不同张力对家兔正中神经形态的影响

采用弦式加载，造成对家兔正中神经的单纯性牵拉，并对神经在单纯性牵张力作用下的形态变化和导致神经急性牵拉伤的临界张力值进行了研究。结果表明：当施加到非游离正中神经上的总应力为２３ｇ·（ｍｍ＾２）＾－１时，内部神经纤维的延长达到生理极限；当总应力升至６１ｇ·（ｍｍ＾２）＾－１时，内部神经纤维的延长达到生理极限；当应力升至２３ｇ·（ｍｍ＾２）＾－１时，神经纤维出现损伤；应力升至１８２ｇ·（ｍｍ＾２）＾－     

腋神经和桡神经与肱骨的关系及其临床意义

目的　观测腋神经、桡神经与肱骨骨性标志的关系 ,为肱骨手术或外固定提供帮助。方法　在 30例 6 0侧成人上肢标本上观、测了腋神经、桡神经与肱骨有关骨性标志的距离。结果　肱骨最大长 (30 6 6 5± 17 4 8)mm ;肱骨最近端到腋神经(5 8 10± 5 6 1)mm ;肱骨最近端到桡神经穿外侧肌间隔处 (177 75± 11 86 )mm ;解剖颈最低点到腋神经 (16 2 4± 2 78)mm ;肱骨最近端到肱骨肌管入口处 (118 4 9± 6 6 1)mm ;并测量计算了各段占肱骨最大长的比例。结论　腋神经在肱骨近端 1/ 5处容易受损 ,而桡神经在肱骨下 3/ 5段为易损伤部。从术前和术中的影像 ,能测量和计算出神经的基本位置 ,可减少或避免神经损伤     

成人AngleII类错牙合软硬组织颅面结构特征：计算机X射线头影测量

背景：研究表明,覆盖在硬组织之上的软组织的厚度存在有较大的差异,不是均匀地覆盖在硬组织之上,即临床治疗错牙合畸形时,仅仅单纯进行硬组织测量将不能获得理想的侧貌外形。 目的：分析成人Angle II类错牙合软硬组织颅面结构特征,并分析Angle II1类与II2类软硬组织相关性。 方法：从2011至2014年佳木斯大学附属口腔医院正畸科门诊病例中选取成人Angle II类错牙合畸形患者60例,年龄在18-38岁之间,平均26.3岁,男女各半,其中Angle II1类和II2类各30例,采用计算机X射线头影测量技术对比分析Angle II1类和II2类错牙合畸形软硬组织测量项目的差异以及其软硬组织相关性。 结果与结论：①硬组织测量结果：两组患者SNB角(蝶鞍中心点、鼻根点及下齿槽座点所构成的角)、SND角(蝶鞍中心点、鼻根点及下颌联合部中心点所构成的角)、ANB角(上齿槽座点、鼻根点与下齿槽座点构成的角)、面角(FH-NP)、上中切牙角(U1-SN,P < 0.001)、LI-NB角(P < 0.01)、下中切牙角(L1-MP,P < 0.01)、上下中切牙角(U1-L1,P < 0.001)的差异有显著性意义(P < 0.05)。②软组织测量结果：两组患者上唇倾角(ULA’ -FH)、下唇突角(LLNs-FH)、上唇突角(ULNs-FH)、鼻唇角(CmSnUL)、下唇-审美平面距(E-LL)的差异有显著性意义(P < 0.05)。③两组患者软硬组织各测量项目间有相关,相关性高低存在差别。结果表明AngleII1类错牙合的上颌骨及上前牙的突度对下唇部的位置有一定的影响。而Angle II2类只有上颌突度对下唇部软组织的位置的影响。Angle II2类错牙合颏部软组织变异较小,而Angle II1类错牙合的颏部软组织变异较大。临床治疗成人Angle II类错牙合畸形患者制定方案时,需结合其各自的软硬组织结构特点进行正畸、正颌外科治疗以及方案的制定。     

数字化X射线摄影图像显示器配置对X射线摄影剂量的影响

目的:研究数字化X射线摄影系统图像获取工作站显示器配置不同对图像质量的影响及对被检者照射剂量的影响.材料与方法:应用对比度细节体模CDRAD2.0影像,以图像质量因子IQF作为图像质量评价标准,计算不同照射剂量下两种图像显示条件下图像质量及照射剂量的差别.结果:所研究的普通显示器与高分辨率、高亮度显示器在不同照射剂量条件下显示的图像质量因子显著不同(p＜0.000).结论:应用高亮度、高分辨率显示器作为图像获取工作站显示器可显著降低体模照射剂量.     

