超声引导下经颈侧方入路行颈神经根阻滞治疗神经根型颈椎病疗效分析

目的 探讨超声引导下经颈侧方入路行颈神经根阻滞治疗神经根型颈椎病的临床疗效。方法选择2016-02～2019-06该院收治的108例神经根型颈椎病患者作为研究对象,按照治疗方法的不同将其分为观察组(55例)和对照组(53例)。对照组采用根据体表解剖定位经颈前方入路行颈神经根阻滞治疗,观察组应用超声引导下经颈侧方入路行颈神经根阻滞治疗,比较两组穿刺时间及穿刺成功率,以及两组治疗后疼痛视觉模拟评分量表(VAS)评分、颈椎功能障碍指数(NDI)评分、健康状况评分、治疗有效率及并发症发生率。结果 观察组穿刺成功率高于对照组,穿刺所用时间短于对照组,差异有统计学意义(P 0. 05)。治疗前,两组VAS评分、NDI评分、生理健康(PH)评分和精神健康(MH)评分比较差异均无统计学意义(P 0. 05)。在治疗后第1、3、6个月,两组的VAS评分均显著低于治疗前(P 0. 05),且观察组VAS评分显著低于对照组(P 0. 05);治疗后第1、3、6个月,两组的NDI评分低于治疗前,PH评分和MH评分高于治疗前,差异有统计学意义(P 0. 05),且在治疗后第3、6个月,观察组NDI评分低于对照组,PH评分和MH评分高于对照组,差异有统计学意义(P 0. 05)。观察组治疗有效率为94. 55%,对照组治疗有效率为79. 25%,差异有统计学意义(P 0. 05)。结论 超声引导下经颈侧方入路行颈神经根阻滞治疗神经根型颈椎病效果理想,穿刺成功率高,具有广阔的临床应用前景。     

卧位整复手法配合走罐、间歇牵引治疗神经根型颈椎病120例临床观察

360例神经根型颈椎病患者随机分为A(间歇牵引)、B(走罐间歇牵引)、C(卧位整复手法配合走罐间歇牵引)三组,各120例,分别进行治疗.结果 C组治疗1、2、3、4个疗程时VAS评分均少于A、B组(P＜0.05).治疗4个疗程后C组治疗效果优良率(91.7%)优于A、B组(81.7%,89.2%)(P均＜0.05).认为卧位整复手法配合走罐、间歇牵引治疗神经根型颈椎病,可缩短疗程,达到最佳疗效.     

初发2型糖尿病对老年冠心病患者心功能影响及西格列汀联合二甲双胍的干预效果

选取年龄≥60岁冠心病患者120例,其中血糖正常组(对照A组) 40例,初发2型糖尿病患者80例;分为二甲双胍干预组(对照B组) 40例,西格列汀联合二甲双胍干预组(观察组) 40例,3组均给予冠心病正规治疗。结果治疗后6个月,28以上指标均较治疗前下降(P 0. 05),但观察组下降较对照B组明显(P 0. 05)。治疗前,对照B组及观察组LVEF、E/A比值低于对照A组,LVEDD水平高于对照A组,(P 0. 05);治疗后观察组LVEF、E/A指标较治疗前均升高,LVEDD较治疗前显著降低,(均P 0. 05);观察组改善程度优于对照B组(P 0. 05)。结论西格列汀联合二甲双胍治疗可改善糖尿病合并冠心病患者的心功能;且降糖效果显著,同时可改善炎性指标及血液高凝状态,副作用小。     

牵引联合Mulligan技术治疗神经根型颈椎病43例疗效观察

目的探讨牵引联合Mulligan技术在神经根型颈椎病中的应用效果。方法前瞻性将86例神经根型颈椎病患者进行随机配对设计。对照组采用颈椎牵引;观察组采用颈椎牵引＋Mulligan技术。采用目测类比法（VAS）及颈椎病临床评价量表（CASCS）评定疗效。结果观察组治疗后VAS评分明显低于对照组,CASCS评分明显高于对照组,P均〈0．01。结论牵引联合Mulligan技术治疗神经根型颈椎病效果较好。     

