地塞米松鞘内注射与静脉注射在显微血管减压术后无菌性脑膜炎中的疗效比较

目的比较腰椎穿刺鞘内注射地塞米松与静脉推注地塞米松治疗显微血管减压术（MVD）术后无菌性脑膜炎（AM）的临床疗效。 方法选择自2015年1月至2020年1月于胜利油田中心医院神经外科就诊行MVD并诊断为AM的138例患者为研究对象,将患者分为对照组（68例）和观察组（70例）。对照组患者采用静脉推注地塞米松（10 mg/次）治疗,频率为按需给药;观察组患者采用腰穿放液联合鞘内注射地塞米松[60 μg/（kg·次）]治疗,频率为每日或隔日1次。比较2组患者治疗后的头痛及发热缓解情况、术后住院时间、治疗次数及激素不良反应情况。 结果治疗后8、72 h后,2组患者头痛、发热症状均明显好转,且观察组明显优于对照组,差异均有统计学意义（P<0.05）;观察组患者的术后住院时间[（7.68±2.23）d]短于对照组[（12.76±2.37）d],治疗次数[（3.5±0.6）次]明显低于对照组[（6.8±0.9）次],差异具有统计学意义（P<0.05）,2组患者均未见明显的激素不良反应。 结论腰穿放液联合鞘内注射地塞米松在治疗MVD术后AM患者中疗效确切,可有效改善患者头痛、发热等临床症状,减轻激素用量,缩短术后住院时间,具有重要的临床推广价值。     

脊柱均匀短缩脊髓轴性减压术治疗脊髓栓系综合征合并脊柱侧凸的疗效分析

目的 探讨脊柱均匀短缩脊髓轴性减压术（HSAD）对脊髓栓系综合征（TCS）合并脊柱侧凸的治疗效果。方法 回顾性纳入2015年4月至2018年1月在海军军医大学（第二军医大学）长征医院骨科因TCS合并脊柱侧凸行HSAD治疗的6例患者,记录手术时间、术中失血量、并发症等资料。并于术前、术后行尿动力学检查评估逼尿肌反射、括约肌功能、功能膀胱容量和最大尿流率。结果 男3例、女3例,年龄为7~23岁,平均年龄为（15.7±6.9）岁,平均随访时间为（28±9）个月。其中5例患者伴大小便失禁,3例伴足下垂,4例伴下肢肌力下降,1例存在腰痛,1例合并髋关节脱位。6例患者手术时间为180~320 min,平均（261±63）min;术中失血量为650~1 100 mL,平均（925±167）mL。1例腰痛患者术后腰痛症状完全缓解,4例伴下肢肌力下降患者术后下肢肌力均有改善。1例患者因术后未行尿动力学检查未予统计;其余5例患者于术前、术后均接受尿动力学检查,其中4例术前尿道外括约肌过动、1例失调,术后2例尿道外括约肌协调、1例改善、2例过动。术前、术后功能膀胱容量分别为195.0（127.5,233.5）mL、213.0（188.5,251.5）mL,差异无统计学意义（Z=-0.4,P=0.70）。术前最大尿流率、残余尿量分别为7.3（1.4,10.3）mL/s、130（106,200）mL,与术后[10.3（5.6,16.2）mL/s、30（6,174）mL]相比差异均有统计学意义（Z均=-2.0,P均=0.04）。5例患者术后膀胱逼尿肌肌力得到不同程度改善,最大尿流率增加,残余尿减少。结论 TCS合并脊柱侧凸可以通过HSAD一期手术治疗,该手术可同时缓解脊髓轴向张力、矫正脊柱畸形、恢复脊柱和脊髓的协调性。患者术后下肢症状和膀胱功能均得以有效改善,同时避免了脑脊液漏、出血多和神经功能恶化等并发症。     

单侧入路双侧减压TLIF手术治疗腰椎管狭窄症的疗效研究

目的 研究单侧入路双侧减压TLIF 手术与传统的PLIF 手术方式相比治疗腰椎管狭窄症的治疗效果。方法 以2016 年10 月～2017 年8 月我院收治的36 例腰椎管狭窄症患者为研究对象,将其随机分为实验组和对照组,其中对照组采用传统的PLIF 手术治疗,实验组采用单侧入路双侧减压TLIF 手术治疗,每组各18 例,比较两组患者的临床疗效及术后康复情况。结果 两组患者的手术时间、术中出血量和住院时间均差异无统计学意义（P>0.05）,但实验组患者的术后引流量更少（P＜0.05）。治疗后两组患者术后第1、3 天的CPK 水平显著高于术前（P＜0.05）,且实验组显著高于对照组（P＜0.05）,但术后第7 天的CPK 水平两组较术前均无统计学意义（P>0.05）。术后3 个月时两组的VAS 评分和ODI 评分均较术前显著下降（P＜0.05）,且实验组明显优于对照组（P＜0.05）。结论 与传统的PLIF 手术方式相比,单侧入路双侧减压TLIF 手术治疗腰椎管狭窄症的疗效更为显著,对于患者造成的手术创伤较小,术后恢复效果更好。     