X射线影像在正常骨组织及骨疾病诊断中的应用分析

背景：X射线影像诊断已经成为临床影像诊断中重要的组成部分,是骨关节系统临床诊治最常用的方法。 目的：对X射线影像在正常骨组织及骨疾病诊断中的应用研究文献进行多层次探讨分析。 方法：以电子检索的方式对CNKI数据库2002/2011X射线影像在正常骨组织及骨疾病诊断中的应用研究文献进行检索分析,采用检索词为“骨组织;髋关节;膝关节;肩关节;肘关节;X射线影像”。骨关节系统是人体的承重系统及运动系统,结构复杂多样化,因此骨组织X射线影像表现也呈现复杂多样性,骨组织X射线影像诊断为临床诊断治疗提供重要的辅助依据。 结果与结论：人体组织结构存在密度和厚度差异的不同,X射线穿透人体时被吸收的量也不同,以致剩余的X射线量也不同,剩余的X射线经过成像介质的显像或计算机的重建过程,在X射线片上就能显示具有黑白对比、层次差异的X射线图像。X射线影像不仅应用于正常骨组织的研究,而且应用于骨组织的疾病诊断。     

脑卒中瘫肢正中神经结构和功能的研究

目的:观察脑出血大鼠瘫肢正中神经超微结构的变化和脑卒中偏瘫患者患肢正中神经传导功能的变化。方法:动物实验:Wister大鼠60只,模型组及假手术各30只,通过胶原酶加肝素联合注射法建立大鼠脑出血动物模型。造模成功后第3 d、14 d取材,观察正中神经镜下变化(光镜、电镜)。临床研究:于2009年7月～2011年12月随机选择淮北市人民医院神经内科经CT或MRI确诊的首次住院的脑卒中偏瘫患者60例,应用肌电图技术测试其患侧和健侧正中神经的传导功能变化。结果:无论是模型组还是假手术祖,大鼠正中神经有髓神经髓鞘及轴索无明显异常变化。脑卒中患者瘫肢正中神经运动神经传导速度(MCV)和感觉神经传导速度(SCV)与对照组(健侧)比较无显著差异(P>0.05)。结论:结果表明脑出血偏瘫大鼠瘫肢周围神经结构无明显损害。脑卒中急性期患者瘫肢正中神经传导功能无异常变化。     

正中神经返支和掌皮支血供的显微解剖

目的为修复正中神经返支提供带血管蒂神经桥接的有关数据和掌皮支血供的解剖学资料。方法用体视学方法研究了40侧灌注红色乳胶液的返支和掌皮支的营养血管。观察返支营养血管的来源、长度、外径和进入神经干的方式;观察掌皮支营养血管的来源和进入神经的方式。结果返支营养动脉主要发自掌浅弓凹侧筋膜支(称之来源动脉)。来源动脉起点至“零点”距离(11.62±2.30)mm,外径(0.95±0.10)mm,长度(10.12±1.30)mm。营养动脉主干长度(2.84±0.10)mm,外径(0.42±0.15)mm。营养动脉从返支主干近侧1/3段直入式进入神经者占86.5%;从返支中、远侧段伴入式进入神经者占14.5%;掌皮支营养动脉主要发自尺动脉(占52.5%)和桡动脉(占37.5%),以直式、伴入式和肌支式进入神经。结论返支营养动脉可作为血管蒂神经移植的受体血管。     

不同剂量X射线对雄性大鼠精子顶体酶活性的影响

目的:检测不同剂量X-射线对雄性大鼠精子顶体酶的影响,以探讨体外X-射线对大鼠精子顶体酶活性的影响。方法:将10周龄成熟雄性大鼠40只,随机分为4组:2Gy、4Gy、6Gy照射组和0Gy对照组;每组10只。按不同剂量照射,1h后处死大鼠,以改良的Kennedy法分别测定不同剂量X射线作用下的精子顶体酶活性。结果:2Gy、4Gy、6Gy照射组与0Gy对照组相比顶体酶活性显著降低(P<0.05),照射组酶活性较0Gy对照组有显著降低;4Gy、6Gy照射组与2Gy照射组相比较顶体酶活性显著降低(P<0.05);而4Gy照射组与6Gy照射组相比较则无统计学意义。结论:X-射线对大鼠精子顶体酶有明显的抑制作用。     

