Carpal tunnel syndrome is the most common compressive neuropathy,presenting with sensorimotor dysfunction.In carpal tunnel syndrome patients,irregular afferent signals on functional magnetic resonance imaging are asso...Carpal tunnel syndrome is the most common compressive neuropathy,presenting with sensorimotor dysfunction.In carpal tunnel syndrome patients,irregular afferent signals on functional magnetic resonance imaging are associated with changes in neural plasticity during peripheral nerve injury.However,it is difficult to obtain multi-point neuroimaging data of the brain in the clinic.In the present study,a rat model of median nerve compression was established by median nerve ligation,i.e.,carpal tunnel syndrome model.Sensory cortex remodeling was determined by functional magnetic resonance imaging between normal rats and carpal tunnel syndrome models at 2 weeks and 2 months after operation.Stimulation of bilateral paws by electricity for 30 seconds,alternating with 30 seconds of rest period（repeatedly 3 times）,resulted in activation of the contralateral sensorimotor cortex in normal rats.When carpal tunnel syndrome rats received this stimulation,the contralateral cerebral hemisphere was markedly activated at 2 weeks after operation,including the primary motor cortex,cerebellum,and thalamus.Moreover,this activation was not visible at 2 months after operation.These findings suggest that significant remodeling of the cerebral cortex appears at 2 weeks and 2 months after median nerve compression.展开更多
Current animal models of chronic peripheral nerve compression are mainly silicone tube models. However, the cross section of the rat sciatic nerve is not a perfect circle, and there are differences in the diameter of ...Current animal models of chronic peripheral nerve compression are mainly silicone tube models. However, the cross section of the rat sciatic nerve is not a perfect circle, and there are differences in the diameter of the sciatic nerve due to individual differences. The use of a silicone tube with a uniform internal diameter may not provide a reliable and consistent model. We have established a chronic sciatic nerve compression model that can induce demyelination of the sciatic nerve and lead to atrophy of skeletal muscle. In 3-week-old pups and adult rats, the sciatic nerve of the right hind limb was exposed, and a piece of surgical latex glove was gently placed under the nerve. N-butyl-cyanoacrylate was then placed over the nerve, and after it had set, another piece of glove latex was placed on top of the target area and allowed to adhere to the first piece to form a sandwich-like complex. Thus, a chronic sciatic nerve compression model was produced. Control pups with latex or N-butyl-cyanoacrylate were also prepared. Functional changes to nerves were assessed using the hot plate test and electromyography. Immunofluorescence and electron microscopy analyses of the nerves were performed to quantify the degree of neuropathological change. Masson staining was conducted to assess the degree of fibrosis in the gastrocnemius and intrinsic paw muscles. The pup group rats subjected to nerve compression displayed thermal hypoesthesia and a gradual decrease in nerve conduction velocity at 2 weeks after surgery. Neuropathological studies demonstrated that the model caused nerve demyelination and axonal irregularities and triggered collagen deposition in the epineurium and perineurium of the affected nerve at 8 weeks after surgery. The degree of fibrosis in the gastrocnemius and intrinsic paw muscles was significantly increased at 20 weeks after surgery. In conclusion, our novel model can reproduce the functional and histological changes of chronic nerve compression injury that occurs in humans and it will be a useful new tool for investigating the mechanisms underlying chronic nerve compression.展开更多
A series of cranial nerve decompression gaskets were prepared with fibers of different fineness and high crimp which were obtained in knit-de-knit texturing process by using different specification general polyethylen...A series of cranial nerve decompression gaskets were prepared with fibers of different fineness and high crimp which were obtained in knit-de-knit texturing process by using different specification general polyethylene terepthalate( PET) multifilament bought from market. The physical properties of the gasket were evaluated comprehensively and biocompatibility was analyzed with MTT assay.展开更多
