39例分娩性臂丛神经损伤新生儿的神经电生理评价

目的:探讨新生儿期电生理检测在评价分娩性臂丛神经损伤中的价值。方法:应用肌电一诱发电位仪对39例分娩性臂丛神经损伤新生儿进行检测。测试项目包括:①患侧臂丛神经五大分支腋神经、肌皮神经、正中神经、尺神经及桡神经运动神经传导速度测定;患侧正中神经、尺神经及桡神经感觉神经传导速度测定;②采用同芯针电极检测臂丛神经支配远端肌肉(三角肌、肱二头肌、4伸指总肌、外展拇短肌、外展小指肌或骨问肌)肌电图。结果:39例新生儿中全臂丛神经损伤11例(28％);上干损伤18例(46％);下干损伤3例(8％);后束损伤7例(18％)。节前损伤11例(28％)。结论:新生儿期神经电生理检测对早期评价分娩性臂丛神经损伤的范围、性质、部位及程度具有重要的临床价值。     

正中神经外侧根部分随肌皮神经走行变异1例

正臂丛的根、干、股、束及分支都可能存在变异[1,2],我们在局部解剖操作中发现1例老年男性尸体标本的右侧正中神经外侧根部分随肌皮神经走行变异,现报道如下:本例标本右侧正中神经外侧根部分随肌皮神经下行,肌皮神经发出喙肱肌支后,在肱二头肌深面发出肱二头肌支和肱肌支,在与肱肌支等高处发出一交通支加入正中神经,随后肌皮神经继续下行向外侧经肱二头肌深面至其外侧缘延续为前臂外侧皮神     

肌皮神经变异1例

肌皮神经自臂丛外侧束发出后,向外侧斜穿喙肱肌,经肱二头肌与肱肌间下行,经肱二头肌下端外侧穿出深筋膜,称为前臂外侧皮神经;正中神经沿肱二头肌内侧沟下行,并由外侧向内侧跨过肱动脉,与该血管一起行至肘窝[1].     

胸背神经移位修复肌皮神经损伤的临床应用

根据100侧上肢标本的解剖研究,我们对1例肌皮神经损伤的患者作了胸背神经移位和其缝接术,获得满意的结果。术后9个月,肱二头肌肌力收缩时在4级以上,屈肘关节时能提起2kg 的重物。     

用肌桥和神经移植修复尺神经术后早期电生理的比较

在骨骼肌桥接神经缺损的实验研究基础上,我们对3例尺神经缺损3～4cm 的患者,用肌桥及神经移植术进行修复。本文将此两种术式作比较,发现用肌桥修复尺神经缺损,除动作电位的电压比神经移植稍低外,早期电生理的恢复是令人满意:神经传导速度、初生再生电位(初生运动单位电位)和动作电位的恢复差别不大。     

左侧肌皮神经变异1例

在局部解剖学实验课中,解剖一男尸上肢,发现臂丛和肌皮神经存在多处变异:臂丛的内外侧束未夹持腋动脉;肌皮神经分支变异,有两个分支支配喙肱肌,同时与正中神经存在交通支;肌皮神经同时穿过喙肱肌和肱二头肌.     

臂丛神经根性撕脱伤动物模型的研究

目的 研究臂丛神经根性撕脱伤实验动物模型。方法 选用Wistar大白鼠，取右下颌骨向下至胸大肌中部皮肤切口，显露胸大肌，分别切断胸大肌、胸小肌；暴露井剪断右锁骨，镜下解剖分离臂丛神经并紧贴近端根部将颈5至颈8剪断，造成臂丛神经根性撕脱伤模型，实验组用颈3、颈4神经修复臂丛中已损伤的颈5、颈6神经，对照组不做修复；用电生理及组织病理学观察神经肌肉组织变化，结果术后3个月病理检查发现，实验组中肌皮神经可见少量神经纤维长入，肱二共肌萎缩轻，失神经组之肌皮神经可见神经纤维变性、崩解、吸收，肱二头肌萎缩明显，电生理检查显示实验组与失神经组之诱发电位峰值电压与刺激电流比值及潜伏期时间与刺激电流强度之比值在统计学上有显著性差异（P〈0．05）。结论 该实验模型操作简单，科学，合理。为臂丛神经根性撕脱伤实验研究奠定了基础。     

肌皮神经变异1例

正常情况下肌皮神经通常自臂丛外侧束发出后,向外侧斜穿喙肱肌经肱二头肌和肱肌之间下行,在肱二头肌下部外侧穿出深筋膜.作者在解剖1例正常青年女性尸体标本时,发现其右侧肌皮神经在臂部行程异常.此类变异较为罕见[1-3],现报告如下.     

