region via supraspinal structures and spinal cord.The present investigationwas to study the role of P_1-purinergic receptors in the spinal mechanisms of weak electroacupuncture-induced analgesia.Leg withdrawal latency(LWL)to noxious radiant heat focused on the ankle regionwas used to assess the effects of acupuncture and that of P_1-purinergic(adenosine)receptor antago-nists,theophylline and caffeine on the electro-acupuncture(EA)analgesia.EA prolonged the LWLby 16.7%±20.3%,with an after-effect lasting about 15 min.Both theophylline and caffeineblocked the EA-induced prolongation of LWL in a dose-dependent manner at the doses of 1.6-16 mg/kg.These results suggest that P_1-purinegic receptor is involved in the spinal mechanisms of weak EAproduced analgesia in the rat.     

用HRP法探讨胃各部的交感传入神经元的节段性分布

<正> 神经解剖学家Peele认为胃和肠的感觉纤维位于迷走神经和交感神经中,但痛觉冲动主要由交感神经传导,恶心感觉则由迷走神经传递,饱满感和胃充实感亦然。Ca-rpenter叙述了内脏有许多传入纤维(包括有髓鞘和无髓鞘两种),内脏痛从腹部至盆腔脏器主要是通过交感神经传入的,迷走神经感觉纤维则关系到内脏运动和分泌反射等。此外,Ranson和Billingsley等神经解剖学家对内脏感觉纤维的论述和Peele及Carpenter等是一致的。至于交感感觉纤维的胞体位于脊神经节的问题已为诸学者所公认。从临床实践证明内脏的痛觉及     

OBSERVATION OF THE CLINICAL EFFECT OF ELECTROACUPUNCTURE COMBINED WITH REHABILITATION TRAINING ON THE MOTION FUNCTION OF PATIENTS WITH INCOMPLETE SPINAL CORD INJURY

Object: This trial is designed to testify the effectiveness of electroacupuncture treatment by observing the situation of motion function in patients with incomplete SCI treated by electroacupuncture combined with rehabilitation training.Methods: This study used a randomized, double-blind and controlled method.Thirty-two subjects who were patients with incomplete SCI were involved in this trial.They were randomly divided into two groups.The conventional rehabilitation training was applied to both groups.In addition, the electroacupuncture method was used in the observation group, and acupuncture with the electric pulsing stimulation was applied to the motor points of the key muscles of the lower extremities.In the control group, the electroacupuncture was applied to Biguan, Futu, Liangqiu, Fenglong, and Jiexi.In each group, the electroacupuncture or rehabilitation treatment was given once a day, one month treatment made a session.Three sessions were required totally.Before and after each session, the American Spinal Injury Association(ASIA) impairment scale, ASIA motor score, modified Barthel index(MBI), integrated electromyography(iEMG) tests were applied to the subjects.Results: The intergroup comparison of the change of ASIA impairment scale was of no statistical significance(P0.05)at 1 month, 2 months and 3 months after treatment.While the ASIA motor score, MBI, and iEMG changes were of statistically significance when tested after treatment for 1 month, 2 months and 3 months.That means the motion function of the subjects was improved in both groups.The intergroup comparison of the ASIA motor score, MBI, and iEMG change was of no statistical significance(P0.05) at 1 month, 2 months after treatment, and of statistically significance at 3 months; the treatment group had better effect than the control group.Conclusion: Both the electroacupuncture and traditional body acupuncture could improve the motion function of patients with incomplete spinal cord injury, but concerning in the long term, the electroacupuncture combined with rehabilitation training achieves better results.