Chronic nerve compression(CNC)neuropathy is a common disease in the clinic and provokes paraesthesia,or numbness at early stage.The changes in muscle fiber composition and motor nerve terminal morphology in distal mus...Chronic nerve compression(CNC)neuropathy is a common disease in the clinic and provokes paraesthesia,or numbness at early stage.The changes in muscle fiber composition and motor nerve terminal morphology in distal muscles were studied in this study.A well-established CNC model was used to assess the changes in the muscles.Behaviors were measured by von Frey filament test The myosin heavy chain isoforms and neuromuscular junctions(NMJs)were stained by immunofluorescence to show the muscle fiber types composition and motor nerve terminals morphologic changes in the flexor digitorum longus(FDL)and lumbrical muscle.The fiber cross-sectional areas of different muscle fiber types were measured.The small-fiber degeneration of cutaneous nerve fibers was examined by detecting the protein gene product 9.5(PGP9.5)with immunofluorescence.At 2nd month after compression,the proportion of type I and type IIB fibers was markedly decreased,and that of type n A fibers was increased in the lumbrical muscle.There was no significant change in composition of muscle fiber types in FDL and NMJ morphology of FDL and lumbrical muscles.Intra-epidermal nerve fibre density(IENFD)declined at 2nd month after the compression.Our study reveals the morphological changes of the FDL and lumbrical muscle at an early stage of CNC.These findings may be helpful to understand muscle damage and pathophysiological development of the nerve compression,and provide new evidence for early treatment of CNC.展开更多
For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognos...For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects surgical outcomes remains uncertain owing to a scarcity of reports and conflicting results. This retrospective study recruited one hundred and fourteen cases(88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) undergoing either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and Hand Questionnaire(DASH) score. For patients with absent sensory nerve action potential, 71 cases(80.7%) achieved at least one McGowan grade improvement, 76 hands(86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative McGowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syndrome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Huashan Hospital, Fudan University, China(approval No. 2017142).展开更多
Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in pa...Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients（65 elbows） diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the Mc Gowan scale as modified by Goldberg： 18 patients（28%） had grade IIA neuropathy, 20（31%） had grade IIB, and 27（42%） had grade III. Postoperatively, according to the Wilson ＆ Krout criteria, treatment outcomes were excellent in 38 patients（58%）, good in 16（25%）, fair in 7（11%）, and poor in 4（6%）, with an excellent and good rate of 83%. A negative correlation was found between the preoperative Mc Gowan grade and the postoperative Wilson ＆ Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.展开更多
BACKGROUND A large ganglionic cyst extending from the hip joint to the intrapelvic cavity through the sciatic notch is a rare space-occupying lesion associated with compressive lower-extremity neuropathy.A cyst in the...BACKGROUND A large ganglionic cyst extending from the hip joint to the intrapelvic cavity through the sciatic notch is a rare space-occupying lesion associated with compressive lower-extremity neuropathy.A cyst in the pelvic cavity compressing the intrapelvic-sciatic nerve is easily missed in the diagnostic process because it usually presents as atypical symptoms of an extraperitoneal-intrapelvic tumor.We present a case of a huge ganglionic cyst that was successfully excised laparoscopically and endoscopically by a gynecologist and an orthopedic surgeon.CASE SUMMARY A 52-year-old woman visited our hospital complaining of pain and numbness in her left buttock while sitting.The pain began 3 years ago and worsened,while the numbness in the left lower extremity lasted 1 mo.She was diagnosed and unsuccessfully treated at several tertiary referral centers many years ago.Magnetic resonance