保留盆腔植物神经对老年男性患者术后性功能及排尿功能的影响

目的:探讨保留盆腔植物神经的直肠癌手术对老年男性患者性功能及排尿功能的影响。方法:1999~2005年因直肠癌手术的170例老年男性患者分为PANP组(含规范的TME手术方法)和非PANP(TME规范情况不详),对两组术后性功能、排尿功能和局部复发率进行回顾性总结、比较。结果:PANP组性功能与排尿功能明显优于非PANP组,但统计学无显著差异(P<0.05)。而PANP组局部复发率低于非PANP组(P>0.05)。结论:老年直肠癌患者应重视性功能和排尿功能的保护。     

创伤性复发性腓骨肌腱脱位的手术治疗

目的研究创伤性复发性腓骨肌腱脱位的手术方法. 方法回顾分析1986年1月～2003年12月手术治疗的21例创伤性复发性腓骨肌腱脱位的病例,所有病例均应用Watson Jones手术. 结果 15例得到随访,随访时间1～15年,平均4.9年.1例因外伤再次脱位,其余14例未再出现脱位,均恢复正常运动或训练,比赛. 结论 Watson Jones手术治疗复发性脱位操作简单,损伤小,效果满意.     

Anatomical Course of the Superficial Branch of the Radial Nerve and Clinical Significance for Surgical Approaches in the Distal Forearm

Abstract 10 embalmed cadaver forearms and wrists were dissected to determine the anatomical course of the superficial branch of the radial nerve in the distal forearm. The superficial radial nerve bifurcated in two branches at a mean of 54,7 mm proximal to the radial styloid. From the styloid process of the radius, the mean distance to the closest dorsal branch of the superficial radial nerve was 3,5 mm and the mean distance to the closest volar branch was 9,8 mm. The mean distance between the closest branch of the superficial radial nerve and Lister?s tubercle was 16,4 mm. The crossing point between the nerve and the cephalic vein was located at a mean of 54,3 mm proximal to the styloid process. At the level of styloid process the mean distance between the closest dorsal branch of the superficial radial nerve and the first dorsal compartment was 15,2 mm and between the closest volar branch and the first dorsal compartment 4,4 mm. Detailed knowledge of anatomic characteristics of the superficial branch of the radial nerve may help prevent injury during operations and treat traumatic lesions of the nerve. Because of great variations in the course of the superficial radial nerve we could not define an absolute safe zone for surgical procedures on the distal forearm. Iatrogenic lesions of the superficial radial nerve are described complications of percutaneous procedures. Therefore open surgical approaches are recommended. Daniela Klitscher and Lars Peter Müller contributed equally to this work.     

Impact of unilateral interposition sural nerve graft on the recovery of sexual function after radical prostatectomy in Japanese men: A preliminary study

PURPOSE: To determine the effect of an interposition nerve graft on sexual function after radical prostatectomy. METHODS: This study includes 64 patients, without hormonal therapy, who underwent a radical prostatectomy and intraoperative electrophysiological confirmation of cavernous nerve preservation. Twelve patients underwent a unilateral interposition sural nerve graft (UNG) for the resected neurovascular bundle. Twenty-one and 31 patients underwent bilateral nerve-sparing (BNS) and unilateral nerve-sparing (UNS) surgery without a nerve graft, respectively. As the age of patients was significantly younger in the UNG group than in the other groups, age-matched analysis also was conducted. Sexual function, evaluated by a self-administered questionnaire using the University of California Los Angeles-Prostate Cancer Index, was compared statistically among the three groups. RESULTS: In the age-matched analysis, the postoperative sexual function (SXF) score of the UNG group showed an intermediate level of recovery between those of the BNS and UNS groups at 12 months and reached the same level as the score at 12 months of the BNS group at 18 months postoperatively. The difference in the SXF score between the UNG and UNS groups began to appear after 6 months postoperatively and increased steadily with time. However, the background factors, such as the baseline SXF score, the usage rate of phosphodiesterase 5 inhibitors, and the rate of comorbidities were different between the UNG and UNS groups. CONCLUSIONS: The difference of the SXF score between the UNG and UNS groups increased with time after 6 months postoperatively. However, it might be difficult at present to attribute a better recovery of the SXF score to the nerve graft because of the difference in the background factors between the groups.     

