大鼠骶髂关节传入神经通路的实验研究

目的:通过逆行神经追踪法研究大鼠骶髂关节的传入神经通路。方法:30只雄性Sprague-Dawley大鼠随机分成非交感神经切除组(A组)和交感神经切除组(B组),每组15只,交感神经切除组切除左侧L1以下椎旁交感干。两组左侧骶髂关节注入30%的辣根过氧化物酶(HRP)20μl,72h后取出双侧的L1-S1背根神经节(DRG),TMB法染色后在光学显微镜下观察HRP阳性神经元细胞并计数。结果:两组左侧L1、L2背根神经节内HRP阳性神经元差异有显著性意义(P<0·05),B组HRP阳性神经元明显减少;左侧L3-S1背根神经节内HRP阳性神经元差异无显著性意义(P>0·05)。结论:L1-S1神经节含有支配同侧骶髂关节的传入神经元,同侧椎旁交感干可能是骶髂关节到L1-L2神经节重要的传入神经旁路,而不是到L3-L5神经节的传入旁路或重要的传入旁路。     

肱骨内上髁骨折致尺神经卡压1例

患者,男,17岁,因右肘肿痛,活动受限30min于2005年6月15日来我院就诊。患者于30min前与同学扳手腕时突感右肘内侧疼痛难忍,逐渐肿胀,活动受限,右手各指无麻木。查体:右肘内侧肿胀明显,压痛,可触及骨擦感,右肘伸屈活动及前臂旋转活动受限,右手各指活动良好,感觉正常。X线片示右肱     

神经电生理对腓总神经卡压的诊断价值

目的 观察神经电生理检测对腓总神经卡压的诊断价值。方法 对腓总神经卡压的临床特征及病因进行分析，并作神经传导速度和肌电图检测和分析。结果 21条患病神经中1条神经波形消失。其余有不同程度的传导速度减慢，尤其是跨腓骨小头段，波幅降低，传导时间延长，42块腓总神经支配的肌肉中有30块出现失神经电位。结论 神经电生理检查在腓总神经卡压的诊断中有重要意义。     

颈椎后纵韧带骨化症后路术后C5神经根麻痹

目的：探讨颈椎后纵韧带骨化症（OPLL）术后C5神经根麻痹的临床特点、治疗及预后。方法：2000年3月至2005年1月．采用后路减压手术治疗OPLL患者157例．其中9例术后卅现C5神经根麻痹。回顾性分析9例患者的临床资料，所有患者术后均进行功能康复训练，其中5例患者给予高压氧辅助治疗，随访观察预后情况。结果：本组C5神经根麻痹的发生率为5．7％．包括单开门椎管成形术2例、全椎板切除减压术7例。其临床表现为三角肌、肱二头肌肌力下降至1～2级，肩部及上臂外侧感觉障碍，肱二头肌腱反射减弱或消失。随访1～4年，9例患者的肌力均恢复至3～4级，7例感觉恢复正常。结论：C5神经根麻痹是颈椎后路手术治疗OPLL的并发症之一，经过功能康复训练等保守治疗后肌力、感觉均可获得一定恢复。     

牙冠延长术在残根残冠修复中的临床疗效

目的评价牙冠延长术在牙体缺损达龈下的残根残冠修复中的临床疗效。方法自2004年5月至2005年6月,对32例患者的36颗牙体缺损达龈下的患牙,术前按断端位于龈下最深距离分为A组(20颗患牙,距离<3.0mm)和B组(16颗患牙,3.0mm≤距离≤4.0mm),均采用牙冠延长术暴露龈下牙体断面,术后6周行桩冠修复。分别记录和比较手术前、后牙周探诊深度(PD)、菌斑指数(PLI)、龈沟出血指数(SBI)和牙齿松动度,以观察临床疗效。结果术后随访患者6个月,两组病例术后6周牙体断端均暴露较好、龈缘颜色正常,术后修复效果有效率为100%,满意率为77.78%。A组术后无松动,修复效果满意;B组术后50.00%出现Ⅰ度松动,修复效果欠佳,两组修复效果比较差异有显著意义(P<0.05)。术后各阶段两组的PD、PLI、SBI均明显优于术前(P<0.05),但两组术后牙周指数比较差异无显著意义(P>0.05)。结论牙冠延长术有利于残根残冠的保存和修复,但要注意适应证的选择。     

Distribution patterns of transforaminal injections in the cervical spine evaluated by multi-slice computed tomography

Transforaminal injections are sometimes used for the diagnosis and treatment of painful conditions in the lumbar and to a lesser degree in the cervical spine. The technique is most often used when investigating/treating radiculopathy caused by degenerative disease. But how selective are the nerve root blocks? What possible structures other than the intended nerve root are affected from such injections? This study was undertaken in order to try to answer these questions, as no study focusing on the possible spread from the transforaminal selective nerve root blocks in the cervical spine has been performed earlier. In three groups of patients, each group including three patients, we injected three different volumes (0.6, 1.1 and 1.7 ml) with a transforaminal technique in the cervical spine. In all the injections, a small amount of contrast media was added. The spread of the injections were then investigated using multi-slice computed tomography with reconstructions. The imaging revealed a possible effect on other nerve roots than the intended ones when a larger volume was used for the root blocks. The spread was related to the injected volume as well as to local anatomy (size of foraminal area). In this study, only 0.6-ml injections could be accepted for being selective enough for diagnostic investigations.     