imaging revealed a suspected paralabral cyst(5 cm×5 cm×4.6 cm)in the left hip joint,extending to the pelvic cavity through the greater sciatic notch.The CA-125 and CA19-9 tumor marker levels were within normal limits.However,the cyst was compressing the sciatic nerve.Accordingly,endoscopic and laparoscopic neural decompression and mass excision were performed simultaneously.A laparoscopic examination revealed a tennis-ball-sized cyst filled with gelatinous liquid,stretching deep into the hip joint.An excisional biopsy performed in the pelvic cavity and deep gluteal space confirmed the accumulation of ganglionic cysts from the hip joint into the extrapelvic intraperitoneal cavity.CONCLUSION Intra-or extra-sciatic nerve-compressing lesion should be considered in cases of sitting pain radiating down the ipsilateral lower extremity.This large juxta-articular ganglionic cyst was successfully treated simultaneously using laparoscopy and arthroscopy.展开更多
BACKGROUND Carpal tunnel syndrome(CTS)is one of the most common peripheral nerve compressive neuropathies.The clinical symptoms and physical examinations of CTS are widely recognised,however,there is still debate arou...BACKGROUND Carpal tunnel syndrome(CTS)is one of the most common peripheral nerve compressive neuropathies.The clinical symptoms and physical examinations of CTS are widely recognised,however,there is still debate around what is the best approach for assessment of CTS.Clinical assessment is still considered the gold standard,however,controversies do exist regarding the need for investigations such nerve conduction studies(NCS)to aid with management decisions.AIM To correlate the severity of NCS results to a scoring system which included symptoms,signs and risk factors.METHODS This was a prospective correlation study.We scored patients’signs and symptoms using our CTS scoring system.This was then correlated with the findings of the NCS.The scoring system included-four symptoms(2 Katz hand diagrams–one for tingling and one for numbness;nocturnal paresthesia and bilateral symptoms)and four clinical signs(weak thumb abduction test;Tinel’s sign;Phalen sign and hypoalgesia in median nerve territory)and two risk factors(age more than 40 years and female sex).We classified the NCS results to normal,mild,moderate and severe.RESULTS There were 61 scores in 59 patients.The mean scores for the categories were as follows:6.75 for normal NCS;5.50 for mild NCS;9.17 for moderate NCS and 9 for severe NCS.All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS.Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.CONCLUSION We feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.展开更多
Carpal tunnel syndrome （CTS） accompanied by secondary axonal degeneration cannot be clearly dis- criminated using the current cross-validated ultrasound severity classification system. This study aimed at exploring ...Carpal tunnel syndrome （CTS） accompanied by secondary axonal degeneration cannot be clearly dis- criminated using the current cross-validated ultrasound severity classification system. This study aimed at exploring cut-off values of ultrasound parameters, including wrist cross-sectional area （W-CSA）, wrist perimeter （W-P）, ratio of cross-sectional area （R-CSA） and perimeter （R-P）, changes of CSA and P from wrist to one third distal forearm （△CSA＆AP） for differentiation. Seventy-three patients （13 male and 60 female） were assigned into group A （demyelination only, n = 40） and group B （demyelination with secondary axonal degeneration, n = 33） based on the outcomes of nerve conduction studies （NCS）. Receiver Operative Characteristics （ROC） curves were plotted to obtain sensitivity, specificity, and accuracy of cut- off values for all the ultrasound parameters. The overall identified cut-off values （W-CSA 12.0 mm2, W-P 16.27 mm, R-CSA 1.85, R-P 1.48, △CSA 6.98 mm2, △P 5.77 mm） had good sensitivity （77.1-88.6%）, fair specificity （40-62.2%） and fair-to-good accuracy （0.676-0.758）. There were also significant differences in demographics （age and severity gradation, P 〈 0.001）, NCS findings （wrist motor latency and conduction velocity, P 〈 0.0001; wrist motor amplitude, P 〈 0.05; distal sensory latency, P 〈 0.05; sensory amplitude, P 〈 0.001） and ultrasound measurements （W-CSA, W-P, R-CSA, R-P, △CSA＆△P, P 〈 0.05） between groups. These findings suggest that ultrasound can be potentially used to differentiate demyelinating CTS with sec- ondary axonal degeneration and provide better treatment guidance.展开更多
