肌电图辅助定位小切口尺神经松解术治疗肘管综合征

Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the ＞ 50%reduction in amplitude or ＞ 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to ＞ 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.     

肌电图辅助定位小切口尺神经松解术治疗肘管综合征

目的 评价肌电图辅助定位小切口尺神经松解术治疗肘管综合征的疗效及手术适应证.方法 选取无明显手内在肌萎缩及肘关节畸形,具有典型临床症状和体征的肘管综合征患者12例,术前通过神经短节段传导(short-segment nerve conduction test,SSCT)检测的方法,以相邻两次动作电位波幅下降＞50%或潜伏期差＞0.5ms为定位标准,对上述患者进行卡压点定位,采用小切口局部尺神经松解术式,并观察卡压点术中与术前定位比较.结果 术中观测结果证明尺神经损害部位位于肱骨内上髁上方3 cm到肱骨内上髁下方1cm之间,与术前SSCT法检测卡压部位相符.12例术后均主诉手部有明显轻松感;术后3个月感觉异常全部恢复,刺痛觉及爪形指恢复,捏力和抓握力恢复;术后6个月时小指展肌肌力已完全恢复至正常,两点分辨觉平均为5.0 mm,神经传导速度(NCV)均＞45.0 m/s,波幅开始增加,SSCT无阳性发现;术后1年肌肉萎缩基本恢复,屈肘试验、肘部Tinel征、夹纸试验阴性,7例肌电图无阳性发现,1例NCV仍低于正常标准,但无临床症状及体征.术中观察神经卡压位置与术前肌电图定位相符.结论 肌电图辅助定位小切口尺神经松解术治疗肘管综合征是一种有效的方法.

Abstract：

Objective To evaluate the therapeutic effect of in situ ulnar nerve decompression at the cubital tunnel via a small incision assisted with electromyography localization and discuss the surgical indications.Methods Twelve patients who were diagnosed with idiopathic cubital tunnel syndrome (CuTS) without intrinsic muscle atrophy and elbow deformity were involved in the study.Before the operation, short-segment nerve conduction test (SSCT) was carried out.The exact compression site was determined by the ＞ 50%reduction in amplitude or ＞ 0.5 ms lengthening in latency of action potentials recorded upon stimulation of the ulnar nerve around the elbow at 1 cm intervals.An in situ ulnar nerve release at the compression site was performed.Compression of the ulnar nerve was observed and documented to verify the accuracy of pre-operative SSCT localization.Results Intraoperative findings confirmed that lesions were located from 3 cm above to 1 cm below the medial epicondyle, which coincided with the compression sites determined by SSCT.All the patients reported alleviation of hand discomfort postoperatively.Follow-up at 3 months postoperatively showed that paresthesia in the distribution of the ulnar nerve in the hand disappeared.Pinprick sensation recovered.There was no subjective or measurable weakness in pinch or grip strength and no clumsiness or loss of coordination.Claw deformity disappeared.Six months after the surgery, the strength of abductor digiti minimi returned to normal.Two-point discrimination of the little finger was 5.0 mm on average.Nerve conduction velocity returned to ＞ 45.0 m/s.Action potential amplitude increased and SSCT yielded no positive findings.Mild atrophy was reversed one year postoperatively.Elbow flexion test, Tinel' s sign and Froment' s test were all negative.Conclusion In situ ulnar nerve decompression via a small incision assisted with electromyography localization is a suitable procedure for certain CuTS cases.     

顺铂和氟尿嘧啶增强食管癌细胞NKG2D配体的表达及CIK细胞的杀伤活性

目的研究顺铂(Cisplatin,DDP)和氟尿嘧啶（5-fluorouracil,5-Fu）对人食管癌EC9706 细胞NKG2D配体表达及CIK细胞杀伤活性的影响。方法MTT法测定DDP、5-Fu的50%抑制浓度（IC50）;以1/2 IC₅₀浓度DDP、5-Fu作用EC9706细胞72 h,RT-PCR检测DNA损伤修复系统相关信号分子的表达。流式细胞仪检测DDP、5-Fu作用前、后EC9706细胞NKG2D配体的表达。乳酸脱氢酶释放法检测效靶比20∶1时,CIK细胞对DDP、5-Fu作用前、后EC9706细胞的杀伤活性。结果DDP、5-Fu的IC₅₀分别为5 μg/ml、10 μg/ml。DDP、5-Fu可上调DNA损伤修复系统相关信号分子mRNA的表达。DDP与 EC9706细胞共孵育72 h后,EC9706细胞MICA、MICB、ULBP2、ULBP3表达较DDP作用前明显增强（P<0.05）,ULBP1无明显变化（P>0.05）。5-Fu与 EC9706细胞共孵育72 h后,EC9706细胞MICA、ULBP2、ULBP3表达明显增强（P<0.05）,MICB、ULBP1无明显变化（P>0.05）。效靶比20∶1时,CIK细胞对EC9706细胞的杀伤活性为（37.08±0.62）%,CIK细胞对1/2 IC₅₀ DDP、1/2 IC₅₀ 5-Fu作用后的EC9706细胞杀伤活性分别为（59.33±2.10）%、（52.44±0.97）%,与作用前相比差异均有统计学意义（P<0.05）。结论DDP、5-Fu通过激活DNA损伤修复系统相关信号分子,提高EC9706细胞NKG2D配体的表达,从而增强EC9706细胞对CIK细胞杀伤的敏感度。     

远端蒂尺侧上副动脉穿支皮瓣的应用解剖

目的　为远端蒂尺侧上副动脉穿支皮瓣设计提供解剖学基础。 方法　通过对14侧红色乳胶灌注的新鲜成人上肢标本进行显微解剖,观测尺侧上副动脉穿支的起源、走行、数量、外径及吻合情况。 结果　尺侧上副动脉起点距肱骨内上髁上方（16.6±1.9）cm,外径（1.6±0.2）mm,穿支动脉出现率93％,在尺侧上副动脉全程都有分布,管径0.5～1.3 mm之间,并在深筋膜表面形成纵向稠密的血管吻合网。远端穿支位置相对恒定,距肱骨内上髁上方距离(3.3±1.2)cm,管径(0.9±0.3)mm,并与尺侧下副动脉、尺侧返动脉发出的皮肤穿支形成血管吻合,有1～2条伴行静脉,直径(0.8±0.4)mm。 结论　尺侧上副动脉穿支所形成的血管吻合网血供可靠,远端穿支管径较粗、位置恒定,以肱骨内上髁上方3 cm尺侧上副动脉远端穿支穿出点为皮瓣旋转点,以臂内侧中下部皮肤为供区,不携带尺侧上副动脉,设计远端蒂尺侧上副动脉穿支皮瓣,可用于修复肘关节皮肤缺损。     

替吉奥联合康莱特注射液二线治疗晚期胰腺癌临床观察

目的 探讨替吉奥联合康莱特注射液在晚期胰腺癌二线治疗中的疗效和安全性.方法 44例含吉西他滨一线化疗失败的晚期胰腺癌患者分别给予单药替吉奥(单药组21例)、替吉奥联合康莱特(联合组23例)治疗,评价2组患者的疗效和不良反应.结果 单药组和联合组患者的疾病控制率分别为52.4%和60.9%,差异无统计学意义(P>0.05).单药组和联合组患者的中位疾病无进展生存时间分别为2.3个月和3.1个月,差异有统计学意义(P<0.05).中位生存时间分别为6.0个月和6.7个月,差异无统计学意义(P>0.05).2组患者不良反应均主要为白细胞减少、血小板减少、贫血、恶心、呕吐、腹泻.结论 替吉奥联合康莱特注射液二线治疗晚期胰腺癌比替吉奥单药更能延长患者的疾病无进展生存时间,且安全性好.     

