肌电图观察超声引导锁骨上臂丛神经阻滞对膈神经传导和膈肌电位的影响

目的肌电图观察超声引导锁骨上臂丛神经阻滞(supraclavicular brachial plexus block,SCBPB)对膈神经传导(phrenic nerve conduction,PNC)和膈肌电位的影响。方法选取90例择期行前臂骨折取内固定装置术患者,随机分为A组(0.375%罗哌卡因20 mL)、B组(0.5%罗哌卡因20 mL)和C组(0.75%罗哌卡因20 mL),每组各30例。所有患者均在超声引导下进行SCBPB,应用肌电图测量PNC数据,对阻滞前、阻滞后5、10、15、30 min的PNC潜伏期及膈肌复合肌肉动作电位(compound muscle action potential,CMAP)波幅测量三次记录平均值。测试阻滞后5、10、15、30 min阻滞情况,观察并记录三组的阻滞起效时间、镇痛效果、阻滞维持时间及术后24 h阻滞相关并发症。结果 A组阻滞后CMAP波幅小于阻滞前50%的概率高于B、C组,差异有统计学意义(P0.05)。A组比B、C组阻滞起效时间慢,阻滞维持时间短,差异有统计学意义(P0.05),三组在臂丛阻滞后PNC潜伏期均有不同程度的延长,30 min阻滞效果、术后24 h阻滞相关并发症无显著差异(P0.05)。结论 0.375%、0.5%和0.75%罗哌卡因20 mL在超声引导下行SCBPB在注药后30 min均可以达到满意的阻滞效果,0.375%罗哌卡因20 mL比0.5%、0.75%罗哌卡因20 mL行SCBPB对CMAP波幅影响小。     

产瘫的分型分度

目的 提出新的产瘫分类方法。方法 通过对358例产瘫的诊治，研究，按照损伤的解剖部位进行分型；按照损伤的程度进行分度。结果 本组358例产瘫均可用新的分型分度法进行,共分5型4度。结论 分型分度法是一种切实可行的新的产瘫分类方法，可以更好地指导产瘫的医，教，研工作。     

根性撕脱的臂丛前根再植入脊髓的显微解剖

目的：探讨臂丛根性撕脱伤前极再植入脊髓的手术入路解剖。方法：在15例颈胸段尸体标本上，观测臂丛根及其前根解剖，测量椎动脉与颈椎、脊髓的关系，以及各脊髓节段与对应椎间盘的相对位置。另4例标本采用侧前方入路行臂丛前根再植入术。结果：由上至下臂丛根长度、脊髓节段长度、脊髓半径、前根根丝数及其起始处至中线距离逐渐减小，椎体半径、椎动脉至中线距离及前根长度逐渐增大；C5-7脊髓节对应C3-4、C4-5、C5-6椎间盘，C8、T1脊髓节对应C6、C7椎体。结论：侧前方入路可使臂丛前根再植入至最佳位点。     

Nerve transfer for treatment of brachial plexus injury：comparison study between the transfer of partial median and ulnar nerves and that of phrenic and spinal accessary nerves

Objective:To compare the effect of using partial median and ulnar nerves for treatment of C5-6 orC5-7 avulsion of the brachial plexus with that of using phrenic and spinal accessary nerves.Methods:The patients were divided into 2groups randomly according to different surgical procedures.Twelve cases were involved in the first group.The phrenic nerve was transferred to the musculocutaneous nerve or through a sural nerve graft,and the spinal accessary nerve was to the suprascapular nerve.Eleven cases were classified into the second group.A part of the fascicles of median nerve was transferred to be coapted with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to the axillary nerve.The cases were followed up from 1to 3years and the clinical outcome was compared between the two groups.     

Diffuse arachnoidal enhancement of a well differentiated choroid plexus papilloma

Summary. Summary.   Introduction: The case of a 38-year old man with a histologically benign choroid plexus papilloma arising within the fourth ventricle with en plaque growth around the brain stem and medulla is described in detail. Up to this point this particular growth pattern has not been published and is a rare presentation for this tumour.   Clinical Presentation: The patient presented with a 1.5 year history of headache, nausea, and vomiting in the morning. Additional symptoms like blurred vision and gait ataxia lead to hospital admission. MRI demonstrated a homogeneously contrast-enhancing tumour completely filling the fourth ventricle and subsequent obstructive hydrocephalus. In addition Gd enhancement encasing the brain stem, the lower aspect of the medulla and the conus medullaris was seen suggesting a disseminated ependymoma or medulloblastoma.   Intervention: An extensive resection of the tumour in the fourth ventricle and CP angle was performed. Infiltrative growth into the structures of the left CP angle and into the rhomboid fossa hampered complete removal. Surprisingly histological examination revealed a well-differentiated papillary choroid plexus papilloma without signs of anaplasia. On follow up imaging the Gd enhancement encasing the pons vanished completely. A growing cyst adjacent to a small tumour residuum left behind on the floor of the fourth ventricle led to re-operation after 8 months with complete removal.   Discussion: This case presents several biological, neuroradiological and surgical aspects which make it noteworthy and we hope that the informations provided add to the understanding of these tumours, expand the differential diagnostic thinking of lesions which present with diffuse arachnoid Gd enhancement upon first presentation. Published online July 18, 2002     