马钱子对家兔骨折愈合的影响

背景：马钱子的主要有效成分为总生物碱,主要功效是通络止痛、消肿散结、兴奋健胃、凉血等,对神经系统、心血管系统等也有一定的药理作用。目的：观察马钱子对实验性家兔骨折愈合过程的影响。方法：制备家兔桡骨骨折模型,随机分为给药组和生理盐水对照组,每组10只。室温条件下,对给药组家兔灌胃马钱子粉混悬液;对照组家兔灌胃生理盐水,1次/d。给药后7,14,28 d各作X射线影像学检查,比较对照组与给药组家兔骨折愈合情况。给药后14,28 d时耳缘静脉取血,与给药前作血清学比较,检测分析家兔骨折模型血清碱性磷酸酶,微量元素钙(Ca)、镁(Mg)、铜(Cu)、铁(Fe)、锌(Zn)质量浓度变化。 结果与结论：家兔骨X射线影像学结果显示给药组家兔骨折愈合速度比对照组快。血清学检查结果表明,给药后14和28 d给药组家兔血清中碱性磷酸酶浓度明显高于给药前和对照组(P < 0.05)。微量元素中,对照组家兔给予生理盐水后28 d时血清Fe质量浓度高于给生理盐水前(P < 0.05);给药组家兔给药后14 d和28 d血清中Ca、Zn水平均高于给药前和对照组;给药后14 d Mg,Fe质量浓度明显高于给药前和同时间点对照组(P < 0.01,P < 0.05);给药后28 d Fe质量浓度明显高于给药前(P < 0.01)。说明马钱子可以增加骨折家兔碱性磷酸酶和微量元素水平,对家兔骨折愈合有促进作用。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

膈神经与肋间神经移位修复臂丛神经根性撕脱伤

BACKGROUND: Phrenic nerve transfer and intercostal nerve transfer are the accepted surgery strategies for the treatment of brachial plexus root avulsion injuries; however, which surgery is more suitable for the repair remains inconclusive. OBJECTIVE: To observe the treatment outcomes of brachial plexus root avulsion injuries by transferring the phrenic nerve to the anterior division of the upper trunk of brachial plexus and the intercostal nerve to the musculocutaneous nerve. METHODS: Twenty patients with brachial plexus root avulsion injuries were included. Among them, 9 were treated with phrenic nerve transfer to the anterior division of the upper trunk of brachial plexus (phrenic nerve transfer group), and 11 were treated with intercostal nerve transfer to the musculocutaneous nerve (intercostal nerve transfer group). Postoperative follow-up ranged from 15 to 36 months. Incision length, blood loss, and operation time were recorded. Muscle strength of the biceps and elbow flexion angle were evaluated. The repair outcome was evaluated by assessing the functional recovery of musculocutaneous nerve according to the criteria issued by the Branch of Hand Surgery of Chinese Medicine Association, and the excellent and good rate was calculated. RESULTS AND CONCLUSION: The excellent and good rate was 66.7% and 63.6%, respectively, in phrenic nerve transfer group and intercostal nerve transfer group, which is not significantly different between both groups (P > 0.05). Smaller length of operation incision, reduced blood loss, and shorter operation time were found in the phrenic nerve transfer group. Two and three patients in bad recovery were in phrenic nerve transfer and intercostal nerve transfer groups, respectively. These findings suggest that the two kinds of surgery strategies for the repair of brachial plexus root avulsion injuries can obtain good results in the functional recovery of elbow flexion. Phrenic nerve transfer exerts superiorities in operation incision, blood loss and operation time. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Anatomical basis of neurotisation of the median nerve in the hand by the radial nerve

Summary The sensory sequelae after lesions of the median nerve cause difficulties in treatment since few sensory transfers are available. Neurotisation of the median by sensory branches of the radial nerve have aroused little interest although they have already been used by some authors after anastomosis at the wrist or through the first or second interosseous spaces. Based on what was originally a purely anatomic study, our interest was directed to the possibilities of performing more distal neurotisation for the treatment of sensory disorders of limited extent. The chief object was to obtain faster sensory reinnervation. 30 hands were dissected and a radial branch was defined as suitable for neurotisation whose diameter approximated that of its palmar digital homolog. Only those findings constantly observed in analysis of the hands studied were taken into account. It is therefore possible to reliably define the type and site of the routes of approach as well as the sensory branches suitable for neurotisation.

