马尾神经根松弛症诊断及治疗研究

目的 :探讨马尾神经根松弛症的诊断及治疗。方法 :对我院开展椎管造影以来 ,发现马尾神经根松弛症9例患者的临床表现、椎管造影及治疗结果进行分析。结果 :9例患者除具有腰椎管狭窄症的一般临床表现之外 ,椎管造影结果显示狭窄节段上方马尾神经根呈波浪状蛇形卷曲 ,甚至“环状”改变 ,9例患者均行手术治疗。经随访 ,除1例患者症状无明显改善外 ,均完全恢复。结论 :椎管造影是诊断马尾神经根松弛症的有效手段 ,手术外围减压及神经根粘连松解是治疗的有效方法     

腰椎间盘突出症并神经根管狭窄的治疗

目的：探讨腰椎间盘突出症合并神经根管狭窄的临床诊断和手术治疗。方法：对1996-1999年间,因腰椎间盘突出症合并神经根管狭窄38例行手术治疗,术中均行神经根管探查并彻底松解受压神经根。结果：术后随访38例,优20例,良15例,一般2例,差1例,优良率92.11%。结论：神经根管扩大和神经根探查彻底减压是手术成功的关键。     

视神经管减压术治疗视神经挫伤20例分析

目的：报告视神经挫伤行视神经管减压术的治疗效果。方法：手术治疗限定于外伤后不超过1月且无严重颅脑损伤及无严重全身疾病者。采用局麻筛蝶窦入口法,手术前后常规用糖皮质激素及神经生长因子。结果：20例术前无光感16例,术后1周视力有光感及手动以上12例,占75％;术前视力在手动－0．04以内4例,术后视力均提高。术后随访3个月除2例外视力均有提高,最好达到0．3。结论：视神经挫伤病期不超过1月虽视力已无光感也不应放弃行视神经管减压术。     

Liposomal Bupivacaine vs Ropivacaine for Adductor Canal Blocks in Total Knee Arthroplasty: A Prospective Randomized Trial

BackgroundThe purpose of this study is to determine the benefit of the analgesic liposomal bupivacaine compared to ropivacaine, by assessing pain and joint stiffness, and total oral opioid consumption by milligram morphine equivalent (MME) after total knee arthroplasty.MethodsPatients were randomized to receive either the study drug (liposomal bupivacaine admixed with bupivacaine) or the control drug (ropivacaine) in an adductor canal block. Only the anesthesiologist performing the block was aware of which arm of the study the patient was randomized to. MME, pain, Knee injury and Osteoarthritis Outcome Score Joint Replacement, and overall benefit of analgesia scores were recorded 24, 48, and 72 hours post-surgery either face-to-face or via telephone depending on patient discharge status.ResultsOne hundred patients were enrolled into the study and analyzed: 54 in the control group and 46 in the experimental group. Primary outcomes measured were pain as a numerical rating scale, MME, and length of stay in hours. Secondary outcomes were joint pain and stiffness recorded as Knee injury and Osteoarthritis Outcome Score Joint Replacement outcome and overall benefit of analgesia score. No statistically significant between-group differences were observed for any measured outcome.ConclusionWe did not find any supporting evidence that liposomal bupivacaine yields increased pain relief following total knee arthroplasty compared to the control drug, ropivacaine.     

收肌管阻滞术联合经皮穴位电刺激用于全膝关节置换术后的临床效果

目的 :探讨收肌管阻滞术(addcutor canal block,ACB)联合经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)在全膝关节置换术(total knee arthroplasty,TKA)术后镇痛及对早期功能锻炼的效果。方法:选取2019年1月至2020年8月初次单侧行TKA的患者84例,其中男45例,女39例;年龄66～77(72.8±8.9)岁;身体质量指数(body mass index,BMI) 19～25(23.6±3.5) kg/m~2。按照随机数字表法将患者分为收肌管阻滞术联合经皮穴位电刺激组(TEAS+ACB组)和单纯收肌管阻滞术组(ACB组),每组42例。ACB组术中实施ACB,TEAS+ACB组在ACB基础上于术后第1～7天行双下肢TEAS。记录并比较两组术后6,12,24,48,72 h的疼痛视觉模拟评分(visual analogue scale,VAS),术后第1,2,3,7天的膝关节功能,术后第7天膝关节活动度与住院天数。结果:TEAS+ACB组VAS评分在静息、活动状态下术后6,12 h与ACB组相比差异无统计学意义(P0.05),在术后24,48,72 h均低于ACB组(P0.05)。TEAS+ACB组膝关节活动度在术后第1天与ACB组相比差异无统计学意义(P0.05),在术后第2,3,7天均大于ACB组(P0.05)。TEAS+ACB组住院天数小于ACB组,术后第7天膝关节活动度大于ACB组(P0.05)。结论:TEAS联合ACB较单纯的ACB有更好的术后镇痛效果,促进患者早期功能锻炼,对TKA术后镇痛是安全、有效的。     

