微创血管减压术治疗三叉神经痛30例

目的探究原发三叉神经痛的病因以及微创血管减压术治疗原发性三叉神经痛的临床疗效。方法回顾性分析2009年8月至2010年8月收治的30例三叉神经痛患者,手术方法采用微创三叉神经根血管减压术,路径采用乙状窦后入路。结果术中发现30例患者三叉神经均存在血管性压迫,行血管减压术后全部患者疼痛均缓解消失,分别于3个月、6个月、1年后进行术后随访,复发2例,无1例死亡。结论原发性三叉神经痛是血管性压迫引起的颅部疾病,治疗方法首选微创乙状窦后入路三叉神经根血管减压术,它具有创伤微小、疗效显著、术后并发症少、无面部感觉障碍等后遗效应的优点,值得广泛临床应用。     

Directionality index of neural information flow as a measure of synaptic plasticity in chronic unpredictable stress rats

This investigation examined whether the directionality of neural information flow could be used to index the measurement of synaptic plasticity in the chronic unpredictable stress (CUS) animals. Evolution map approach (EMA) was employed to determine the direction of information flow between the cortex and thalamus, while the experiment was performed by inducing long-term potentiation of the thalamocortical pathway after recording intracranial EEG at the same two positions in Wistar rats of both normal and stressed groups. The results showed that the coupling direction index was significantly diverted in stressed state compared to that in normal state, while the strength of thalamus driving frontal cortex was considerably reduced in the rats of CUS model. Moreover, the data obtained from LTP experiment exhibited that chronic stress decreased medial prefrontal cortex (mPFC) synaptic plasticity, which was certainly in accordance with the EEG findings. These results demonstrated that using EMA measurement, directionality index of neural information flow may be as a measure of synaptic plasticity.     

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

INTRODUCTION

Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space.

PATIENTS AND METHODS

In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids.

RESULTS

With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0).

CONCLUSIONS

This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.     

Cardboard dural retractor for drilling of the sphenoid wing in the pterional approach

Background

In the pterional approach, adequate removal of the sphenoid wing is essential. For safe drilling of the medial part, the dura beside the wing is usually retracted with a metal instrument and damage to the instrument may occur. We developed an alternative retraction method that uses a cardboard shield.

Methods

Before drilling the medial part of the sphenoid wing, a cardboard shield featuring a notch and a bend in its center is prepared. The notch is inserted between the wing to be drilled and the dura.

Results

The shield retracted the dura beside the wing effectively and provided sufficient space for the diamond drill bit. It held up to the drilling and protected the dura.

Conclusion

This simple method provides a safe adequate operative field without involving additional instruments or expenditures.     

Minimally invasive transmuscular approach for the treatment of lumbar far lateral disc herniation

Background

The purpose of this study was to evaluate a minimally invasive surgical technique for the treatment of lumbar far lateral disc herniation. This technique combines the tubular retractor with the operative microscope.

Objective and methods

This retrospective study analyzed the files of 26 patients: 15 men and 11 women. The average age was 56 years (range, 19-83 years). The most commonly operated level was L3-L4 (46%), then L4-L5 (30.5%) and finally L2-L3 (15.5%). All patients were operated under general anesthesia. The intraoperative radioscopic location was absolutely necessary. A 12-15 mm paramedian incision was made on the side of the herniation (30 mm from the medial line). We then inserted the tubular muscular retraction system followed by the 14 mm diameter working channel. Guided by operating microscope, the articular isthmus was reamed to expose the root and the disc. The disc herniation was then removed after opening and removing the inter-transverse ligament.

Results

The average duration of the surgery was 55 min. This operating time decreased as the surgeons gained experience. The radicular pain, estimated using the analogical visual scale, varied from seven before surgery to two during the postoperative period. All the patients were standing up the day after surgery. The average duration of the postoperative stay in the hospital was three days (range, 1-5 days). We noted no complications from the surgical procedure.The average duration of the follow-up was two years (range, 6-36 months).

Conclusion

This technique combines the advantages of endoscopic surgery (less muscular and osseous damage) and microscope-guided surgery (three-dimensional vision) and provided good functional results in this series.     

经腓骨入路显露后踝治疗三踝骨折

自2003年9月至2006年9月共治三踝骨折53例,均采用手术治疗,取得了满意疗效,现总结报告如下。     

经皮椎体后凸成形术中单双侧经椎弓根穿刺路径的选择

[目的]探讨骨质疏松性椎体骨折经皮后凸成形术中单双侧经椎弓根入路的选择.[方法]36例骨质疏松性椎体压缩性骨折患者,术前根据伤椎椎弓根CT层面经椎弓根进针线确定单、双侧入路,采用球囊或Sky扩张器行椎体后凸成形术.术前、术后1周及1年时摄x线片测量椎体高度恢复率、后凸Cobb's角及疼痛视觉类比评分(VAS).[结果]36例50节骨质疏松性椎体压缩性骨折中,44节椎体行经皮椎体后凸成形术.术前计划单侧经椎弓根入路32节椎体,双侧经椎弓根入路12节椎体;术中单侧入路22节椎体,双侧入路22节椎体,其中10节椎体由单侧入路改为双侧入路.术后1周及1年时VAS评分、椎体后凸Cobb's角及椎体高度恢复率较术前均改善(P<0.05).但单侧组与双侧组比较,上述参数无显著性差异(P>0.05).[结论]根据术前伤椎CT椎弓根进针线可以初步确定单、双侧椎弓根穿刺路径.腰椎及大部分胸椎可以采用单侧经椎弓根入路行经皮椎体后凸成形术,部分下胸椎骨质疏松性骨折患者需行双侧经椎弓根入路.