龙氏手法结合刃针治疗颈性眩晕的临床效果观察

目的观察龙氏手法结合刃针治疗颈性眩晕的临床疗效,评价该方法的有效性和安全性,为临床应用推广提供依据。方法采用随机数字表法将56例颈性眩晕患者分为治疗组和对照组各28例,治疗组采用龙氏手法复位结合刃针治疗,对照组采用单纯刃针治疗,两组均治疗2个疗程,比较两组颈性眩晕症状与功能评估量表评分。结果治疗后治疗组和对照组的颈性眩晕症状与功能评估量表评分均较治疗前显著升高,差异均有统计学意义(P 0. 05);治疗组眩晕症状改善与功能评估量表评分高于对照组,差异有统计学意义(P 0. 05)。治疗组的临床疗效显著优于对照组,差异有统计学意义(P 0. 05)。结论龙氏手法结合刃针能够整复寰枢关节错位,松解颈枕部肌群、韧带的痉挛,从而缓解对神经、血管的压迫和刺激,达到治疗眩晕的目的,且临床疗效显著,操作安全,有较好的临床实用性,值得临床推广应用。     

手法治疗神经根型颈椎病的体感诱发电位的观察研究

目的 观察手法治疗神经根型颈椎病的体感诱发电位(somatosensory evoked potentials,SEP)变化.方法 40例神经根型颈椎病患者分为手法组及常规组各20例,治疗前及治疗2周后检查SEP.结果 治疗后总有效率手法组95%,常规组85%;临床治愈率手法组为60%,常规组40%.两组间疗效及平均治疗时间差异无统计学意义.治疗前SEP异常率为55%(22/40例),主要表现为N9、N11及N13潜伏期延长;治疗后2组各潜伏期均有改善,手法组N11潜伏期改善较常规组更显著(P<0.05).结论 手法治疗可改善神经根型颈椎病的临床症状.     

神经肌肉关节促进法对神经根型颈椎病患者感觉功能恢复的影响

目的探讨神经肌肉关节促进法(NJF)对神经根型颈椎病患者感觉功能恢复的影响。方法选择颈6神经根受压的神经根型颈椎病患者56例,随机分为对照组和观察组各28例,观察组运用神经肌肉关节促进法,对照组运用传统康复,各治疗2 w。治疗前、后运用感觉定量分析仪评定受试者健侧和患侧手掌侧大鱼际的冷感觉、热感觉、冷痛觉和热痛觉的阈值。结果神经根型颈椎病患者患侧冷感觉和热痛觉阈值较健侧降低(P0.05);患侧热感觉;热感觉阈值和冷痛觉阈值较健侧升高(P0.05)。两组患者治疗前感觉阈值无明显差异(P0.05);观察组患者经过2 w治疗后,冷感觉和热痛觉阈值均有提高(P0.05);热感觉和冷痛觉阈值均有降低(P0.05)。对照组患者冷感觉、热感觉、冷痛觉和热痛觉其结果均无统计学意义(P0.05)。结论 NJF可提高神经根型颈椎病患者的感觉功能。     

镇静疗法在慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者无创通气治疗中的应用观察

目的 观察镇静疗法在慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者无创通气(NIV)治疗中的应用效果。方法 将84例AECOPD合并呼吸衰竭患者随机分为观察组(42例,其中Ⅱ型呼衰患者26例,记为A组)和对照组(42例,其中Ⅱ型呼衰患者26例,记为B组),两组均行NIV治疗,观察组在此基础上给予泵注镇静药物咪达唑仑治疗,镇静药应用时间为2 h,期间比较观察组和对照组的治疗有效率、不良反应情况及治疗前后氧合指数(PaO₂/FiO₂)、血二氧化碳分压(PCO₂)、平均动脉压(MAP),另比较A组和B组治疗前后PCO₂、呼吸频率(RR)。结果与对照组比较,观察组治疗有效率高,人机对抗、面部受压发生率低(P均<0.05);与同组治疗前比较,观察组和对照组治疗后PaO₂/FiO₂增加,观察组治疗后PCO₂减小(P均<0.05);与对照组比较,观察组治疗后PCO₂减小(P<0.05)。与同组治疗...     

