腰椎管狭窄症术后下肢残留麻木的发生率及影响因素

[目的]探讨腰椎管狭窄症术后下肢残留麻木的发生率和影响因素。[方法]2001年1月～2003年2月手术治疗56例腰椎管狭窄症患者，术后随访10d，1、3个月、1年和2年，记录患者神经功能和残留症状。[结果]术前82．1％的患者有下肢麻木，术后10d，1、3个月、1年和2年分别有43．6％、39．I％、36．6％、35．3％和35．7％的患者下肢残留麻木，与病程、术前JOA评分和椎管狭窄类型有关，与年龄和神经根直径无关。[结论]腰椎管狭窄症患者术后1个月内下肢麻木恢复最快，术后1年和2年下肢麻木发生率为35．3％和35．7％，推测神经组织的潜在恢复能力影响下肢麻木的发生率。     

悟透寒热说辨证--医案连载（五）

病案14晚上手心发烧20年
　　彭某某,女,69岁。
　　2015年12月25日初诊：晚上手心发烧20余年,但脚不发烧,失眠,精神尚可,偶尔头痛;有时牙痛,服牛黄制剂和红霉素无效,吃饭稍多就腹胀。脉沉细,舌浅淡、润,苔薄白。温阳益气汤加减：炙黄芪30 g,参须10 g,麻黄4 g,附子10 g,干姜10 g,细辛3 g,桂枝10 g,炒白术20 g,当归15 g,升麻6 g,川芎15 g,黄连3 g,吴茱萸6 g,青蒿6 g,磁石30 g,炙甘草10 g。     

Trigeminal neuropathy

Trigeminal neuropathies (TNs) are well recognized disorders characterized and manifesting as skin and mucosal numbness in the region innervated by the trigeminal nerve. Facial numbness indicates trigeminal sensory alteration affecting the trigeminal system. TNs always pose differential location difficulties as multiple diseases are capable of producing them: they can be the result of traumatism, tumors, or diseases of the connective tissue, infectious or demyelinating diseases, or may be of idiopathic origin. Their importance is explained by the fact that TN may represent the first manifestation of tumor disease, or of relapse in patients with prior neoplastic processes. As such, these manifestations are ominous, and patient life expectancy is often short. The clinical exploration reveals a loss of sensitivity in the cutaneous territory corresponding to the affected nerve, which can be partial (hypoesthesia) or complete (anesthesia). The sensory defect is occasionally associated with hyperesthesia (i.e., the patient suffers a decrease in sensory perception, but when sensation is perceived, it may cause considerable discomfort). Complementary studies are needed to establish the etiologic diagnosis, with laboratory tests to discard the possible causative diseases underlying the trigeminal neuropathy, and the opportune radiographic examinations in the form of plain X-rays or a routine cranial computed tomography scan.     

急性主动脉夹层患者首发症状与院前延迟的关系研究

目的 探讨急性主动脉夹层患者首发症状与院前延迟的关系,为临床实施院前针对性健康教育提供参考.方法 选取急性主动脉夹层患者488例,收集患者首发症状、一般资料、疾病相关因素、院前相关因素及院前时间,分析首发症状与院前延迟的关系.结果 患者院前时间为135.5(48.3,1735.5) min,其中院前时间≤150 min...     

肩痛颗粒治疗肩周炎的临床观察

目的:初步观察和评价肩痛颗粒治疗肩痹(肩周炎)属风寒湿痹证者的疗效和安全性。方法:采用随机双盲、双模拟、平行阳性药对照的临床试验方法,将72例肩周炎(风寒湿痹证)患者,随机分为试验组(肩痛颗粒组)和对照组(祛痹肩安丸组),两组每次服用颗粒剂和丸剂各1袋,一日3次,疗程为4周。按照症状、体征分级量化标准,对治疗前及用药后每周进行疗效评价;并对患者进行用药前后的三大常规、心、肝、肾功能等安全性检查,观察以上安全性指标的变化。结果:疗效性结果:肩痛颗粒组的愈显率为29.63%,总有效率为92.59%;而祛痹肩安丸组分别为16.67%和83.33%。两组差别无统计学。每周证候总积分:试验组患者用药后21、28d中医证候总积分下降值和下降率均高于对照组,但差别无统计学意义。安全性结果:治疗前后患者的指标差异值无临床意义,未观察到药物引起的不良反应和不良事件。结论:肩痛颗粒在目前的口服剂量疗程范围内,治疗证属风寒湿痹的肩周炎疗效确切,安全,无毒副作用,是一种治疗肩周炎安全、有效的中药新药。     