正中神经合并肌皮神经变异1例

<正>笔者在解剖一具男尸时发现其右侧正中神经和肌皮神经变异较大,现报道如下。右侧正中神经为双支型,第一支由臂丛内侧束和外侧束神经纤维组成,与腋动脉和肱动脉伴行于喙肱肌内侧,起始处横径为3.1mm;第二支由臂丛外侧束发出,穿经喙肱肌,起始处横径为5.2mm,在距起点12.7cm处与第一支汇合,汇合后的横径为6.8mm。肌皮神经肱二头肌支在距第二支起点8.4cm处发出,支配肱二头肌。     

肱桡肌的显微外科解剖学

观察了２０具（４０例）成人尸体的肱桡肌，它多数有３条动脉和１条神经供应，神经元损伤分离后可达４３．０５ｍｍ，结果提示由于肌皮神经损伤所致肱二头肌瘫痪，肱桡肌为理想的移植肌替代肱二头肌的功能。     

The intra-lingual course of the nerves of the tongue

The intra-lingual course of the nerves of tongue has never been studied in the human by the Sihler method. This technique was applied to six human tongues and allowed coloration of the nerves and illustration of the tongue. The course of the hypoglossal, glossopharyngeal, and lingual nerves was defined. Constant anastomoses between the lingual and hypoglossal nerves, between the glossopharyngeal nerve and the hypoglossal and lingual nerves, were demonstrated and may help explain the “neck–tongue” syndrome. This cartography of the nerves of the tongue allowed the definition of the motor and sensory consequences of tongue surgery.     

腹股沟神经卡压征的应用解剖

目的：为腹股沟神经卡压征的防治提供解剖基础。方法：在50侧(25具)成年男性尸体标本上对腹股沟区皮神经行解剖学观测。结果：髂腹下神经皮支6％(3侧)，髂腹股沟神经皮支90％(45侧)，生殖股神经生殖支的皮支42％(21侧)，髂腹股沟神经与生殖股神经生殖支形成的吻合支12％(6侧)，生殖股神经股支的皮支8％(4侧)。结论：腹股沟区皮神经行程变异很大，解剖变异是导致神经卡压的主要原因。     

Deep palmar communications between the ulnar and median nerves

Innervation of the hand is supplied via the radial, median, and ulnar nerves. A common border of sensory distribution between the ulnar and median nerves is along the fourth digit. However, this sensory distribution may be affected by communication between these two nerves. Among the known communications between the median and ulnar nerves, the deep anastomotic branch in the hand is the least described and rarely illustrated in the literature. This study aims to provide data on the prevalence of a deep communicating branch via cadaveric dissection. We examined 50 hands taken from 25 adult cadavers. Communicating branches were found in 16% of the hands examined, with rami occurring bilaterally in two specimens. By describing the origin and pathway of this communicating branch, we hope to provide surgeons and clinicians with knowledge that may help avoid iatrogenic injuries.     

人膈肌内神经分支分布

目的：探讨人膈的神经支配和肌内神经分支分布特点。方法：改良Sihler’s肌内神经分支染色法。结果：(1)一侧膈神经入肌后一般分为3—4支(3支型4例,4支型2例),1支(前支)向前内侧走行,支配胸部,1～2支(前外侧支)向外侧走行,支配肋部,最后1支(后支)最粗大,向后下走行,分为后外侧支和后脚支,分别支配膈中心腱外侧叶后外侧的肋部和腰部,各级神经的分支在肌束中部密集排列成神经丛。(2)6例标本均未发现左侧或右侧膈神经越过中线至对侧。(3)2例带肋间肌的标本肉眼未见有肋间神经分支进入膈。结论：(1)左、右膈神经分布于膈,未见左右侧膈神经重叠支配和优势支配。(2)膈神经的终末分支在肌束中部密集排列形成似“肾形”的神经丛带。     

腰骶神经根的组织化学研究

采用动物腰骶神经根和人体新鲜腰骶神经后根标本进行组织学和组织化学研究,发现电刺激诱发痉挛的后根小束的神经纤维为 AchE 反应阳性,高位后根内感觉和肌支传入纤维相混合,不利于手术中进行电刺激选择。本研究结果为临床选择性腰骶神经后根切断术的手术部位和电刺激选择的必要性等问题提供了依据。     

