骶管神经阻滞术治疗尾骨疼痛综合征120例

尾骨疼痛综合征（coccygodynia syndrome）,即尾骨部、骶骨下部及其相邻肌肉或其他软组织疼痛,可由发生在该部的多种病变或损伤所致,如尾骨或骶尾关节的损伤、骶尾关节炎、感染、肿瘤及尾骨畸形等。无明显病因者,多因长期紧张坐位工作,或习惯性不良坐姿造成。其特点为长时间坐位或从坐位起立时或挤压尾骨尖端时疼痛加重,多见于女性。     

颅神经微血管减压术58例疗效分析

原发性三叉神经痛、偏侧面肌痉挛、舌咽神经痛是常见的功能性神经外科疾病。目前公认血管压迫是导致其发病的主要原因。微血管减压术（microvasculardecompression,MVD）是治疗三叉神经痛、面肌痉挛、舌咽神经痛等颅神经疾病的有效外科治疗方法,临床疗效显著而持久,术后并发症少。我院自1998～2008年,采用微血管减压术治疗原发性三叉神经痛、偏侧面肌痉挛、舌咽神经痛共58例,效果良好。现就手术治疗情况总结分析如下。     

神经血管减压术治疗半面痉挛的听力损害分析

乙状窦后径路的面神经血管减压及梳理术后,部分患者出现耳鸣、耳闷和听力损害。笔者1985年以来调查经上述手术的患者268例。在隔音室内以250、500、1000、2000、4000、8000Hz电测听分别测手术前后的气、骨导听觉阈值。进行比较。差值10dB以内为无变化,≥10～30dB为轻度减退,≥30-60dB为中度减退,≥60-90dB为重度减退。全部患者中56例有     

胃食管术后胃肠减压两种置管深度与效果观察

胃肠减压是胃-食管术后常用的治疗措施之一,该法利用负压吸引及虹吸作用的原理,引流胃内积液、积气,降低胃肠压力、减轻腹胀、降低缝线张力及切口疼痛,促进消化道功能恢复.胃管置入的深度是否合适,引流是否通畅,直接影响减压效果.笔者于2010-04至2011-04对传统置管深度[1]和改良置管深度[2]两种胃肠减压效果进行了临床观察比较,现报道如下.     

前跗管综合征14例诊治体会

前跗管综合征是踝关节前远侧“十”字韧带与其深面的跗骨构成的骨 纤维管内的腓深神经受到卡压所致 ,多发生在部队训练中。此综合征临床报道较少 ,常常出现误诊。 1991～ 1998年 ,我们诊治前跗管综合征 14例 ,报告如下。1　临床资料1 1　一般情况　本组男 13例 ,女 1例 ;年龄 19～4 2岁 ,平均 2 3 5岁。均为单侧发病 :左足 9例 ,右足 5例。发病诱因 :踝关节扭伤 5例 ,跑、跳等训练伤 5例 ,鞋太紧 2例 ,无明显诱因 2例。症状与体征 :足背酸胀痛 ,足背内侧及第 1、2趾皮肤麻木 ,前跗管部位压痛 ,第 1、2跗趾蹼及第 1趾背侧和第 2趾背内侧皮肤…     

腕尺管综合征1例神经电生理检查分析

1 病例报告 患者女,42岁。无明显诱因出现左手环指及小指麻木1年,症状逐渐加重,左手乏力、疼痛、肌肉萎缩、精细动作受限。查体：左手爪形手,骨间肌及外展小指肌萎缩（＋＋）、肌力2级,手指外展及内收均明显受限,外展拇短肌、尺侧腕屈肌、掌长肌、桡侧腕屈肌等肌力均正常,屈腕正常。左手环指及小指尺侧半掌面皮肤刺痛觉减退,尺神经背支支配区感觉正常。     

经翼点硬膜内外入路视神经管减压术

对颅前窝骨折合并视神经损伤，早期诊断，合理选择手术指征，采用经翼点硬膜内外入路视神经管减压术，能最大可能挽救病人视力，改善预后。     

乙状窦后入路血管减压术治疗原发三叉神经痛

原发三叉神经痛病因长期以来存在争议,治疗也比较困难。我科从1991年以来采用乙状窦后入路三叉神经根微血管减压术治疗原发三叉神经痛186例,取得满意效果。现报告如下:     

糖尿病下肢周围神经痛的外科治疗

 目的 探讨下肢多神经减压手术治疗糖尿病周围神经病变引起的下肢疼痛和麻木的方法及疗效.方法 采用Dellon三切口手术对具有神经卡压体征的糖尿病周围神经病变患者进行下肢神经减压手术.结果 患者下肢疼痛麻木症状明显缓解.其中明显缓解率在70％以上,麻木缓解率在80％以上.结论 神经减压手术为糖尿病周围神经病变的治疗提供了一条有效的新途径.     