小儿腮腺炎并发中枢神经系统感染52例临床分析

目的:探讨小儿腮腺炎并发中枢神经系统感染的临床特点.方法:对52例小儿腮腺炎并发中枢神经系统感染的临床资料进行回顾性总结分析.结果:3～7月份为小儿腮腺炎并发中枢神经系统感染的发病高峰季节(92.31%).发病年龄以6～12岁为主(82.69%),多发生于腮腺肿痛3天以上伴有持续发热者(78.85%),少数患者同时有其它脏器的损害,一般治疗疗效较好.结论:腮腺炎极易并发中枢神经系统感染,年长儿发生率高,应推广接种流腮活疫苗降低发病率.     

延迟一期修复外周神经损伤38例报告

目的 探讨应用显微外科技术延迟一期修复四肢外周神经损伤的治疗体会。方法 应用显微外科技术延迟一期修复各种原因所致的四肢外周神经损伤38例41条，手术方法包括神经瘢痕松解、神经直接缝合术等。结果 术后随访6个月～7年，平均33个月，优良率为81．6％。结论 对失去一期修复手术治疗机会的周围神经损伤患者应尽早行延迟一期手术，可取得较好疗效。     

CT引导下颈侧入路舌咽神经毁损术

目的探讨CT引导下颈侧入路舌咽神经毁损术对舌咽神经痛及舌咽神经支配区顽固性疼痛的疗效. 方法 A组16例舌咽神经痛及B组12例舌咽神经支配区顽固性疼痛,采用CT引导经皮穿刺定位于茎突前缘第2颈椎水平,注入局麻药仅阻滞舌咽神经,注入7%苯酚甘油溶液0.8 ml. 结果 A组完全缓解率87.5%(14/16),总有效率100%(16/16),随访6个月无复发;B组完全缓解率50%(6/12),总有效率83.3%(10/12),随访6个月,复发6例(50.0%).2组均无严重并发症. 结论 CT介导下颈侧入路舌咽神经毁损术具有疗效可靠,定位准确,操作安全的特点,并有效减少严重并发症的发生.     

按压骨穴调节围绝经期妇女心脏植物神经功能的研究

目的观察按压骨穴对围绝经期妇女心脏植物神经功能的影响。方法设按压骨穴组30例、空白对照组30例。用美国BraemarDL700型动态心电检测仪,检测试验前后的心率变异性(HRV):TF代表总频,LF代表交感神经活性,HF代表迷走神经活性,LF/HF代表交感神经与迷走神经均衡性。结果按压骨穴后4项指标均有显著下降(P<0.01,P<0.05)。空白对照组变化不显著(P>0.05)。骨穴组4项指标的变化率与对照组比较均有显著性差异(P<0.01)。结论按压骨穴有抑制心脏交感神经活性的良性调整作用,此效应具有相对的特异性。     

海绵窦上段动眼神经的应用解剖研究

目的：探讨海绵窦上段动眼神经的应用解剖并讨论其临床意义。方法：经血管灌注后观测10例尸颅的海绵窦上段动眼神经及其毗邻与血供。结果：海绵窦上段动眼神经与海绵窦上段背侧紧邻海马钩回，内侧与视交叉、后交通动脉毗邻，外上与脉络膜前动脉相邻，腹侧紧贴鞍背突。海绵窦上段动眼神经80％未见神经外营养血管，可见20％后交通动脉发出1～2根分支进入神经。结论：海绵窦上段动眼神经毗邻结构复杂，滋养血管细小；在海绵窦上缘手术时，应特别注意辨认和保护动眼神经。     

Elemental composition and water content of myelinated axons and glial cells in rat central nervous system

The distribution of elements (e.g. Na, Cl, K) and water in CNS cells is unknown. Therefore, electron probe X-ray microanalysis (EPMA) was used to measure water content and concentrations (mmol/kg dry or wet weight) of Na, Mg, P, S, Cl, K and Ca in morphological compartments of myelinated axons and glial cells from rat optic nerve and cervical spinal cord white matter. Axons in both CNS regions exhibited similar water content ( 90%), and relatively high concentrations (wet and dry weight) of K with low Na and Ca levels. The K content of axons was related to diameter, i.e. small axons in spinal cord and optic nerve had significantly less (25–50%) K than larger diameter axons from the same CNS region. The elemental composition of spinal cord mitochondria was similar to corresponding axoplasm, whereas the water content (75%) of these organelles was substantially lower than that of axoplasm. In glial cell cytoplasm of both CNS areas, P and K (wet and dry weight) were the most abundant elements and water content was approximately 75%. CNS myelin had predominantly high P levels and the lowest water content (33–55%) of any compartment measured. The results of this study demonstrate that each morphological compartment of CNS axons and glia exhibits a characteristic elemental composition and water content which might be related to the structure and function of that neuronal region.