山茱萸提取物对大鼠原发性肝癌组织中B7-H6表达的影响

  目的  探讨山茱萸提取物对原发性肝癌（hepatocellular carcinoma,HCC）大鼠B7-H6表达的影响。  方法  选取60只SD大鼠随机分为模型组、苦参碱组和山茱萸组,以二乙基亚硝胺诱发大鼠模型,分别给予苦参碱组和山茱萸组大鼠相应药物灌胃,模型组大鼠给予0.9% NaCl溶液灌胃。计数各组大鼠肝脏表面的癌结节数及其抑瘤率;经H&E染色后观察各组大鼠肝癌组织的病理学改变。应用免疫组织化学法和Western blot法检测模型组、苦参碱组和山茱萸组大鼠肝癌组织中B7-H6的表达。  结果  苦参碱组和山茱萸组大鼠的肝癌结节数明显少于模型组（P＜0.05）;山茱萸组的抑瘤率显著高于苦参碱组（P＜0.05）。免疫组织化学结果显示,山茱萸组和苦参碱组肝癌组织中B7-H6的阳性表达显著高于模型组（P＜0.05）,山茱萸组B7-H6的阳性表达显著高于苦参碱组（P＜0.05）。Western blot法结果显示,山茱萸组和苦参碱组B7-H6的蛋白表达显著高于模型组（P＜0.05）,山茱萸组B7-H6的蛋白表达显著高于苦参碱组（P＜0.05）。  结论  山茱萸提取物可能通过上调肿瘤组织B7-H6的表达,抑制大鼠肝癌组织的生长。      

术后镇痛病案的调查分析

目的通过术后镇痛调查,了解病人及家属对术后镇痛的要求,并发症防治及建议等.方法对自愿接收硬膜外术后镇痛的妇科、产科病人,在镇痛结束后发放镇痛调查表,通过问卷形式,按照调查要求逐项填写,然后返回麻醉科统计分析,与麻醉记录单一同分类保存.结果对记录完整的2617份调查表进行统计处理.普遍认为此项业务可以开展,自愿接受率达100%,并发症发生率低于文献报道.结论通过术后镇痛问卷调查,为今后科研工作提供确切的数据,也为今后继续开展此项业务奠定良好基础.     

云南大理白族居民高血压患病情况及相关因素

高血压是最常见的心脑血管疾病之一,其中原发性高血压约占95%,是导致冠心病、脑卒中、充血性心力衰竭和肾功能障碍的最主要危险因素。随着社会经济高速发展,人口老龄化的加剧,人们生活水平及行为方式发生了巨大的变化。建国以来,我国进行了4次高血压抽样调查,其中1959年高血压患病率为5.11%,1979年为7.73%，1991年为11.88%,     

22例老年肾病综合征临床表现和病理分析

目的：了解老年肾病综合征的临床表现和病理特点。方法：选择我院2001年1月～2007年1月老年肾病综合征患者21例行肾穿刺活捡。结果：22例老年肾痛综合征原发性肾小球肾炎占14例。继发性肾小球肾炎占7例，肾活检膜性肾病7例，给强的松或强的松联合环磷酰胺治疗，总缓解率77．3％。结论：老年肾病综合征病理复杂，主张行肾活捡以明确诊断及指导治疗，对激素或激素联合免疫抑制荆治疗反应较好。     

颈前路微气钻扩大减压H型骨块榫状植骨治疗脊髓型颈椎病

0　引言　脊髓型颈椎病的前路术式及植骨方法临床上已成熟 ,我院 1994 - 10 /1997- 0 8用微气钻行颈前路扩大性减压 H型骨块榫状植骨治疗脊髓型颈椎病 3 4例 ,效果满意 .1　对象和方法1.1　对象　本组 3 4 (男 2 5 ,女 9)例 .年龄 4 2～ 75 (平均 5 1)岁 .发病至术前时间平均 5 mo( 6d～ 96m o) . 3 4例均有脊髓受损进行性加重表现 :下肢步态不稳 ,行走如踏棉花包感 2 1例 ,胸腹束带感 2 6例 ,手部僵硬握力减弱 17例 ,括约肌功能障碍 10例 ,巴氏征阳性 3 2例 ,霍夫曼征阳性 2 7例 .外伤史发病 9例 .全部病例均有颈椎正侧位、双斜位及动力位…