Background:Obstructed defecation syndrome(ODS)is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms.It is challenging in clinical practice.Acupuncture has advantages in th...Background:Obstructed defecation syndrome(ODS)is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms.It is challenging in clinical practice.Acupuncture has advantages in the treatment of complex symptoms because of its multi-target and bi-directional regulation of the human body.Since 2500 years ago,acupuncture has been applied empirically to the treatment of constipation.Does acupuncture have any effect on ODS?Objectives:By showing the clinical thoughts,methods,and achievements of acupuncture series in ODS in recent ten years by the author’s team,and two scientific papers published in English on acupuncture treatment of chronic intractable constipation and stress urinary incontinence,it is proved that the core scheme of acupuncture treatment of defecation disorder syndrome(ODS)is flexible.In order to raise awareness of the therapeutic effect of acupuncture in ODS,it can be integrated into existing practice to get opportunities for multidisciplinary cooperation and further research and development.Materials and Methods:By summarizing the diagnosis and treatment of ODS,the first-line selection of pelvic floor rehabilitation and the minimally invasive sacral neuromodulation were reviewed,and it was pointed out that there was a gap between the high demand of patients and the expectation of cost-effectiveness.Then,on the basis of modern eastern and western medical achievements,the holistic concept was introduced into the treatment of pelvic floor dysfunction,and an acupuncture scheme suitable for ODS was proposed.Results:Acupuncture is based on the idea of improving the patients’central nervous system,autonomic nervous system and intestinal nervous system,and is effective in treating ODS.The acupoints were set two groups when patient in supine position,which includes ST 25(Tianshu),SP 15(Daheng),SP 14(Fujie),CV 6(Qihai),CV 4(Guanyuan),ST 36(Zusanli),ST 37(Shangjuxu);When patient is in prone position,it includes BL 20(Pishu),BL 23(Shenshu),BL 25(Dachangshu),BL 33(Zhongliao),BL 34(Xialiao),and GV 20(Baihui).The key was the technique of deep needling of the ST 25(Tianshu)and deep needling of the BL 33(Zhongliao)&BL 34(Xialiao).It needs 2-15 Hz sparse-dense wave electrical stimulation,30 minutes each time,a total of 20 times,which was a scheme that could achieve satisfactory short-term and long-term effects.Conclusion:At present,clinical and basic experimental studies have proved that acupuncture plays a role in treating ODS in a multi-target way.This is a very promising research direction of pelvic floor integrated medicine.In the future,further study on optimizing the protocol and meeting the patient’s gap individually and cost-effectively.展开更多
基金supported by the National Natural Science Foundation of China,No.81371965,81672144a grant from the Shanghai Pujiang Program of China,No.16PJD035
文摘Carpal tunnel syndrome is the most common compressive neuropathy,presenting with sensorimotor dysfunction.In carpal tunnel syndrome patients,irregular afferent signals on functional magnetic resonance imaging are associated with changes in neural plasticity during peripheral nerve injury.However,it is difficult to obtain multi-point neuroimaging data of the brain in the clinic.In the present study,a rat model of median nerve compression was established by median nerve ligation,i.e.,carpal tunnel syndrome model.Sensory cortex remodeling was determined by functional magnetic resonance imaging between normal rats and carpal tunnel syndrome models at 2 weeks and 2 months after operation.Stimulation of bilateral paws by electricity for 30 seconds,alternating with 30 seconds of rest period（repeatedly 3 times）,resulted in activation of the contralateral sensorimotor cortex in normal rats.When carpal tunnel syndrome rats received this stimulation,the contralateral cerebral hemisphere was markedly activated at 2 weeks after operation,including the primary motor cortex,cerebellum,and thalamus.Moreover,this activation was not visible at 2 months after operation.These findings suggest that significant remodeling of the cerebral cortex appears at 2 weeks and 2 months after median nerve compression.