临床护理路径在椎管占位切除术及稳定性重建术后患者护理中的应用效果

目的探讨临床护理路径在椎管占位切除术及稳定性重建术后患者护理中的应用效果。方法选取2017年6月至2019年12月医院收治的116例行椎管占位切除术及稳定性重建术的患者作为研究对象,将2017年6月至2018年8月收治的58例患者设为对照组,2018年9月至2019年12月收治的58例患者设为观察组。对照组采用常规护理,观察组采用临床护理路径干预,比较两组住院天数、护理满意度、并发症发生情况。结果观察组住院天数短于对照组,护理满意度评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论临床护理路径应用于椎管占位切除术及稳定性重建术后患者,可有效缩短患者的住院天数,提高护理满意度,降低并发症发生率。     

国人男性椎管的测量与观察

本文对广西出土的113例男性干燥椎骨的椎孔,进行了矢径、横径的测量和形态观察。椎孔的矢、横径在壮族(30例),汉族(57例)间无显著差异(P>0.05)。在C_(3～6)椎骨水平,推管的矢径和形态与脊髓的外形不一致,矢径于该处形成生理性狭窄,以C_4处为最小(12.92mm)。除C_1外,椎管的形态可分为4型:Ⅰ型圆型;Ⅱ型三角型;Ⅲ型过渡型;Ⅳ型不整型。 C_(1,2)椎管的形状为圆型,向下至C_6,通过半圆形逐步过渡到三角形(C_6占81.31％);再向下至T_6,三角形通过蛤形和多边形又逐渐过渡为圆形(T_6占84.76％);再向下至L_5,又通过蛤形逐渐过渡为三角型(L_5占99％)。从L_3至L_5,三角形椎孔有逐步通过钟形向三叶形过渡的趋势。三叶形腰椎管占5.02％。本文结果支持Eisenstein的观点,认为三叶形结构是一种普通的、非病理性的现象,与年龄增长、骨赘或椎孔狭窄无关,这或许是一种正常的发育性变异。     

Behavior of horizontal semicircular canal afferents in alert monkey during vestibular and optokinetic stimulation

Summary The behavior of single vestibular nerve fibers from the lateral semicircular canal was recorded during sinusoidal oscillations of the head, during optokinetic stimulation with the head stationary, and during spontaneous oculomotor behavior in the alert monkey. The response of similar fibers to adequate vestibular stimulation was also studied in some of the animals under deeply anesthetized conditions. In the alert animals all units were spontaneously active and their discharge was modulated only by adequate vestibular stimulation. Ipsilateral horizontal rotations of the head were excitatory for all units. No modification of this basic vestibular response by visual stimulation including full-field striped drum rotation was observed. Furthermore no correlation of unit activity with oculomotor function including voluntary saccadic and pursuit eye movements was found in any of the units. The regularity of spontaneous discharge was the most consistent characteristic that differentiated the unit response into types. Most units were very regular in discharge, but a few were very irregular. The averaging of unit discharge over several cycles of oscillatory head rotation showed that the irregular type units were also consistently modulated by adequate vestibular stimulation. Both regular and irregular type units were found in the anesthetized animals. Unimodal distributions of the quantitative values for unit resting discharge rate, sensitivity, and phase relationship were found. The distributions for these three parameters were similar in the units recorded in the anesthetized animals. Thus at least these characteristics of semicircular canal response seem not to be affected by the vestibular efferent system which should be altered or eliminated in the case of the anesthetized animals.Research supported by NIH Grant EY0995-04.     

下颌第三磨牙根尖与下颌管的位置关系

本文对50侧96例成人下颌骨第三磨牙根尖与下颌管的位置关系等进行了观测,下颌管在根尖下方者占86.5%,在根尖外侧者占8.3%,在根尖内侧者占5.2%。第三磨牙根尖至下颌管间的距离在2mm以内占35.4%.根尖与下颌管之间的位置关系及距离可供临床应用参考。