Posterior tibial nerve entrapment at the ankle

Compression of the posterior tibial nerve of the ankle, also known as tarsal tunnel syndrome (TTS), is being seen withincreasing frequency in athletes, particularly runners. For this reason, it behooves the sports medicine professional to be well informed about this condition. TTS is caused by either extrinsic or intrinsic pressure on the posterior tibial nerve or its terminal branches. The syndrome, although analogous to carpal tunnel syndrome, is much less common. The most common symptoms of TTS are numbness and burning pain in the medial heel and foot. The condition is often difficult to differentiate from plantar fasciitis. Electrodiagnostic studies, including nerve conduction studies and electromyography, help confirm the diagnosis. Conservative measures are usually unsuccessful, and surgical decompression of the tarsal tunnel is generally regarded as the treatment of choice.     

跗骨窦综合征的磁共振成像研究

目的 研究跗骨窦综合征的磁共振成像(MRI)特点.方法 采用1.5T MRI扫描仪,常规做横轴位和矢状位SE T1和FSE T2加权扫描,也可以根据需要做冠状位和斜位扫描,均使用表面线圈,层厚和间隔分别为5mm和1mm.结果 MRI能显示跗骨窦内组织的炎症、变性或损伤.本组12例跗骨窦综合征的MRI表现为T1信号降低9例,不均匀信号3例;T2呈高信号12例;2例伴韧带撕裂,4例伴骨皮质下小囊肿,2例可见相邻跟骨、距骨的骨髓水肿.结论 MRI可以清楚显示跗骨窦的解剖和病理变化,是诊断跗骨窦综合征的有用工具.     

Carpal tunnel syndrome: Staging of median nerve compression by MR imaging

The purpose of this prospective study was to determine the potential of MR imaging to depict morphologic alterations of the median nerve correlating with the stage of carpal tunnel syndrome (CTS). Eighteen wrists of normal subjects and 81 wrists of patients with CTS were examined. MR imaging was performed with proton-density- and T2-weighted spin-echo sequences. Staging of CTS was done on the basis of clinical and electrophysiological testing, including evaluation of the number of previous steroid infiltrations in conservative treatment. Median nerve flattening, cross-sectional area, and signal intensity were measured from the distal radius to the end of the carpal tunnel. Delineation and structure of the median nerve were recorded qualitatively by two experienced radiologists in consensus. Three major MR imaging criteria of early CTS were (a) isolated prestenotic and intracarpal swelling of the median nerve (P < .01), (b) the absence of significant flattening, and (c) a generalized increase in signal intensity retrograde to the distal radius (P < .01). The nerve showed sharply delineated contours and a homogeneous signal pattern. Advanced CTS was characterized by retrograde swelling of the median nerve to the distal radius (P < .01) and decreased signal intensity (P < .05). Demarcation of the nerve became poorer, and its signal pattern appeared fasciculated. After steroid infiltration, the median nerve was difficult to delineate, showed an inhomogeneous structure, and swelling was less pronounced than without steroid infiltration (P < .05). MR imaging yields typical morphologic findings that correlate with the duration and severity of median nerve compression. Hence, MR imaging allows staging of median nerve compression in CTS and thus may contribute to therapeutic decision-making.     

高频超声技术诊断肘管综合征的价值

目的：探讨超声技术诊断肘管综合征（CTS）的准确性。方法：对30例肘管综合征患者的30只手和50例无CTS志愿者的100只手肘部行动态超声检查,测量并比较两组尺神经的上下径、横径及截面积,并用ROC曲线评价超声诊断肘管综合征标准值的准确性。结果：CTS患者的尺神经在内上髁水平的截面积、上下径及左右径明显大于正常对照组,两组比较差异有统计学意义,尺神经的截面积增大对于诊断肘管综合征最有预测价值。以尺神经在内上髁水平的截面积7.5mm2为阈值,诊断敏感度为93%,诊断特异性为91%。结论：超声测量尺神经的截面积是诊断肘管综合征的可靠方法。     

Ultrasound features of carpal tunnel syndrome: a prospective case-control study

Purpose The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). Material and methods Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29–78) in the symptomatic and 45.1 years (range 24–82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination. Results In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area of 10 mm² (DT) and 9 mm² (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median nerve mobility and decreased median nerve echogenicity. Conclusion Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm² (DT) and 9 mm² (IT) and several additional findings.     

肘管综合征患者尺神经及其支配肌肉的MRI表现

目的 探讨肘管综合征患者尺神经及其支配肌肉的MR表现.方法 回顾性分析经临床症状、体检和肌电图检查临床诊断为肘管综合征的28例患者,作为肘管综合征组.招募28名健康志愿者作为对照组.所有受试者均行单侧肘关节MR平扫,其中15例肘管综合征组患者行三维T2可变反转角快速自旋回波(3DT2SPACE)序列扫描,观察尺神经形态、信号特征、在肘管内是否增粗及信号增高,并观察周围肌肉改变.测量尺神经横截面积及神经肌肉信号强度比,并采用组间t检验进行比较.结果 28例肘管综合征患者中,24例尺神经增粗,26例尺神经信号增高;4例尺神经周围肌肉信号增高和(或)萎缩.28名对照组受试者中,2名尺神经增粗,16名尺神经信号增高;1名出现滑车上肘肌.15例行3D T2SPACE序列扫描的肘管综合征患者中,14例表现为局部尺神经增粗或信号增高,1例神经未见明显异常.对照组和肘管综合征组受试者尺神经横截面积分别为(0.06±0.01)和(0.15±0.06)cm2,神经肌肉信号强度比分别为1.57±0.39和2.86± 1.45,差异均有统计学意义(t值分别为2.220和4.546,P均＜0.05).结论 MRI上肘部尺神经信号增高、增粗及其所支配的肌肉萎缩、信号增高是肘管综合征的直接征象.     

Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome

AIM: To investigate the diagnostic value of ultrasonography in mild and moderate idiopathic carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Cross-sectional areas (CSA), flattening ratios at three different levels, swelling ratio, and palmar displacement were analysed in 26 patients (14 with bilateral and 12 with unilateral disease, 40 wrists in total) for the presence and the severity of CTS. Twenty had normal nerve conduction studies (NCS) defined as "mild", and 20 of them had abnormal NCS defined as "moderate". The control group consisted of 20 healthy participants. RESULTS: All parameters were significantly different between patient and control groups. Palmar displacement, swelling ratio, CSA at all levels and distal flattening ratio had the highest significance (p < 0.0001). The criterion with the highest sensitivity was the swelling ratio > or = 1.3 (72.5%), followed by the middle CSA > 9 mm2 and the palmar displacement > 2.5 mm. All of these criteria had a higher sensitivity in diagnosing moderate cases (85-100%) than diagnosing mild cases (30-55%). There was a significant difference between normal and mild CTS groups regarding palmar displacement, distal flattening ratio, middle CSA and swelling ratio (p < 0.0001 for all) and between normal and moderate groups regarding all parameters (p < 0.01 - 0.0001) When combined middle CSA, palmar displacement and swelling ratio had an overall discriminatory accuracy of 83.8%. CONCLUSION: Additional diagnostic confirmation can be provided by ultrasonography and may be preferred as the initial step instead of electrophysiological studies. Detection of at least two of the three criteria (median nerve CSA > 9 mm2 at pisiform level, swelling ratio > or = 1.3, and palmar displacement > 2.5 mm) may be helpful for the verification of the diagnosis.     

Dynamic MR imaging of carpal tunnel syndrome

 Objective. To evaluate the diagnostic value of the MR imaging syndrome before and after performance of provocative exercises in patients with dynamic carpal tunnel syndrome. Design. Fat-suppressed proton-density and T2-weighted spin-echo images of the wrist were obtained prior to and after provocative, standardized exercises. Images were interpreted in masked fashion with regard to six MR criteria of carpal tunnel syndrome: (a) bowing of the transverse ligament, (b) and (c) deformation of the median nerve at the pisiform and hamate levels respectively, (d) signal abnormality of the median nerve, (e) presence of fluid in the wrist joints and/or carpal tunnel, and (f) presence of synovial swelling. Patients. Twenty-one wrists in 20 patients with subjective complaints of carpal tunnel syndrome and equivocal or negative clinical findings and negative electrodiagnostic examinations were included (age range 21–61 years, mean 37 years, 2 men and 18 women). The diagnosis of dynamic carpal tunnel syndrome was made and confirmed by surgery in 18 of the 21 symptomatic wrists. The control group consisted of 15 asymptomatic wrists in volunteers (age range 22–60 years, mean 35 years, 8 men and 7 women). Results and conclusions. Sensitivities and specificities of the six MR criteria were 90.5–100%, and 6.7–86.7%, respectively, both before and after exercise. Likelihood ratios proved statistically significant differences between the symptomatic and asymptomatic wrists (P<0.0001–0.0002) for the prevalence of all MR criteria with the exception of fluid within the carpal joints and/or carpal tunnel. Changes of the MR appearance after exercise had a low sensitivity (4.8–71.4%) but high specificity (86.7–100%) for dynamic carpal tunnel syndrome. In conclusion, MR imaging contributes to the diagnosis of carpal tunnel syndrome when clinical signs are confusing and electrodiagnostic studies are negative. Dynamic examinations improve specificity of MR imaging for such diagnosis.     

肘管综合征超声定量检测的临床应用价值

目的:探讨肘管综合征(cubital tunnel syndrome,CTS)超声定量诊断的临床应用价值。方法:收集CTS患者33例作为患者组,共39个患病肘关节;选取30例健康志愿者作为对照组,共60个健康肘关节。用高频超声检查2组尺神经,并比较2组间尺神经形态、回声、横截面积(cross sectional area,CSA)及CSA肿胀率的差异。结果:患者组超声声像图中69.2%可见明显卡压,表现为卡压处尺神经局部扁平或变细,卡压的近端及远端肿胀变粗,回声降低;30.8%未见明显卡压,仅表现为肘部尺神经肿胀;尺神经最粗CSA与运动神经传导速度的相关系数r=-0.528。结论:超声对CTS的定量检测中,CSA肿胀率诊断价值最大,CSA和CSA肿胀率相结合能提高诊断灵敏度。