颈复康治疗神经根型颈椎病疗效观察

目的观察颈复康治疗神经根型颈椎病的疗效。方法60例神经根型颈椎病患者均口服颈复康冲剂10 g,2次/d,连用28 d。治疗前后采用双抗体夹心ELISA法检测患者血清中的肿瘤坏死因子α（TNF-α）、白介素-10（IL-10）,采用视觉模拟评分（VAS）评价疼痛程度。结果本组治疗前血清TNF-α为（9.46±4.67）μg/L,IL-10为（4.17士1.93）μg/L,VAS为（5.67士1.93）分;治疗后分别为（5.19±2.43）μg/L、（8.31±3.75）μg/L、（1.31±0.75）分,与治疗前比较,P均〈0.05。结论颈复康可有效治疗神经根型颈椎病,与其降低TNF-α、升高IL-10水平有关。     

单次静脉输注丙种球蛋白治疗川崎病合并冠状动脉病变的疗效观察

目的：观察单次静脉输注丙种球蛋白治疗川崎病（ KD）合并冠状动脉病变的临床疗效。方法将68例KD合并冠状动脉病变患者随机均分为A、B组各34例,均给予阿司匹林退热治疗,A、B组分别单次静脉输注丙种球蛋白2、1 g/kg,均在8～12 h内输完。记录两组治疗后冠状动脉血栓情况、冠状动脉直径变化、冠状动脉瘤发生情况和临床症状等。结果 A、B组治疗总有效率分别为61．8％（21/34）和50．0％（17/34）。 A组治疗前后冠状动脉直径分别为（4．2±0．8）、（2．6±0．5）mm,P＜0．05;B组治疗前后冠状动脉直径分别为（4．4±0．7）、（3．0±0．7） mm,P＜0．05;治疗后B组冠状动脉直径大于A组（P＜0．05）。 A组出现动脉血栓2例（5．9％）,B组未出现血栓异样;两组均未出现巨大冠状动脉瘤。两组总发热时间、淋巴结肿大消退时间、充血与水肿消退时间差异均无统计学意义（P均＞0．05）结论首次静脉丙种球蛋白能减小KD合并冠状动脉病变患者冠状动脉直径,明显改善病情,但剂量增大可能会增大血液黏度,增加形成血栓的风险。     

游离神经移植修复周围神经缺损100例

目的 探讨自体腓肠神经等感觉神经游离移植修复四肢神经缺损。方法 对100例外伤所致四肢神经缺损者根据神经缺损部位及游离移植神经长度。分别用带血管的神经游离移植和单纯的神经游离移植。神经供区：腓肠神经(87例)、臂内侧皮神经(6例)、前臂内侧皮神经(1例)、前臂外侧皮神经(2例)、腓浅神经(2例)、隐神经(2例)。结果术后随访71例(85条神经)。随访时间18～60个月，其中优(M4S3 )13例(14条)．良(M3S3)22例(26条)。可(M2S2)32例(40条)，差(M1S1以下)4例(1条)。结论 用自体神经移植修复四肢神经缺损，可有效恢复损伤神经．对肢体的功能恢复仍有较为满意的效果。     

The value of intraoperative nerve monitoring against recurrent laryngeal nerve injury in thyroid reoperations

Reoperative thyroidectomy is challenging for surgeons because of the higher incidence of recurrent laryngeal nerve (RLN) palsy. RLN identification is the gold standard during thyroidectomy; however, it is sometimes difficult to perform thyroid reoperations. In recent years, intraoperative nerve monitoring (IONM) has gained increased acceptance, and the use of IONM can be a valuable adjunct to visual identification. The aim of this study was to evaluate the value of IONM during thyroid reoperation.A total of 109 patients who met our criteria at the Affiliated Hospital of Hangzhou Normal University from January 2010 to June 2020 were retrospectively analyzed and divided into the IONM group and the visualization-alone group (VA group) according to whether neuromonitoring was used during the operation. The patients’ characteristics, perioperative data, and intraoperative information including the RLN identification, time of RLNs confirmation, operative time, intraoperative blood loss, and the rate of RLN injury were collected.Sixty-five procedures (94 RLNs at risk) were performed in the IONM group, whereas 44 (65 RLNs at risk) were in the VA group. The rate of RLN identification was 96.8% in the IONM group and 75.4% in the VA group (P < .05). The incidence of RLN injury was 5.3% in the IONM group and 13.8% in the VA group (P > .05). The incidence of surgeon-related RLN injury rate was 0% in the IONM group compared to 7.7% in the VA group (P < .05), but the tumor-related or scar-related RLN injury rate between the 2 groups were not significantly different (4.3% vs 3.1%, 1.1% vs 3.1%, P > .05).IONM in thyroid reoperation was helpful in improving the RLN identification rate and reducing the surgeon-related RLN injury rate, but was ineffective in reducing the tumor-related and scar-related RLN injury rate. In the future, multicenter prospective studies with large sample sizes may be needed to further assess the role of IONM in thyroid reoperations.     