臂丛神经下干不同损伤诱发神经病理性疼痛大鼠后足的痛行为学特征

目的 比较颈胸椎前路和后路臂丛神经下干切断伤与根性撕脱伤诱发神经病理性疼痛大鼠术侧后足的痛行为学特征.方法 18只成年雌性SD大鼠随机接受右侧前路下干切断、前路及后路下干根性撕脱手术(每组6只),另外6只健康大鼠作为对照组.臂丛损伤术前及术后3、7、14和28 d,检测大鼠术侧后足的机械痛缩足阈值、冷刺激诱发痛评分及热刺激缩足潜伏期.结果 对照组与3个损伤组之间术前三项痛行为学指标的差异无统计学意义.与术前相比,前路切断伤组冷刺激诱发痛评分明显增高(P<0.01),机械痛缩足阈值及热刺激缩足潜伏期则无明显变化;前路及后路撕脱伤组术后各时间点机械痛缩足阈值均显著降低(P<0.01),冷刺激诱发痛评分均明显增高(P<0.01),而热刺激缩足潜伏期则无显著变化.与切断伤组相比,两撕脱伤组术后各时间点热刺激缩足潜伏期则无显著差异,而后足机械痛缩足阈值均显著降低(P<0.05),冷刺激诱发痛评分亦显著增高(P<0.01),这种痛行为学的变化可持续至28 d(最长观察期);两撕脱伤组间各痛行为学指标的差异无统计学意义.结论 大鼠前、后入路臂丛下干根性撕脱伤均可作为理想的神经病理性疼痛模型,而臂丛下干切断伤因致痛效果较差则不宜用作神经病理性痛模型.     

选择性臂丛神经根切断治疗上肢痉挛脑瘫的远期疗效评价

目的评价选择性臂丛神经根切断治疗上肢痉挛性脑瘫的远期疗效。方法对1997年3月-2002年1月间施行选择性臂丛神经根切断术治疗上肢痉挛性脑瘫的患者，进行随访并对远期功能进行评价，采用Lazareg肌张力分级标准评定临床效果。结果16例17侧获得随访，随访时间为5．0～9．7年，平均8．6年。手术方式为选择性臂丛神经根全根切断10侧，部分切断2侧，高选择性分束切断5侧；其中切断神经根为颈63次，颈816次。术后远期疗效优3例，有效5例，无效8例9侧。结论选择性臂丛神经根切断治疗上肢痉挛性脑瘫远期大多数疗效下降和无效，但术前严格选择痉挛较局限的病例、术中进行高选择性臂丛神经根分束切断、术后坚持长期康复训练仍然能获得较好的疗效。     

臂丛神经闭合性损伤和肿瘤的超声诊断

目的探讨高频超声在诊断臂丛神经闭合性损伤和肿瘤中的价值。方法用高频超声检查和诊断6例创伤性臂丛神经损伤与3例臂丛神经肿瘤，随机选择12例健康成年人作为正常对照组，观察臂丛神经的正常超声图像。结果高频超声显示斜角肌间隙和锁骨下动脉是臂丛神经检查的重要解剖标志，正常臂丛神经长轴显示多条线性平行回声，短轴呈圆形中等回声，内有点状弱回声，C5-7和上、中干显示率为100％（12／12），C8、T1和下干显示率为83．3％（10／12）。6例臂丛神经损伤显示神经增粗水肿，部分正常束状回声消失或不连续，内部点线回声不清，呈略低回声与周围软组织粘连。3例臂丛神经肿瘤显示为实性瘤样低回声与臂丛神经相连续，其内有血流信号，其中2例为超声检查最早诊断。结论高频超声可作为检查臂丛神经闭合性损伤和肿瘤的首选方法，值得临床推广应用。     

虚拟人的腰丛神经断层解剖学及可视化研究

目的观测“虚拟中国人”（virtual Chinese human,VCH）女性Ⅰ号、男性Ⅲ号腰丛神经连续横断面的走行,建立腰丛神经的可视化数字模型。方法应用“虚拟中国人”女性Ⅰ号（VCH—FⅠ）和男性Ⅲ号（VCH．Mm）数据集,在薄层断面图像上观察腰丛神经的构成及其与腰大肌和周围血管的关系,应用Amira3．1（WGS）软件对腰丛神经及其周围结构进行计算机三维重建并立体显示。结果在VCH-FⅠ和VCH—MⅢ的薄层断面图像上可以清楚地显示腰丛神经的主要结构,重建的数字化模型可准确地反映腰丛神经解剖学结构特点。结论VCH—FⅠ和VCH—MⅢ数据集能够提供完整精确的腰丛神经断面解剖,重建的数字化模型为腰丛神经损伤的影像诊断和外科治疗提供了良好的形态学依据。     

神经移植重建面神经在腮腺癌根治术中的应用

目的：探讨腮腺深叶癌切除面神经后，即刻功能性修复的临床效果。方法：对1984年1月至2005年10月间收治的11例腮腺癌患者，术中采用将肿瘤连同腮腺及面神经切除，同时行颈丛神经移植重建面神经的治疗方法。结果：术后面神经功能均完全恢复，所有患者术后6个月复诊，见患者静态时面部对称，动态时口角轻度偏斜，术后一年两侧面部完全对称，睁、闭眼及提口角功能基本恢复正常。结论：腮腺癌根治术中采用颈丛神经移植能有效地恢复面神经的功能，既达到肿瘤切除的彻底性，又符合功能外科的发展要求，是一种比较理想的手术方法。