Release of the transverse carpal ligament alone is associated with elevated pressure beneath the distal volar forearm fascia in a cadaver model of carpal tunnel syndrome

PURPOSE: The purpose of this study is to determine whether release of the distal volar forearm fascia (DVFF) is necessary at the time of median nerve decompression for carpal tunnel syndrome. METHODS: Five fresh-frozen cadaver specimens were mounted vertically with the hand dependent and a 2.27-kg weight suspended from the fingers. A pressure sensor wire was used to measure pressures starting just distal to the transverse carpal ligament (TCL). The wire was withdrawn proximally in 5-mm increments and into the forearm until pressure was below 10 mm Hg. An incision in the forearm was extended distally until the pressure sensor was found. The distance from this point to the distal volar wrist crease was measured. The TCL was released, keeping the DVFF intact, and the experiment was repeated. Paired t-tests determined whether there were statistically significant differences between measurements before and after TCL release. RESULTS: Average peak pressure under the intact TCL was 57.8 +/- 10.1 mm Hg. Average peak pressure under the DVFF with the TCL intact was 61.2 +/- 43.6 mm Hg. Following release of the TCL, average peak pressure beneath the TCL significantly decreased to 14.0 +/- 9.0 mm Hg, whereas average peak pressure at the intact DVFF increased to 64.8 +/- 48.7 mm Hg. Average locations where DVFF pressure became less than 10 mm Hg with an intact TCL and with released TCL were 4.30 +/- 1.8 cm and 4.00 +/- 1.8 cm proximal to the distal volar wrist crease, respectively. There was no significant difference between DVFF pressures before or after TCL release. CONCLUSIONS: In a cadaver model of carpal tunnel syndrome, release of the TCL alone is associated with persistent pressures >30 mm Hg in the region of the DVFF. Release of the TCL did not significantly change the location of the pressure drop-off under the DVFF.     

踝关节的横及冠状断层影像解剖学

目的：为踝关节病变的影像学诊断提供解剖学基础。方法：①观测15例干性胫、腓及距骨的关节面。②成年男尸右足标本7例，先依骨性标志画线，新鲜2例画线后，各行轴位CT、MRI扫描及冠状位MRI扫描后冻硬，再切制横断层4例，冠状断层3例。结果：①距骨上关节面前、后宽为30．2、23．5mm；距骨内、外踝关节面矢状径与垂直径分别为30．8、14．9mm与27．5、23．7mm;外踝关节面前缘至距骨颈后缘间距为9．3mm。胫骨内踝与腓骨外踝关节面矢状径与垂直径分别为21．8、14．7mm和16．9、21．6mm。②观察了每一断层内关节及周围结构的形态、毗邻及其在连续断层的变化规律，并匹配相应CT及MRI。距骨滑车上关节面前宽32．9mm，距骨上、胫骨下关节面软骨厚1．7mm与1．8mm，胫距关节、内踝处及腓距关节腔径值分别为2．4、2．8、1．4mm，骨间韧带长1.8mm。结论：踝关节的断层解剖，为影像学诊断及关节镜技术等提供了解剖学依据。     

The aging hippocampus: a multi-level analysis in the rat

In the current experiment we conducted a multi-level analysis of age-related characteristics in the hippocampus of young adult (3 months), middle-aged (12 months), and old (24 months) Fisher 344xBrown Norway hybrid (FBNF1) rats. We examined the relationships between aging, hippocampus, and memory using a combination of behavioral, non-invasive magnetic resonance imaging and spectroscopy, and postmortem neuroanatomical measures in the same rats. Aging was associated with functional deficits on hippocampus-dependent memory tasks, accompanied by structural alterations observed both in vivo (magnetic resonance imaging-hippocampal volume) and postmortem (dentate gyrus neuronal density and neurogenesis). Neuronal metabolic integrity, assessed by levels of N-acetylaspartate with magnetic resonance spectroscopy, was however, preserved. Further, our results suggest that neurogenesis (doublecortin) seems to be related to both performance deficits on hippocampus-dependent tasks and hippocampal volume reduction. The observed pattern of age-related alterations closely resembles that previously reported in humans and suggests FBNF1 rats to be a useful model of normal human aging.     

腰椎横突的应用解剖

目的：为探讨L3横突综合征提供解剖学依据。方法：对30套正常成年男性干燥腰椎骨横突长,[宽,厚,横间距及横突间夹角等进行了测量,同时对8具成年男尸的腰椎横突区进行了解剖观测,结果：（1）L3横突最长,L5横突宽及厚最大,横突长,宽,厚左右侧相比无显著性差异,横突间距亦以L5最大。横突间夹角在不同椎序间无显著性,(2) 腰筋膜中层的纤维聚集成束附着于腰椎横突末端,在L3横突末端附着范围最大,每一横突间隙内有一恒定神经血管束从胸腰筋膜中层突出,腰神经后外侧支被纤维束固定寺横突背面。结论：（1）腰椎横突长度的解剖序列为L3＞L5＞L2＞L4＞1。（2）L3横突过长,胸腰筋膜在L3横突末端附着范围最大,腰神经后外侧支被纤维束固定于横突背面等是导致L3横突综合征的解剖学基础。     

针刀治疗第三腰椎横突综合征:随机对照观察

目的:探讨针刀对第三腰椎横突综合征的治疗效果。方法:将第三腰椎横突综合征患者180例按区组随机法分为针刀治疗组、阻滞组及针刺对照组,分别进行针刀、阻滞及针刺治疗。治疗前、后分别按“腰椎疾患治疗成绩评分表”评分,对测评结果进行统计学分析。结果:治疗前后成绩评分,针刀组治疗前(9.6±2.7)分,治疗后(23.0±5.7)分,改善指数0.56±0.61;阻滞组治疗前(9.9±2.8)分,治疗后(15.1±7.1)分,改善指数0.33±0.27;针刺组治疗前(9.7±2.9)分,治疗后(13.2±6.5)分,改善指数0.24±0.21。3组治疗前后评分,针刀治疗组优于阻滞及针刺对照组(P<0.001,t=18.32,5.65,4.21);3组疗效比较,针刀治疗组明显优于阻滞及针刺对照组(P<0.01,χ2=38.1,41.1);3组治疗后评分均比治疗前分值差异有显著性意义(P<0.001,t=6.39,11.85)。结论:与阻滞、针刺治疗组相比,针刀是保守治疗第三腰椎横突综合征值得采用的有效方法之一。     

Enhanced Meningeal Lymphatic Drainage Ameliorates Neuroinflammation and Hepatic Encephalopathy in Cirrhotic Rats

1. Download : Download high-res image (373KB)
2. Download : Download full-size image

     

Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke

Objectives

To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke.