腕部尺神经卡压的解剖学研究及其临床意义

目的:为腕部尺神经卡压的诊断和治疗提供解剖学依据。方法:对20例新鲜成人上肢标本的腕部进行解剖,观测尺神经行径中可能存在的卡压因素。结果:尺神经在腕尺管内分成浅、深两支,浅支于小鱼际肌腱弓浅面出腕尺管;深支在小鱼际肌腱弓深面穿出腕尺管后,走行于小指对掌肌浅、深两头腱性起点和钩骨钩之间的间隙,小指对掌肌浅头腱性起点近侧缘锐利成腱弓样,存在率100%。腕尺管内尺神经和尺动脉之间存在3种交叉伴行关系:尺动脉发出的小鱼际肌营养血管和尺神经深支交叉占10%,尺动脉深支和尺神经浅支交叉占20%,尺动脉深支和尺神经深、浅支分别交叉占70%。结论:尺神经在腕部的行程分为腕尺管段和小鱼际肌段,小指对掌肌腱弓可以卡压尺神经深支,尺动脉和尺神经之间的多种交叉伴行关系是尺动脉卡压尺神经的基础。

腕部尺神经损伤的显微外科修复

目的 探讨腕部尺神经损伤的治疗方法。方法 对应用显微外科技术修复腕部尺神经损伤 4 7例进行总结。结果 术后平均随访 1年 2个月 ,按照手外科学会上肢周围神经功能评定试行标准评定 ,优良率为 72 .3%。结论 腕部尺神经损伤会影响手部精细动作 ,临床上应该重视尺神经的修复 ,特别是尺神经深支的修复。

肌间沟-腋路臂丛神经联合阻滞用于单侧腕部尺桡贯通伤手术临床效果观察

目的观察肌间沟-腋路臂丛神经联合阻滞用于单侧腕部尺桡贯通伤手术的临床效果。方法将90例患者在单侧腕部尺桡贯通伤手术中采用单纯肌间沟臂丛神经阻滞,单纯腋路臂丛神经阻滞及肌间沟-腋路臂丛神经联合阻滞麻醉,观察3组的麻醉效果。结果肌间沟-腋路臂丛神经联合阻滞麻醉效果满意,更大地满足了手术要求,且无麻醉并发症发生。结论肌间沟-腋路臂丛神经联合阻滞优于单纯肌间沟或腋路臂丛神经阻滞。

神经束膜吻合术治疗腕部尺神经损伤的效果观察

目的观察神经束膜吻合术治疗腕部尺神经损伤的效果。方法104例腕部尺神经损伤患者随机分为两组,各52例。对照组应用神经外膜吻合术治疗,观察组应用神经束膜吻合术治疗。比较两组的治疗效果以及尺神经传导速度、复合肌肉动作电位波幅。结果观察组的优良率为96.15%,显著高于对照组的76.92%(P<0.05)。术后3、6、12个月,两组的尺神经传导速度和复合肌肉动作电位波幅均显著高于术前,且观察组均显著高于对照组(P<0.05)。结论神经束膜吻合术治疗腕部尺神经损伤的效果显著,可有效提高患者术后尺神经传导速度和复合肌肉动作电位波幅。

色素沉着绒毛结节性滑膜炎致腕部尺神经卡压（附二例报告及文献综述）

色素沉着绒毛结节性滑膜炎致腕部尺神经卡压（附二例报告及文献综述）徐建光，胡韶楠，徐文东，顾玉东色素沉着绒毛结节性滑膜炎系一组发生于关节、四路与滑运的滑映特殊病变（临床上较少见），常见于联关节和踝关节．而发生在闭关节则甚为少见．近年，我院为２例因色素沉...

300例健康大学生寸口脉寸、关、尺三部长度与身高及全臂长之间的关系探讨

目的:探讨健康人群寸口脉寸、关、尺三部长度与身高及全臂长之间的关系,为实现三探头传感器的自动定位奠定基础。方法:分别测定300名在校健康大学生寸口脉寸关尺三部长度、身高、全臂长,分析寸口脉寸关尺三部长度、身高及全臂长之间的相关性,并建立回归方程。结果:寸口脉寸关尺三部长度与身高为正相关,相关系数r=0.402,P<0.001;寸口脉寸关尺三部长度与全臂长亦呈正相关,相关系数r=0.204,P<0.001。回归方程分别为:Y1=4.9796X+151.93;Y2=1.1724X+48.12。结论:本研究建立的寸口脉寸关尺三部长度、全臂长及身高之间的数值关系,将为实现三部脉象传感器的自动定位提供重要的理论支撑。

尺侧腕部撞击综合征的MRI诊断及鉴别诊断

目的分析总结尺侧腕部撞击综合征(ulnar-sided wrist impaction syndromes)的临床及影像学表现,提出诊断及鉴别诊断依据,从而提高对尺侧腕部撞击综合征的认识水平。方法选择慢性腕部疼痛或腕部不适患者52例,对所有研究对象的临床资料及腕关节MRI征象,采用四格表χ~2检验进行统计学分析。结果尺侧腕部撞击综合征17例,非尺侧腕部撞击综合征35例,其中类风湿性关节炎25例,骨内囊肿8例,月骨坏死2例。尺侧腕部疼痛/压痛、尺侧腕部应力实验阳性在撞击组与非撞击组间有统计学差异。尺骨阳性变异、尺骨头信号异常、TFCC损伤两组间有统计学差别。结论月骨及三角骨水肿、坏死信号出现在腕部多种疾病,详细分析异常信号的位置及形态,并结合尺骨头水肿、坏死及硬化,尺骨阳性变异、TFCC变薄穿孔等影像学征象及患者的临床症状及体征,可以明显提高与月骨无菌坏死,类风湿性关节炎,退行性变等疾病的鉴别诊断水平。

人尺侧腕屈肌肌亚部构筑学研究

目的查清人尺侧腕屈肌尺侧亚部和桡侧亚部的肌构筑情况 ,揭示该肌的形态学特征 ,为临床矫形外科“半肌”移位手术提供比较详细的形态学依据。方法 (1)观察 2 0侧人尺侧腕屈肌大体形态 ,并测量有关数据 ;(2 )取下 2 0侧人尺侧腕屈肌沿肌内腱长轴分为尺侧亚部和桡侧亚部 ,分别测量构筑学指数。结果尺侧腕屈肌尺侧亚部的肌长、肌重、羽状角、及生理横切面积的构筑指数均较桡侧亚部大 ,而肌纤维长则较桡侧亚部短。结论尺侧腕屈肌尺侧亚部和桡侧亚部都是半羽肌 ,尺侧亚部能产生多于桡侧亚部 1倍以上的肌力。

小指对掌肌腱弓的解剖学研究

目的探讨Guyon管以远尺神经深支卡压征的解剖学基础。方法对20例新鲜成人上肢标本腕部进行显微解剖,肉眼及镜下观测腕部尺神经分支与周围组织的关系。结果尺神经穿出Guyon管后进入小指对掌肌浅、深两头和钩骨钩之间的间隙,该间隙可分为顶、底和桡侧壁,有一个入口和一个出口,暂称其为小指对掌肌间隙。小指对掌肌浅头腱性起点的近侧缘锐利,呈腱弓样,存在率100%,暂称其为小指对掌肌腱弓。结论小指对掌肌腱弓可以卡压尺神经深支,引起除小鱼际肌以外的尺神经支配的所有手内在肌的功能障碍。

三角纤维软骨复合体损伤的诊断和治疗

本文通过三角纤维软骨复合体的解剖、生物力学、损伤分型的描述,对其损伤的诊断和疗进行了诸多方面的综述。

灰色皮病合并外周神经受压综合征误诊为麻风2例

灰色皮病又称持久性色素异常性红斑。腕部尺神经受压又叫Gugon氏管综合征,为尺神经在腕尺管受囊肿或疤痕压迫所致。跗管综合征为胫后神经在跗骨处受挤压引起。

原发性高血压患者的性格特征和脉象特征及其相关性研究

目的:观察原发性高血压患者关部和尺部脉力的差异;D型性格和原发性高血压的关系;尺部弱和D型性格的关系。方法:所有入组的人进行D型性格问卷调查,同时采用ZMIII型智能脉象仪依次采集关部和尺部脉象。分别记录脉象仪所得脉图中关、尺部的脉图参数,比较D型性格在高血压组和正常人组间的差异,比较两组关部和尺部的脉力。结果:高血压组D型性格明显比对照组增多;高血压组患者尺部比关部脉力弱,健康人组则关、尺部脉力相似,正常人组社交抑制得分大于等于10的人尺部比关部脉力弱。结论:原发性高血压患者脉象以弦脉为主且具有尺部弱的脉象特征,SI大于等于10分者具有尺部弱的脉象特征,尺部弱的脉象和善惊易恐的性格特征有关。