斯氏狸殖吸虫体壁神经细胞与神经纤维的观察

目的　探讨斯氏狸殖吸虫的体壁神经细胞和神经纤维的分布特点和相互间关系。方法　采用乙酰胆碱酯酶定位技术对斯氏狸殖吸虫的神经细胞和神经纤维进行显示。结果　斯氏狸殖吸虫前部体壁内神经纤维密集 ,以纵行神经纤维为主 ,虫体中部以相互交叉的斜行神经纤维为主。斯氏狸殖吸虫有两类神经细胞 ,即双极和多极神经细胞 ;虫体前部的纵行神经纤维上以多极神经细胞分布较多 ,中部较少 ,后部最少。双级神经细胞分布于神经节内、神经干内过神经干旁。在虫体的横截面上 ,神经细胞位于神经纤维下。结论　斯氏狸殖吸虫的前部体壁神经纤维密集 ,多极神经细胞较多 ,可能与虫体前部肌活动能力强有密切关系。     

An alternative nerve conduction study method to evaluate early diabetic neuropathy: Ratio of different diameter nerve fibers in peroneal nerve

Different nerve fibers may have disparate conduction parameters even though they are in the same peripheral nerve. Hyperglycemia can have differential effects on nerve fibers, depending on diameter. In diabetes, conventional nerve conduction studies have allowed us to classify a peripheral nerve as normal or not. But, there may be differential involvement in disparate nerve fibers of the same peripheral nerve. This study evaluated the effects of hyperglycemia on nerve fibers of peroneal nerve by diameter. Thirty-five diabetic patients with normal nerve conduction studies and thirty-two healthy controls were included to the study. The peroneal nerve was stimulated from two points (upper and below the fibula head) and recorded from the tibialis anterior (TA) and extensor digitorum brevis (EDB) muscles. Then the ratios of conduction velocity parameters recorded in these sides were compared between the diabetic and control groups. The conduction velocity recorded from EDB seemed to be faster in both groups. But there were no significant differences among the ratios between the groups. Our study has demonstrated the conduction parameters of two nerve fibers with different diameters in the peroneal nerve. The ratios of conduction parameters were similar in both groups, suggesting that fibers in the peroneal nerve are similarly affected by hyperglycemia.

     

Phrenic nerve conduction in leprosy

Phrenic nerve conduction was performed bilaterally in 22 multibacillary (BL-LL) and 18 paucibacillary (BT-TT) leprosy patients and 25 control subjects. Prolonged phrenic nerve conduction time and/or reduced amplitude of diaphragm muscle action potential beyond 2.5 standard deviations of control mean values was observed in 9 BL-LL patients (4 bilateral) and 6 BT-TT patients (all unilateral). Out of the nine BL-LL patients with phrenic nerve involvement, median motor and/or sensory nerve conduction was also abnormal in seven patients. On fluoroscopy, diaphragm movements were normal in all patients. The study documents subclinical phrenic nerve involvement in leprosy--a fact not previously recognized.     

Malignant peripheral nerve sheath tumors of intrathoracic vagus nerve.

The authors report two cases of malignant peripheral nerve sheath tumors arising from the vagus nerve in the mediastinum in patients who had no stigmata of neurofibromatosis (von Recklinghausen's disease). Computed tomography showed homogeneous soft tissue masses, with minimal calcification seen in one patient. T2-weighted magnetic resonance images showed regions of low signal intensity caused by a dense cellular population.