脊柱定点减压牵引治疗腰椎间盘突出症临床观察

目的 观察脊柱定点减压牵引治疗腰椎间盘突出症的临床疗效。方法 选取2016 年1 月～2018 年12 月在我院治疗的腰椎间盘突出症患者100 例,随机分为观察组和对照组,每组各50 例。两组均给予基础治疗、针灸治疗及中频超声透入治疗。观察组采用脊柱定点减压牵引疗法,对照组采用传统牵引疗法,比较两组患者的临床治疗效果,并检测两组患者治疗前后VAS 评分、JOA 评分、ODI 评分及突出椎间盘最大矢径（AB）。结果 治疗前后两组VAS 评分、JOA 评分及ODI 评分比较,差异有统计学意义（P＜0.001）,治疗前后突出椎间盘最大矢径（AB）比较,差异无统计学意义（P>0.05）。观察组总有效率为86%,明显高于对照组的72%（P＜0.05）。结论 脊柱定点减压牵引治疗对腰椎间盘突出症治疗效果更好,临床症状改善明显,临床应用价值高,适合推广使用。     

MRTA对三叉神经痛患者微血管减压术后疗效的预测

目的:评价磁共振体层血管成像(MRTA)对预测三叉神经痛患者微血管减压术(MVD)后疗效的价值.方法:277例行MVD的三叉神经痛患者手术前、后接受MRTA检查,由2名影像医师分别读取术前及术后NVC分级,术后疗效分为优、良和差3组,采用SPSS 13.0软件包中的x2检验确定术前NVC的压迫程度、术后NVC压迫程度和术后NVC的缓解度在3组的分布有无差异.结果:250例(90.2％)病例术后2年疗效为优,18例(6.5％)为良,8例(2.9％)为差,1例(04％)因术后颅内出血死亡.术前不同NVC分级的病例,术后疗效无显著差异(x2=5.542,P=-0.476);术后不同NVC分级(x2=18.693,P＜0.05)和不同NVC缓解度(x2=11.484,P＜0.05)的病例,术后疗效有显著差异.结论:MVD术后行MRTA检查,是预测术后疗效较为有效的方法之一,术后NVC分级越大和NVC缓解度越小的病例,MVD术后疼痛缓解不佳的可能性越高.     

Delayed Unilateral Soft Palate Palsy without Vocal Cord Involvement after Microvascular Decompression for Hemifacial Spasm

Microvascular decompression is a very effective and relatively safe surgical modality in the treatment of hemifacial spasm. But rare debilitating complications have been reported such as cranial nerve dysfunctions. We have experienced a very rare case of unilateral soft palate palsy without the involvement of vocal cord following microvascular decompression. A 33-year-old female presented to our out-patient clinic with a history of left hemifacial spasm for 5 years. On postoperative 5th day, patient started to exhibit hoarsness with swallowing difficulty. Symptoms persisted despite rehabilitation. Various laboratory work up with magnetic resonance image showed no abnormal lesions. Two years after surgery patient showed complete recovery of unitaleral soft palate palsy. Various etiologies of unilateral soft palate palsy are reviewed as the treatment and prognosis differs greatly on the cause. Although rare, it is important to keep in mind that such complication could occur after microvascular decompression.     

Cervical Compressive Myelopathy due to Anomalous Bilateral Vertebral Artery

We report a very rare case of cervical compressive myelopathy by an anomalous bilateral vertebral artery (VA) entering the spinal canal at the C1 level and compressing the spinal cord. A 70-year-old woman had been suffering from progressive gait disturbance. Magnetic resonance imaging revealed that a bilateral VA at the V4 segment had abnormal courses and caused compression to the high cervical cord. VA repositioning was performed by anchoring a suture between the artery and around the arachnoid membrane and dentate ligament, and then, microvascular decompression using a Teflon sponge was done between the VA and the spinal cord. The weakness in the patient improved in the lower extremity after the operation. Anomalous VA could be one of the rare causes of cervical compressive myelopathy. Additionally, an anchoring suture and microvascular decompression around the VA could be a sufficient and safe method to indirectly decompress the spinal canal.     

Peripheral nerve entrapment syndromes of the upper limb

Peripheral nerve entrapment syndrome is a condition caused by the persistent application of pressure to a nerve. Symptoms include pain, numbness and tingling, and muscle weakness. The distribution of symptoms depends upon the nerve affected. This article discusses the aetiology, epidemiology and pathogenesis of peripheral nerve entrapment in the upper limb, and the principles of diagnosis and management. Common examples of nerve entrapment are described in greater depth.     

A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.     

胰岛素对骨骼肌微血管的调节作用

骨骼肌血管系统有丰富的分支网状结构,近年来人们多采用测定1-甲基黄嘌呤(1-MX)的代谢情况、对比增强超声成像(CEU)、激光多普勒超声仪(LDF)和实时对比超声等方法检测骨骼肌微血管的灌注情况.研究发现,胰岛素在未改变骨骼肌大动脉血流量的情况下,就可以引起骨骼肌微循环灌注的增加,而且这一作用具有剂量依赖性;而存在胰岛素抵抗时,胰岛素对阻力动脉的调节作用受损.胰岛素对血管的调节作用与其介导的一氧化氮和内皮素-1的表达密切相关,胰岛素抵抗时二者的表达失衡.