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Bases anatomiques de la neurotisation du nerf médian à la main par le nerf radial

Résumé Les séquelles sensitives après lésion du nerf médian posent un problème thérapeutique car peu de transferts sensitifs sont disponibles. La neurotisation du médian par les branches sensitives du radial suscite peu d'intérêt bien que déjà utilisée par quelques auteurs après anastomose au poignet ou à travers le ler ou 2ème espace inter-osseux. A partir d'un travail uniquement anatomique, notre intérêt s'est porté sur les possibilités effectives de neurotisations plus distales pour le traitement de troubles sensitifs limités dans leur topographie. L'intéret étant surtout d'obtenir une réinnervation sensitive plus rapide. 30 mains ont ainsi été disséquées. Nous avons défini comme neurotisable un rameau radial dont le diamètre était voisin de son homologue digital palmaire. Seules ont été prises en compte les données constantes retrouvées après l'analyse des mains étudiées. Il est ainsi possible de définir de manière fiable le type et le siège des voies d'abord ainsi que les rameaux sensitifs utilisables pour la neurotisation.

     

不同镇痛方式对全膝关节置换后关节功能及不良反应的影响

背景：全膝关节置换后剧烈疼痛是导致患者置换后膝关节功能恢复不佳的重要因素,如何给予患者置换后效果满意的镇痛方案是目前研究的热点。 目的：观察不同镇痛方案对全膝关节置换患者置换后疼痛和功能恢复的影响。 方法：将徐州市中心医院自2010年3月到2014年2月期间收治的60例单侧的膝关节置换患者随机分为3组：硬膜外镇痛组,静脉镇痛组,连续股神经阻滞镇痛组,每组各20例,均采用相应方法进行术后镇痛。记录并比较3组患者置换前、置换后不同状态下1,6,24,48,96 h的目测类比评分,置换后24,48,72 h关节活动度恢复情况;膝关节置换患者膝关节KSS评分;置换后出现的不良反应。 结果与结论：与置换前比较,置换后1,24,48,96 h连续股神经阻滞镇痛组患者目测类比评分降低(P < 0.05)。连续股神经阻滞镇痛组患者关节活动度恢复最好,其次为硬膜外镇痛组患者,静脉镇痛组恢复最差(P < 0.05);同置换前比较,3组患者置换后1,3个月膝关节功能KSS评分均升高(P < 0.05)。同连续股神经阻滞镇痛组患者比较,置换后1,3个月硬膜外镇痛组,静脉镇痛组患者膝关节功能评分降低(P < 0.05)。结果证实,连续股神经阻滞镇痛方案置换后总体效果较好,能够帮助患者更好的进行置换后关节功能恢复,安全可靠。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

The proximal radial artery perforator flap (PRAP-flap): an anatomical study for its use in elbow reconstruction

We investigated the anatomical vascular basis of the proximal radial artery perforator flap (PRAP-flap) and we report here the first clinical application in a case of reconstructive surgery as an alternative to traditional regional fasciocutaneous pedicled flaps or microsurgery solutions. In 16 unembalmed cadaveric forearms, the radial artery was slowly injected with acrylic resin through the brachial artery and the superficial flexor compartment was dissected. The flap was raised from the lateral and medial sides of the forearm toward the axis represented by the radial artery, and the characteristics (number, diameter, site and interval of origin, and course) of its collaterals were evaluated. In the proximal forearm, the vessels were less numerous (mean values 8.6 vs. 11.5, P < 0.05) but larger in diameter (mean values 0.7 vs. 0.4 mm, P < 0.05) than in the distal forearm. The first four proximal perforator arteries originated within a mean distance of 4.3 cm from the origin of the radial artery, with a 95% confidence interval of 3.8–4.8 cm. The perforator arteries followed the axis of the forearm and anastomosed in the fascial plane, forming longitudinal fan-shaped arterial chains, giving rise to an epifascial vascular network. This anatomical study allowed us to plan and perform a PRAP-flap in a 35-year-old woman who was suffering from comminuted fractures of the olecranon and distal epiphysis of the humerus and soft tissue loss from traumatic injury of the elbow. From the antebrachial surface, a proximally based radial forearm fasciocutaneous flap was raised, with a vascular pedicle of 16 × 5 cm, a cutaneous island of 4 × 5 cm, and a pivot point 5 cm from the interepicondylar line. The flap showed good immediate and long-term viability: it was completely incorporated with good pliability and the patient regained good functional quality of the elbow joint. The anatomical features and the demonstrative reconstructive result obtained in the here-reported surgical case support the clinical evidence that a reliable forearm skin paddle may be raised on a subcutaneous fascial axial pedicle supplied only by proximal perforators of the radial artery. The so-obtained PRAP-flap is useful for the coverage of elbow defects when other reconstructive options are no longer available.     

