Effectiveness of Neuromuscular Electrical Stimulation on Lower Limbs of Patients With Hemiplegia After Chronic Stroke: A Systematic Review

Objective

To investigate the effectiveness of neuromuscular electrical stimulation (NMES) with or without other interventions in improving lower limb activity after chronic stroke.

Surgical Treatment of a Brown Recluse Spider Bite: A Case Study and Literature Review

Spider bite envenomation can cause local, constitutional, and/or systemic symptoms. The present case study reports on 5 years of follow-up for a “probable” brown recluse spider bite of the foot and ankle that was refractory to conservative treatment and was subsequently treated with surgery. The present case study reports the atypical occurrence of long-term peripheral neuropathy after necrotic arachnidism induced by “probable” brown recluse (Loxosceles recluse) envenomation, in a 46-year-old male. The state of published data suggests to minimize inflammation and tissue necrosis, prevent bacterial superinfection, and control pain levels. For patients with long-term peripheral neuropathy refractory to conservative therapy, surgical intervention may further improve their symptoms.     

Potential Entrapment of an Accessory Superficial Peroneal Sensory Nerve at the Lateral Malleolus: A Cadaveric Case Report and Review of the Literature

The superficial peroneal nerve presents great anatomic variability regarding its emergence from the crural fascia, course, branching pattern, and distribution area. Entrapment neuropathy of the superficial peroneal nerve has been documented in the published data, resulting in pain and paresthesia over the dorsum of the foot. We report a case of a female cadaver in which an accessory superficial peroneal sensory nerve was encountered. The nerve originated from the main superficial peroneal nerve trunk, proximal to the superficial peroneal nerve emergence from the crural fascia, and followed a subfascial course. After fascial penetration, the supernumerary nerve was distributed to the skin of the proximal dorsum of the foot and lateral malleolar area. A potential entrapment site of the nerve was observed at the lateral malleolar area, because the accessory nerve traveled through a fascial tunnel while perforating the crural fascia, and presented with distinct post-stenotic enlargement at its exit point. The likely presence of such a very rare variant and its potential entrapment is essential for the physician and surgeon to establish a correct diagnosis and avoid complications during procedures to the foot and ankle region.     

神经生长因子对小鼠颈上神经节和大鼠腓神经损伤后修复的影响

目的 应用形态学方法观察研究神经生长因子（NGF）对长春新碱（VCR）损伤的小鼠颈上神经节和钳夹损伤的大鼠腓神经修复再生作用。方法 颈上神经节：出生2d的昆明种小鼠随机分为实验组、对照组和空白对照组。实验组皮下注射VCR（0.2mmol/L～10ul/g体重）和NGF（2、5、10ug/g体重）,对照组仅注射VCR,每天1次,连续4d。光镜下测量颈上神经节横径并且观察神经节细胞形态变化。周围神经：将钳夹损伤腓神经的SD大鼠随机分为实验组和对照组,并从损伤后第1天在近损伤处分别肌注NGF（2、4、8ug/kg体重）和生理盐水,每天1次,连续12d。取腓神经和趾长伸肌,光镜观察,并计数损伤处远端和近端神经纤维数量。结果 VCR可损伤颈上神经节,神经节横径缩小,节细胞凋亡解体;NGF则可改善VCR的损害作用,神经节横径增大61%～95%,节细胞数明显增多59%～70%,细胞凋亡现象显著减轻,改善程度与NGF剂量相关。NGF对排神经再生和趾长伸肌形态变化也有明显改善作用,尤以大剂量NGF的作用更显著。结论 NGF对长春新碱损伤的小鼠颈上神经节和经钳夹损伤的大鼠腓神经有明显的促修复作用。     

游离腓动脉穿支皮瓣在手部软组织缺损中的疗效观察

目的:探讨游离腓动脉穿支皮瓣在手部软组织缺损中的临床疗效。方法:选取2010年7月～2011年7月在本院进行治疗的60例手部软组织缺损患者为研究对象,将所有患者根据不同的手术方式分为对照组(游离胸脐皮瓣组)30例和观察组(游离腓动脉穿支皮瓣组)30例,将两组患者的治疗后的手部功能、感觉及治疗后1、3、10d的微循环指标进行检测及比较。结果:观察组治疗后的手功能优良率及感觉功能S3～S4比例均高于对照组,而治疗后1、3、10d的微循环指标均优于对照组,差异均有统计学意义(P均<0.05)。结论:游离腓动脉穿支皮瓣在手背软组织缺损中的临床疗效较佳,可更为快速且有效地改善微循环。     

腓浅动脉岛状筋膜蒂皮瓣在小腿皮肤缺损中的应用

目的探讨采用腓浅动脉岛状筋膜蒂皮瓣治疗小腿皮肤缺损的临床效果。方法对31例膝关节至足踝部皮肤缺损患者采用腓浅动脉岛状筋膜蒂皮瓣移位治疗。结果随访31例，时间3周-5年。27例皮瓣完全成活，4例皮瓣远端部分坏死。结论采用腓浅动脉岛状筋膜蒂皮瓣治疗小腿皮肤缺损，该皮瓣血供可靠，切取方便，不牺牲主干血管，基本可满足小腿前外侧创伤修复的需要。     

带骨骺的儿童腓骨移植应用解剖学

解剖观察了70侧的儿童腓骨上骨骺的动脉来源、分布和吻合情况。其血供来源共见7种,胫前返动脉和腓浅动脉的腓骨头支是营养骨骺的重要血管。带骨骺儿童腓骨移植应以胫前动脉为血管蒂,腓骨体移植仍以腓血管为蒂。     

Common peroneal nerve rupture with multiple ligament knee injury: A case report

In peroneal nerve palsy with closed knee injury, most of the case improves by follow‐up. We present a case of peroneal nerve rupture with closed multiple ligament knee injury, requiring nerve transplantation. In multiple ligament knee injury, it is necessary to consider the possibility of peroneal nerve rupture.     

Endoscopic Anterior Tarsal Tunnel Release: A Case Report

Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. We report a patient with anterior tarsal tunnel syndrome who was successfully treated with endoscopic anterior tarsal tunnel release. Our endoscopic technique, because it preserves the inferior extensor retinaculum, is potentially less traumatic than traditional surgical techniques for repairing this entrapment neuropathy.     

Multiple Locations of Nerve Compression: An Unusual Cause of Persistent Lower Limb Paresthesia

A paucity of appreciation exists that the “double crush” phenomenon can account for persistent leg symptoms even after spinal neural decompression surgery. We present an unusual case of multiple locations of nerve compression causing persistent lower limb paresthesia in a 40-year old male patient. The patient's lower limb paresthesia was persistent after an initial spinal surgery to treat spinal lateral recess stenosis thought to be responsible for the symptoms. It was later discovered that he had peroneal muscle herniations that had caused superficial peroneal nerve entrapments at 2 separate locations. The patient obtained much symptomatic relief after decompression of the peripheral nerve. The “double crush” phenomenon and multiple levels of nerve compression should be considered when evaluating lower limb neurogenic symptoms, especially after spinal nerve root surgery.