脑中风患者肢体麻木康复疗法及护理措施

脑中风发病后导致患者神经不同程度的受损,加之有的患者脑血管存在狭窄等病变,导致肢体麻木。多数患者还伴有全身乏力、头昏、言语不利等并发症,需要接受系统的正规康复治疗。医护人员首先要做好患者及家属的心理护理,情绪稳定,正确对待疾病,增强战胜病魔的信念;严密观察患者各项体征指标,监督患者正常用药配合治疗;同时要做好患者及家属院外康复指导,对患者的早期康复意义重大。     

Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve

Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant.     

Vibration perception threshold of forest worker's finger during temporary obstructed blood circulation

Summary Vibration detection threshold (VPT) of 149 professional forest workers was measured during a compulsory annual health examination. The authors' earlier developed measuring method for VPT of finger was modified. The blood circulation of the hand was obstructed for 6 min and VPT was measured 4 min after releasing the obstruction. VPTs of all forest workers increased during obstruction. In forest workers suffering from decreased hand grip force (decreased HGF) the increase of VPT differed significantly from forest workers without symptoms, and VPT in the former group still increased after releasing the obstruction. VPT remained also at the raised level after releasing the obstruction with forest workers suffering from vibration-induced white finger (VWF). Nevertheless, on an individual basis even the modified measuring method failed to discriminate subjects without symptoms from those with symptoms of hand-arm vibration syndrome. The raised VPT and sensitivity for obstruction of blood circulation suggest that the reason for decreased HGF in forest workers may be a consequence of an injury in the peripheral nerves.     

当归四逆汤治疗腰椎间盘突出症术后麻木综合征临床观察

目的:观察当归四逆汤治疗腰椎间盘突出症术后麻木综合征的临床疗效。方法:将39例腰椎间盘突出症患者,随机分为治疗组(19例)和对照组(20例),两组均接受神经减压术,治疗组术后加服当归四逆汤治疗,治疗6周。应用下腰痛JOA评分对治疗效果进行评定。结果:在术后2周及6周时评价两组治疗效果,术后两组的JOA评分与术前相比均有显著性差异(P0.01),治疗组术后2周及6周时均较对照组有显著改善(P0.01)。结论:神经减压术治疗腰椎间盘突出症患者可获得较好的疗效,当归四逆汤有利于促进术后麻木综合征的恢复,可强化减压手术的治疗效果。     

膝关节置换术后皮肤麻痹的解剖基础及相关临床研究

目的 　探讨膝关节置换术后隐神经髌下支损伤所致的皮肤麻痹的解剖基础,改良手术切口,减少膝前皮肤麻木并发症。 方法　解剖观察12例成人尸体下肢标本,观测隐神经髌下支形态、神经束的走行及毗邻关系。设计改良膝外侧皮肤切口行膝关节置换手术入路进行临床验证,比较术后效果。 结果　解剖研究发现隐神经髌下支自缝匠肌穿出后,标本在髌骨中心平面神经距髌骨内侧缘约3.2 cm,75%标本有3束分支分布于髌骨下极及胫骨粗隆区域,以髌骨下极与粗隆连线中点为中心作圆,神经纤维主要分布左侧在第2象限,右侧在第1象限。临床研究采用改良膝关节外侧切口行膝关节置换术15例,方法可行,术后膝前皮肤麻木的发生率及范围较对照组减少,有统计学意义。 结论　根据膝关节隐神经髌下支解剖分布特点,改良膝前皮肤切口行膝关节置换术可减少术后膝前麻木。     

恶性肿瘤患者化疗后手足麻木的中医证型分布及相关因素分析

目的 探讨恶性肿瘤患者化疗后手足麻木的中医证型分布以及性别、糖尿病史、吸烟史、饮酒史与中医证型的相关性。方法 选择化疗后手足麻木的恶性肿瘤患者57例,观察其中医证型分布及病性证素特点,并用统计学软件分析中医证型与性别、糖尿病史、吸烟史、饮酒史是否具有相关性。结果 恶性肿瘤患者化疗后手足麻木的中医证型分为5种：占比最大的为气虚血瘀证,其次为气滞血瘀证、肝肾不足证、肝郁脾虚证,占比最小的为阳虚寒滞证;病性证素以血瘀、气虚为主;饮酒史在各中医证型上的差异具有统计学意义（P <0.05）。结论 恶性肿瘤患者化疗后手足麻木的中医证型主要为气虚血瘀证,患者个人饮酒史与中医证型之间具有相关性。     

Chronic upper extremity pain and co‐occurring symptoms in a general population

Objective

To estimate the prevalence of self reported chronic upper extremity pain associated with physical impairment in a general population, and its co‐occurrence with chronic upper extremity numbness or tingling and chronic pain at other locations.