大鼠坐骨神经固有频率测定

目的:确定实验大鼠坐骨神经的固有频率，观察不同状态下神经固有频率的变化，为神经再生修复研究中康复治疗仪器的频率选择提供参考。方法:将18只SD大鼠随机分为正常组、SNI 7 d组、SNI 28 d组，每组各6只，正常组不予干预，模型组行坐骨神经钳夹伤术。于造模后第7天通过振动平台对正常组、正常组的离体神经（即离体组）、SNI 7 d组，以及造模后第28天对SNI 28 d组大鼠施加振动频率源，在振动响应检测模块测得的数据基础上，根据频率特性曲线确定大鼠坐骨神经固有频率。结果:正常组、离体组、SNI 7 d组、SNI 28 d组大鼠坐骨神经频率特异性曲线均显示单一峰值；组间固有频率比较差异均无统计学意义（P=0.156）；组间两两比较显示，正常组与离体组、SNI 7 d组、SNI 28 d组比较，SNI 7 d组与SNI 28 d组比较，差异均无统计学意义（P>0.05）。固有频率检测值总体均数为9.635 Hz。结论:实验大鼠坐骨神经固有频率约为9.635 Hz，且固有频率是相对稳定的，不会因其所处状态不同而发生较大变化。     

健康青年人四肢远端神经F波特征

目的:观察健康青年志愿者的正中、尺、腓、胫神经F波最短潜伏期以及出现率与年龄、性别的关系.方法:选择延边大学医学院健康志愿者996名为研究对象,采用美国NICOLET公司出产的Portabook肌电图诱发电位仪,检测正中神经、尺神经、腓神经和胫神经F波,比较分析男18～21岁组、女18～21岁组与男22～25岁组、女2...     

组织工程化人工神经研究进展

利用各种神经导管可成功桥接修复短段周围神经缺损已为许多学者公认 ,但是 ,这些神经导管由于缺乏许旺细胞或内部支架来支持、促进神经再生轴突长距离生长 ,因此不能有效修复长段周围神经缺损[1,2 ] 。应用组织工程技术构建神经导管 ,为修复长段周围神经缺损提供了新的方法和思路。这项研究的核心是模拟周围神经天然结构 ,将许旺细胞与生物支架材料有机结合成为类似Ｂ櫣ｎｇｎｅｒ带的结构 ,为再生神经提供良好的生长环境 ,充分发挥许旺细胞对再生神经的营养 ,诱导作用 ,从而促进神经的再生。组织工程化人工神经的主要内容是将经体外培养扩…     

同种异体神经移植处置入bFGF复合降解膜的实验研究

目的　探讨在异体神经移植处置入bFGF(basicfibroblastgrowthfactor)复合降解膜,提高神经再生的效果。方法　60只大鼠随机分成A、B、C组,每组2 0只,所有动物左下肢坐骨神经切除2cm后,移植经冷冻处理的同种异体坐骨神经移植物。A组神经移植物经bFGF处理并在移植处置入bFGF复合降解膜,B组移植物不经bFGF处理,移植处置入不含bFGF的降解膜,C组移植物不经bFGF处理,移植处不置入降解膜。术后90、180d行电生理、组织学、血—神经屏障等各项指标观测。结果　A组再生有髓神经纤维的数量和直径明显较B、C组的多而粗(P <0 .0 5 ) ,结缔组织增生较少,血—神经屏障恢复和电生理指标均优于B、C组。结论　bFGF复合降解膜有提高同种异体神经移植再生的作用。     

Branching patterns of the common and superficial fibular nerves in fetus

In this study, we focused on finding out whether branching patterns of the common fibular (CFN) and superficial fibular (SFN) nerves change throughout the early period of life. The popliteal fossa and legs on both sides of 20 fetuses (13 females and 7 males) were dissected. The ages of the fetuses varied between 20 and 36 weeks. The levels where the CFN diverged from the sciatic nerve, the CFN diverged to its terminal branches, and the cutaneous branches of the SFN became superficial and diverged were evaluated, together with the similarity of the patterns of these nerves on both sides. We observed that, comparing with the results of previous studies on adults, both the sciatic and the CFNs in the fetuses were diverging into their terminal branches more distally. Additionally, the SFN appeared to become superficial more proximally in the fetus than in the adult. SFN was piercing the crural fascia before diverging into its terminal branches in 29 legs. Only in 8 of them, it was becoming superficial within the middle one-third of the leg, which was observed more frequently in males (42.9% of 14 legs) than in females (13.3% of 15 legs). But there was no statistically significant gender difference (P = 0.07). The medial dorsal cutaneous (MDCN) and intermediate dorsal cutaneous (IDCN) nerves which were piercing the crural fascia separately were observed in 27.5% of the subjects, all females. In these, MDCN was piercing the fascia superior to the level where the SPN becomes superficial, whereas the IDCN was piercing it to a level lower to this and always in the inferior one-third of the leg. We suggest that the detailed information about the branching patterns of the CPN and SPN in early ages will be beneficial, particularly in tumor and deformity surgery. The reason for different patterns and piercing levels of the nerves may be the effect of the elongating extremity during aging that enforces the fascia and modifies its position with a more stable structure, the nerve.