Surgical anatomy of the radial nerve at the elbow

An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (±11) and 157 (±11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (±4) and 6 (±1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (±13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (±13) and 121 (±13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (±6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (±14) and 110 (±23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries.     

肘部及前臂上段正中神经卡压综合征的临床解剖学研究

目的 探讨肘部正中神经卡压综合征的解剖学基础。方法 解剖观察５０侧上肢标本,结果 肱二头肌腱膜与正中神经的关系有非覆盖４０例（８０％）,部分覆盖型６侧（１２％）和完全覆盖型４侧（８％）。旋前圆肌纤维桥斜过正中神经前方３２侧（６４％）。旋前圆肌肱骨头肌内有腱束８例（成人,占１８．６％）,尺骨头汪岙较厚筋膜４７侧（９４％）。指浅屈肌起始结构有联合腱弓型４４侧（８８％）,纤维情怀２侧型（４％）和腱束型（     

The effects of graded compression of the median nerve in the carpal canal on grip force

The relationship between tactile hypoesthesia and precision grip force was examined using compression of the median nerve in healthy adults. Hypoesthesia was graded by varying the pressure that an external clamp exerted over the carpal canal. Electrical stimulation of the median nerve in the forearm evoked a compound sensory nerve action potential (SNAP) that we recorded from the digital nerves of the index finger. Clamp pressure was varied to achieve SNAPs that were 75%, 50%, and 25% of precompression amplitude (100%). Grip force and tactile sensibility (Semmes-Weinstein filaments, cotton wisps, sharp/dull) did not change in parallel with reductions of the SNAP. Subjects reported paresthesias at the thumb and index finger at 75% SNAP. Tactile pressure thresholds increased to the clinical range of 'diminished light touch', but subjects detected cotton wisps stroked along the finger. At 75% SNAP grip force did not change compared to 100% SNAP. Simple prehension can proceed efficiently despite these modest reductions in tactile signals. At 50% SNAP the digits remained sensate, but were reported to feel "thick, like cardboard". No subject could detect cotton wisps and tactile thresholds increased by one filament. Sharp/dull distinctions remained. Grip force increased by 55% compared to grip force at SNAPs of 100% and 75%. There were no changes in skin slipperiness, so the increased grip force represented elevated 'safety margin' (grip force exceeding that needed to prevent slip). At 25% SNAP subjects described the skin innervated by the median nerve as feeling "numb", but grip force increased little compared to 50% SNAP. Grip force continued to reflect changes in grip surface friction, and mechanical transients from setting the object on the table triggered coordinated reductions in grip force. We suspect that the loss of information from SA I and FA I, but not FA II, tactile afferents provoked the increased grip force. Electronic Publication     

Stretch-induced nerve injury: a proposed technique for the study of nerve regeneration and evaluation of the influence of gabapentin on this model

The rat models currently employed for studies of nerve regeneration present distinct disadvantages. We propose a new technique of stretch-induced nerve injury, used here to evaluate the influence of gabapentin (GBP) on nerve regeneration. Male Wistar rats (300 g; n=36) underwent surgery and exposure of the median nerve in the right forelimbs, either with or without nerve injury. The technique was performed using distal and proximal clamps separated by a distance of 2 cm and a sliding distance of 3 mm. The nerve was compressed and stretched for 5 s until the bands of Fontana disappeared. The animals were evaluated in relation to functional, biochemical and histological parameters. Stretching of the median nerve led to complete loss of motor function up to 12 days after the lesion (P<0.001), compared to non-injured nerves, as assessed in the grasping test. Grasping force in the nerve-injured animals did not return to control values up to 30 days after surgery (P<0.05). Nerve injury also caused an increase in the time of sensory recovery, as well as in the electrical and mechanical stimulation tests. Treatment of the animals with GBP promoted an improvement in the morphometric analysis of median nerve cross-sections compared with the operated vehicle group, as observed in the area of myelinated fibers or connective tissue (P<0.001), in the density of myelinated fibers/mm² (P<0.05) and in the degeneration fragments (P<0.01). Stretch-induced nerve injury seems to be a simple and relevant model for evaluating nerve regeneration.     

初次全膝关节置换后的腓总神经损伤：危险因素及防治策略研究现状

BACKGROUND: Common peroneal nerve injury is one of the rare but serious complications after total knee arthroplasty. With the increased amount of operations, peroneal nerve injury would become more and more common, although the incidence rate is relatively low.