Methods

A general health questionnaire was mailed to 3,000 persons (age 25–74 years) who were randomly selected from a general population register.

Results

The response rate was 83%. The prevalence of chronic upper extremity pain associated with physical impairment was 20.8% (95% confidence interval [95% CI] 19.2–22.5), and that of co‐occurring numbness or tingling was 6.7% (95% CI 5.7–7.7). Among the responders with chronic upper extremity pain associated with physical impairment, 84% reported more than 1 painful area.

Conclusion

Chronic upper extremity pain associated with physical impairment and co‐occurring chronic upper extremity numbness or tingling were common in the general population. The presence of more than 1 location for pain in the upper extremity as well as in other parts of the body was frequent.

     

针刺联合手法治疗神经根型颈椎病的疗效评估

目的：观察针刺联合中医推拿手法治疗神经根型颈椎病的疗效并探究其机制。方法：选取2021年1月至2022年10月辽宁中医药大学附属第二医院骨科收治的神经根型颈椎病患者120例作为研究对象,按照随机数字表法分为对照组和观察组,每组60例。2组患者均行常规牵引疗法。对照组配合单纯中医推拿手法治疗,观察组在中医推拿手法治疗基础上联合针刺治疗。疗程均为1个月。比较治疗前后2组患者麻木评分、颈部残障指数（NDI）、简化McGill疼痛问卷（MPQ）评分、血清白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）、血清白细胞介素-1β（IL-1β）、血液流变学指标水平变化情况,以及治疗有效率。结果：观察组治疗有效率（91.67%）明显高于对照组（73.33%）,2组比较,差异有统计学意义（P<0.05）;治疗后2组患者MPQ、NDI、麻木3个评分均显著下降（均P<0.05）,与对照组比较,观察组改善明显（P<0.05）;治疗后2组患者血液流变学各项指标表达水平均显著下降（P<0.05）,且观察组改善更为显著（P<0.05）。结论：针刺联合中医推拿手法治疗神经根型颈椎病疗效突出,可改善患者颈部麻木、疼痛等症状,同时改善颈部功能障碍状态,降低血黏度,下调血清IL-6、TNF-α和IL-1β表达水平。     

黄芪桂枝五物汤治疗神经根型颈椎病麻木症之探析

麻木是临床诸多疾病的常见症状,遵循历代医家对于麻木的认识,结合临床的观察和实践,黄芪桂枝五物汤作为经典名方治疗神经根型颈椎病,以病证结合,方证相应的思路进行论治,是临床使用的关键点。     

Numbness after medial unicompartmental knee arthroplasty: Prevalence and effect on functional outcome

BackgroundThe prevalence of skin sensation alteration after total knee arthroplasty is well established but less so in medial unicompartmental knee arthroplasty (MUKA). The aim of this study was to determine the prevalence, extent of numbness and its effect on mid-term functional outcomes after MUKA.MethodsA level 2 prospective cohort study was conducted. Twenty patients (21 knees) were recruited. Demographics, length of surgical incision and the thigh-to-calf ratio was recorded. At the 1-year postoperative period, the extent of numbness was measured using a quantifiable grid-based system for both pinprick and fine touch. Preoperative, 3 months and 1 year postoperative Knee Society Scores (KSS) and 36-Item Short Form Health Survey (SF-36) scores were recorded.ResultsAt the 1-year postoperative period, the prevalence of numbness to both fine touch and pin prick was 58% and 66%, respectively. The mean area of numbness to fine touch and pin prick was 336 mm² and 521 mm²_, respectively. The prevalence and extent of numbness was not significantly associated with surgical factors such as incision length and thigh-to-calf ratio. Prevalence and extent of numbness was not significantly associated with SF-36 scores and KSS at the 1-year postoperative period.ConclusionsThere is a high prevalence of numbness around the knee 1 year after MUKA. Surgical incision length and thigh-to-calf ratio was not associated with the extent of numbness. The presence and extent of numbness did not affect functional outcomes scores at the 1-year postoperative period. This study finding allows for accurate preoperative counselling with regards to numbness and its effects for patients undergoing MUKA.