阿奇霉素氯化钠注射液致舌尖麻木

1例34岁女性患者，因支气管炎给予阿奇霉素氯化钠注射液200ml（0．4g）静脉滴注。输入约80ml时患者出现舌尖麻木。查体未见舌体异常。输注完毕后2h，舌尖麻木消失。次日，第2次静脉滴注阿奇霉素后，再次出现舌尖麻木。第3天以头孢曲松替代阿奇霉素，未再见该症状。     

温肾健脾汤联合背俞穴针刺对脾肾阳虚型系统性硬皮病的效果

目的探讨自拟温肾健脾汤联合背俞穴针刺对脾肾阳虚型系统性硬皮病的效果分析。方法选取2018年1月—2019年1月在辽宁省大连市大连市中医医院针灸门诊的80例脾肾阳虚型系统性硬皮病患者,随机分为试验组和对照组。对2组患者采用临床常规的治疗方法,对照组40例系统性硬皮病患者采用临床常规口服D-青霉胺治疗;试验组40例系统性硬皮病患者采用自拟温肾健脾汤联合背俞穴针刺治疗方法,比较2组患者治疗后的临床有效率和2组患者血清抗核抗体谱、血清抗着丝点抗体转阴累积人数。结果试验组患者治疗后临床总有效率高于对照组患者,差异有统计学意义(P<0.05);试验组患者治疗后血清抗核抗体谱、血清抗着丝点抗体转阴人数多于对照组患者,差异有统计学意义(P<0.05)。结论对脾肾阳虚型系统性硬皮病患者采取自拟温肾健脾汤联合背俞穴针刺进行治疗的临床效果较好,可以增加系统性硬皮病患者疗效,值得推广。     

Independent Risk Factors for Positive and Negative Symptoms in Patients with Diabetic Polyneuropathy

Patients with diabetes occasionally develop diabetic polyneuropathy (DPN), which is characterized by both positive symptoms such as pain and negative symptoms such as numbness/dysesthesia. However, these symptoms have always been collectively analyzed to determine their risk factors. This study aimed to independently analyze the risk factors for neuropathic pain and numbness/dysesthesia in DPN patients. In total, 298 patients with diabetes (age: 61.1 ± 10.4 years; 176 male) were included. The relationships among the incidence of DPN and its clinical parameters were determined using logistic regression models. Then, the statistical model was applied in two groups of DPN patients: those with pain only or both pain and the negative symptoms (pain group; n = 25) and those with the negative symptoms only or both pain and the negative symptoms (numbness/dysesthesia group; n = 60). All logistic regression models were adjusted for the duration of diabetes, glycosylated hemoglobin levels, and age. The depression score was higher for patients with DPN than for those without, although it did not reach an abnormal level. An abnormal Achilles tendon reflex (ATR) and insulin treatment, but not smoking, hypertension, hyperlipidemia, and diabetic retinopathy, were associated with DPN. Furthermore, female sex and an abnormal ATR and insulin treatment were significant clinical features in the pain and numbness/numbness groups, respectively. Overweight and obesity were the common clinical features in both groups. We conclude that the positive and negative symptoms of DPN possibly have independent risk factors, suggesting different underlying mechanisms and the need for separate diagnosis and treatment.     

复方南星止痛膏治疗寒湿痹阻型膝关节骨关节炎临床观察

目的观察复方南星止痛膏治疗寒湿痹阻型膝关节骨关节炎的临床疗效。方法将150例患者随机分为三组,分别采用局部外敷复方南星止痛膏治疗、局部外敷骨痛贴膏治疗、患处局部热敷。结果三组治疗后VAS评分均有明显下降,与自身治疗前比较,差异有统计学意义(P<0.05)。结论复方南星止痛膏对寒湿痹阻型膝关节骨关节炎患者疼痛的治疗效果确切,副作用小。     

Preventing Lateral Skin Numbness after Medial Unicompartmental Knee Arthroplasty

Background

The authors report the results of preserving the infrapatellar branch of the saphenous nerve during unicompartmental knee arthroplasty to prevent lateral skin numbness.

Methods

All 100 cases had medial compartmental osteoarthritis and a minimally invasive technique had been used. The mean follow-up duration was two years and eight months (range, 24 to 42 months).

Results

The classification according to the location of this nerve was observed as either Mochida Type I with 76 cases (76%), Type II with 16 cases (16%), and unclassified type with 8 cases (8%). In Type I, the nerve was saved in 62 cases (82%), but could not be preserved in Type II because of the surgical procedure. These results showed that the mean distance from the joint line to the nerve of Type I was 9.13 mm (range, 4 to 15 mm) and the nerve passed inferiorly.

Conclusions

This study showed the location of this nerve can be predicted ahead of the procedure, which will help preserve it during the surgery.