基金supported by the National Natural Science Foundation of China,No.81471270
文摘Current animal models of chronic peripheral nerve compression are mainly silicone tube models. However, the cross section of the rat sciatic nerve is not a perfect circle, and there are differences in the diameter of the sciatic nerve due to individual differences. The use of a silicone tube with a uniform internal diameter may not provide a reliable and consistent model. We have established a chronic sciatic nerve compression model that can induce demyelination of the sciatic nerve and lead to atrophy of skeletal muscle. In 3-week-old pups and adult rats, the sciatic nerve of the right hind limb was exposed, and a piece of surgical latex glove was gently placed under the nerve. N-butyl-cyanoacrylate was then placed over the nerve, and after it had set, another piece of glove latex was placed on top of the target area and allowed to adhere to the first piece to form a sandwich-like complex. Thus, a chronic sciatic nerve compression model was produced. Control pups with latex or N-butyl-cyanoacrylate were also prepared. Functional changes to nerves were assessed using the hot plate test and electromyography. Immunofluorescence and electron microscopy analyses of the nerves were performed to quantify the degree of neuropathological change. Masson staining was conducted to assess the degree of fibrosis in the gastrocnemius and intrinsic paw muscles. The pup group rats subjected to nerve compression displayed thermal hypoesthesia and a gradual decrease in nerve conduction velocity at 2 weeks after surgery. Neuropathological studies demonstrated that the model caused nerve demyelination and axonal irregularities and triggered collagen deposition in the epineurium and perineurium of the affected nerve at 8 weeks after surgery. The degree of fibrosis in the gastrocnemius and intrinsic paw muscles was significantly increased at 20 weeks after surgery. In conclusion, our novel model can reproduce the functional and histological changes of chronic nerve compression injury that occurs in humans and it will be a useful new tool for investigating the mechanisms underlying chronic nerve compression.
文摘A series of cranial nerve decompression gaskets were prepared with fibers of different fineness and high crimp which were obtained in knit-de-knit texturing process by using different specification general polyethylene terepthalate( PET) multifilament bought from market. The physical properties of the gasket were evaluated comprehensively and biocompatibility was analyzed with MTT assay.
基金the National Natural Science Foundation of China(No.81471270).
文摘Chronic nerve compression(CNC)neuropathy is a common disease in the clinic and provokes paraesthesia,or numbness at early stage.The changes in muscle fiber composition and motor nerve terminal morphology in distal muscles were studied in this study.A well-established CNC model was used to assess the changes in the muscles.Behaviors were measured by von Frey filament test The myosin heavy chain isoforms and neuromuscular junctions(NMJs)were stained by immunofluorescence to show the muscle fiber types composition and motor nerve terminals morphologic changes in the flexor digitorum longus(FDL)and lumbrical muscle.The fiber cross-sectional areas of different muscle fiber types were measured.The small-fiber degeneration of cutaneous nerve fibers was examined by detecting the protein gene product 9.5(PGP9.5)with immunofluorescence.At 2nd month after compression,the proportion of type I and type IIB fibers was markedly decreased,and that of type n A fibers was increased in the lumbrical muscle.There was no significant change in composition of muscle fiber types in FDL and NMJ morphology of FDL and lumbrical muscles.Intra-epidermal nerve fibre density(IENFD)declined at 2nd month after the compression.Our study reveals the morphological changes of the FDL and lumbrical muscle at an early stage of CNC.These findings may be helpful to understand muscle damage and pathophysiological development of the nerve compression,and provide new evidence for early treatment of CNC.
基金supported by the National Natural Science Foundation of China,No.81371374(to ZD)
文摘For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects surgical outcomes remains uncertain owing to a scarcity of reports and conflicting results. This retrospective study recruited one hundred and fourteen cases(88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) undergoing either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and Hand Questionnaire(DASH) score. For patients with absent sensory nerve action potential, 71 cases(80.7%) achieved at least one McGowan grade improvement, 76 hands(86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative McGowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syndrome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Huashan Hospital, Fudan University, China(approval No. 2017142).