锁定加压钢板微创固定治疗肱骨干骨折的初步报告

目的探讨锁定加压钢板(LCP)经肱骨前侧入路微创穿皮固定治疗肱骨干骨折的方法及疗效。方法2004年2月-2005年1月间,使用LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折17例,男12例,女5例;年龄18-75岁(平均48岁)。根据AO分型:A型3例,B型10例,C型4例。结果经14-25个月(平均19．1个月)随访,17例患者全部愈合。骨折愈合时间为9-14周(平均11．3周)。末次随访时,肩关节前屈135°-180°(平均174°),后伸20°-40°(平均38°),外展70°-90°(平均87°);肘关节前屈115°-135°(平均133°),后伸-10°-0°(平均-1°);手臂肩残疾问卷表(DASH)评分6-44分(平均11分)。术后3例出现并发症:1例GustiloⅢB型开放性骨折发生浅表感染,经保守治疗后痊愈;1例术后出现一过性桡神经麻痹,3个月后症状完全消退;另有1例出现明显的肩肘关节功能障碍。无继发骨折移位及内固定物失效或断裂。结论LCP经肱骨前侧入路微创穿皮固定治疗肱骨干骨折可以提供稳定的固定,骨折愈合率较高,神经血管结构相对安全;更适合于粉碎性或骨质较差的肱骨干骨折。     

Spinal epidural hematoma. Report of a case and review of the literature

We report the case of a thoracic epidural hematoma at the T7-T9 level which occurred after placement of spinal epidural catheter for continuous anaesthesia in acute pancreatitis. The male patient felt a sudden back pain after six days of successful analgesia and became paraplegic 24 hours afterwards. An emergency laminectomy and removal of the hematoma were performed; however, the patient recovered only incompletely.We discuss the clinical signs and symptoms of spinal epidural hematoma as well as its diagnostics and therapy. The controversial views from the literature concernings its etiology are critically reviewed.     

背根神经节内P物质、降钙素基因相关肽免疫阳性神经元与阴茎包皮系带感觉信息的传递

目的:探讨背根神经节(DRG)内P物质(SP)、降钙素基因相关肽(CGRP)免疫阳性神经元与阴茎包皮系带感觉信息传递之间的关系。方法:通过荧光金(FG)逆行标记对大鼠阴茎包皮系带内神经末梢的来源作追踪定位,并结合SP、CGRP免疫荧光标记法,研究大鼠DRG内FG标记阳性神经元中SP、CGRP免疫阳性神经元的形态和分布。结果:FG逆行标记结果发现,大鼠阴茎包皮系带内的神经末梢起源于第6腰髓对应的背根神经节(L6-DRG)和第1骶髓对应的背根神经节(S1-DRG)的神经元。对这些神经元分别作SP、CGRP免疫荧光标记后发现,标记细胞大小不等,分别呈深红色和深绿色,沿神经束成行排列或散在分布。FG/SP、FG/CGRP双标记阳性细胞均为中小型,其数量分别占FG逆行标记阳性细胞总数的1/3和1/2,FG/SP/CGRP三标记阳性细胞占FG逆行标记阳性细胞总数的1/5。结论:大鼠L6-DRG和S1-DRG内的SP、CGRP免疫阳性神经元可能参与阴茎包皮系带感觉信息的传递。     

Mechanical Testing of Seven Fixation Methods for Generation of Compression Across a Midtarsal Osteotomy: A Comparison of Internal and External Fixation Devices

The purpose of this study was to assess 7 methods of fixation for a midtarsal osteotomy. Polyurethane foam models (N = 6) and cadaver specimens (N = 4-7) were used to examine the force generated by the different constructs of fixation. A midtarsal osteotomy was performed on each specimen in the test groups. The osteotomies were fixated either with 2 parallel 0.062-in Kirschner wires and 40-mm-long, 4-mm partially threaded, cancellous, cannulated titanium screws, an external ring fixator (frame), a frame with wires tensioned (tension), a frame with wires tensioned and compressed toward the osteotomy (tension and compression), a frame with tension, compression, and parallel Kirschner wires, or a frame with tension, compression, and two 4.0 cannulated parallel screws, respectively. Each model was fixated, and the force generated by the construct across the osteotomy was recorded via the use of pressure-sensitive film. Statistical analysis of the data in the polyurethane foam group determined that the use of frame with tension, compression, and two 4.0 parallel cannulated screws was statistically superior to 1) frame, 2) frame with tension, 3) 2 parallel Kirschner wires, 4) two 4.0 cannulated parallel screws, and 5) frame with tension and compression. A cadaver study determined that the frame with tension, compression, and 2 parallel Kirschner wires was statistically superior to 1) frame and 2) two parallel Kirschner wires. These findings suggest that there is a difference in the force generated by the type of fixation construct across a midtarsal osteotomy.