基金supported by grants from the National Program on Key Basic Research Project of China(973 Program),No.2014CB542200a grant from Innovation Program of Ministry of Education,No.IRT1201+1 种基金the National Natural Science Foundation of China,No.31271284,31171150,81171146,30971526,31100860,31040043,31371210Program for New Century Excellent Talents in University of Ministry of Education of China,No.BMU20110270
文摘Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients（65 elbows） diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the Mc Gowan scale as modified by Goldberg： 18 patients（28%） had grade IIA neuropathy, 20（31%） had grade IIB, and 27（42%） had grade III. Postoperatively, according to the Wilson ＆ Krout criteria, treatment outcomes were excellent in 38 patients（58%）, good in 16（25%）, fair in 7（11%）, and poor in 4（6%）, with an excellent and good rate of 83%. A negative correlation was found between the preoperative Mc Gowan grade and the postoperative Wilson ＆ Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.
文摘BACKGROUND A large ganglionic cyst extending from the hip joint to the intrapelvic cavity through the sciatic notch is a rare space-occupying lesion associated with compressive lower-extremity neuropathy.A cyst in the pelvic cavity compressing the intrapelvic-sciatic nerve is easily missed in the diagnostic process because it usually presents as atypical symptoms of an extraperitoneal-intrapelvic tumor.We present a case of a huge ganglionic cyst that was successfully excised laparoscopically and endoscopically by a gynecologist and an orthopedic surgeon.CASE SUMMARY A 52-year-old woman visited our hospital complaining of pain and numbness in her left buttock while sitting.The pain began 3 years ago and worsened,while the numbness in the left lower extremity lasted 1 mo.She was diagnosed and unsuccessfully treated at several tertiary referral centers many years ago.Magnetic resonance imaging revealed a suspected paralabral cyst(5 cm×5 cm×4.6 cm)in the left hip joint,extending to the pelvic cavity through the greater sciatic notch.The CA-125 and CA19-9 tumor marker levels were within normal limits.However,the cyst was compressing the sciatic nerve.Accordingly,endoscopic and laparoscopic neural decompression and mass excision were performed simultaneously.A laparoscopic examination revealed a tennis-ball-sized cyst filled with gelatinous liquid,stretching deep into the hip joint.An excisional biopsy performed in the pelvic cavity and deep gluteal space confirmed the accumulation of ganglionic cysts from the hip joint into the extrapelvic intraperitoneal cavity.CONCLUSION Intra-or extra-sciatic nerve-compressing lesion should be considered in cases of sitting pain radiating down the ipsilateral lower extremity.This large juxta-articular ganglionic cyst was successfully treated simultaneously using laparoscopy and arthroscopy.
文摘BACKGROUND Carpal tunnel syndrome(CTS)is one of the most common peripheral nerve compressive neuropathies.The clinical symptoms and physical examinations of CTS are widely recognised,however,there is still debate around what is the best approach for assessment of CTS.Clinical assessment is still considered the gold standard,however,controversies do exist regarding the need for investigations such nerve conduction studies(NCS)to aid with management decisions.AIM To correlate the severity of NCS results to a scoring system which included symptoms,signs and risk factors.METHODS This was a prospective correlation study.We scored patients’signs and symptoms using our CTS scoring system.This was then correlated with the findings of the NCS.The scoring system included-four symptoms(2 Katz hand diagrams–one for tingling and one for numbness;nocturnal paresthesia and bilateral symptoms)and four clinical signs(weak thumb abduction test;Tinel’s sign;Phalen sign and hypoalgesia in median nerve territory)and two risk factors(age more than 40 years and female sex).We classified the NCS results to normal,mild,moderate and severe.RESULTS There were 61 scores in 59 patients.The mean scores for the categories were as follows:6.75 for normal NCS;5.50 for mild NCS;9.17 for moderate NCS and 9 for severe NCS.All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS.Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.CONCLUSION We feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.
文摘Carpal tunnel syndrome （CTS） accompanied by secondary axonal degeneration cannot be clearly dis- criminated using the current cross-validated ultrasound severity classification system. This study aimed at exploring cut-off values of ultrasound parameters, including wrist cross-sectional area （W-CSA）, wrist perimeter （W-P）, ratio of cross-sectional area （R-CSA） and perimeter （R-P）, changes of CSA and P from wrist to one third distal forearm （△CSA＆AP） for differentiation. Seventy-three patients （13 male and 60 female） were assigned into group A （demyelination only, n = 40） and group B （demyelination with secondary axonal degeneration, n = 33） based on the outcomes of nerve conduction studies （NCS）. Receiver Operative Characteristics （ROC） curves were plotted to obtain sensitivity, specificity, and accuracy of cut- off values for all the ultrasound parameters. The overall identified cut-off values （W-CSA 12.0 mm2, W-P 16.27 mm, R-CSA 1.85, R-P 1.48, △CSA 6.98 mm2, △P 5.77 mm） had good sensitivity （77.1-88.6%）, fair specificity （40-62.2%） and fair-to-good accuracy （0.676-0.758）. There were also significant differences in demographics （age and severity gradation, P 〈 0.001）, NCS findings （wrist motor latency and conduction velocity, P 〈 0.0001; wrist motor amplitude, P 〈 0.05; distal sensory latency, P 〈 0.05; sensory amplitude, P 〈 0.001） and ultrasound measurements （W-CSA, W-P, R-CSA, R-P, △CSA＆△P, P 〈 0.05） between groups. These findings suggest that ultrasound can be potentially used to differentiate demyelinating CTS with sec- ondary axonal degeneration and provide better treatment guidance.
文摘Background:Obstructed defecation syndrome(ODS)is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms.It is challenging in clinical practice.Acupuncture has advantages in the treatment of complex symptoms because of its multi-target and bi-directional regulation of the human body.Since 2500 years ago,acupuncture has been applied empirically to the treatment of constipation.Does acupuncture have any effect on ODS?Objectives:By showing the clinical thoughts,methods,and achievements of acupuncture series in ODS in recent ten years by the author’s team,and two scientific papers published in English on acupuncture treatment of chronic intractable constipation and stress urinary incontinence,it is proved that the core scheme of acupuncture treatment of defecation disorder syndrome(ODS)is flexible.In order to raise awareness of the therapeutic effect of acupuncture in ODS,it can be integrated into existing practice to get opportunities for multidisciplinary cooperation and further research and development.Materials and Methods:By summarizing the diagnosis and treatment of ODS,the first-line selection of pelvic floor rehabilitation and the minimally invasive sacral neuromodulation were reviewed,and it was pointed out that there was a gap between the high demand of patients and the expectation of cost-effectiveness.Then,on the basis of modern eastern and western medical achievements,the holistic concept was introduced into the treatment of pelvic floor dysfunction,and an acupuncture scheme suitable for ODS was proposed.Results:Acupuncture is based on the idea of improving the patients’central nervous system,autonomic nervous system and intestinal nervous system,and is effective in treating ODS.The acupoints were set two groups when patient in supine position,which includes ST 25(Tianshu),SP 15(Daheng),SP 14(Fujie),CV 6(Qihai),CV 4(Guanyuan),ST 36(Zusanli),ST 37(Shangjuxu);When patient is in prone position,it includes BL 20(Pishu),BL 23(Shenshu),BL 25(Dachangshu),BL 33(Zhongliao),BL 34(Xialiao),and GV 20(Baihui).The key was the technique of deep needling of the ST 25(Tianshu)and deep needling of the BL 33(Zhongliao)&BL 34(Xialiao).It needs 2-15 Hz sparse-dense wave electrical stimulation,30 minutes each time,a total of 20 times,which was a scheme that could achieve satisfactory short-term and long-term effects.Conclusion:At present,clinical and basic experimental studies have proved that acupuncture plays a role in treating ODS in a multi-target way.This is a very promising research direction of pelvic floor integrated medicine.In the future,further study on optimizing the protocol and meeting the patient’s gap individually and cost-effectively.