大龄儿童尺桡骨远干骺交界部骨折的治疗策略

目的探讨大龄儿童尺桡骨远干骺交界部骨折的治疗方法及疗效。方法回顾性分析自2013-01—2018-12采用切开复位钢板内固定治疗的34例尺桡骨远干骺交界部骨折,对于合并尺骨远端骨折者行闭合复位弹性髓内钉内固定,记录骨折愈合时间、并发症情况以及末次随访时的腕关节活动功能情况。结果 34例均获得随访,随访时间13~46个月,平均21个月。3例合并尺骨远端骨折者闭合复位失败行切开复位。切口均一期愈合,未出现感染、血管损伤、骨筋膜室综合征、骺板早闭、钢板松动、断裂等并发症。2例进钉处出现皮肤激惹反应。1例出现骨折延迟愈合,其余33例骨折愈合时间8~12周,平均10周。末次随访时按Gartland-Welley评分评价腕关节活动功能:优27例,良5例,可2例。结论切开复位钢板内固定治疗尺桡骨远干骺交界部骨折、闭合复位弹性髓内钉内固定治疗尺骨远端骨折的临床疗效显著,术后并发症发生率较低,早期可获得满意的功能恢复效果。

Statistical Downscaling Prediction of Summer Precipitation in Southeastern China

A statistical downscaling approach based on multiple-linear-regression(MLR) for the prediction of summer precipitation anomaly in southeastern China was established,which was based on the outputs of seven operational dynamical models of Development of a European Multi-model Ensemble System for Seasonal to Interannual Prediction(DEMETER) and observed data.It was found that the anomaly correlation coefficients(ACCs) spatial pattern of June-July-August(JJA) precipitation over southeastern China between the seven models and the observation were increased significantly;especially in the central and the northeastern areas,the ACCs were all larger than 0.42(above 95% level) and 0.53(above 99% level).Meanwhile,the root-mean-square errors(RMSE) were reduced in each model along with the multi-model ensemble(MME) for some of the stations in the northeastern area;additionally,the value of RMSE difference between before and after downscaling at some stations were larger than 1 mm d-1.Regionally averaged JJA rainfall anomaly temporal series of the downscaling scheme can capture the main characteristics of observation,while the correlation coefficients(CCs) between the temporal variations of the observation and downscaling results varied from 0.52 to 0.69 with corresponding variations from-0.27 to 0.22 for CCs between the observation and outputs of the models.

Drought Response to Air Temperature Change over China on the Centennial Scale

Climate data from the Climatic Research Unit （CRU） for the period 1901-2013 are used to investigate the drought response to air temperature change over China on the centennial scale. Drought is observed to have increased evidently across China, except for some regions in eastern China. This increase is much stronger in northern China compared to southern China, especially in Northwest and North China. These change characteris- tics of drought are closely associated with air temperature change, with the severe droughts in the major drought episodes of the last century generally coinciding with higher temperatures. The significantly increasing trend of drought in China based on observations only appears when considering the effects of air temperature change, which can explain -49% of droughts in observations and 30%-65% of droughts in Coupled Model Intereomparison Project Phase 5 （CMIP5） model simulations. Furthermore, the response of drought to air temperature change generally increases as the drought time scale increases. Furthermore, drought shows relatively high sensitivity in spring and early summer in China on the centennial scale.

阴阳尺部脉诊法及其临证应用

尺部脉诊法是通过诊察尺部脉象诊断病证的脉诊法，其核心是以先天阴阳、水火、命门的消长出入为对象，重视奇经八脉和奇恒之腑的生理、病理变化，明确并扩展了狭义阴阳理法的具体内容。笔者对脉象的体悟倾向于现场指感，不拘于脉名规矩，审脉经验独特，并给予相应的方药治疗。

Distribution Characteristics of Heavy Metals and Grain Size of Sediments from Hailing Bay, China

The geochemical properties of sediment in the nearby seawater areas of Hailing Bay of the western Guangdong province were first time investigated in the dry period of 2001 and the flood period of 2002, respectively. The temporal and spatial characteristics of Cu, Pb, Zn, Cd and Hg concentrations, organic carbon and total sulfides contents, and granulometric distribution in the surface sediment from the Hailing Bay were analyzed. Results demonstrated that there were no remarkable changes in the composition of sediment between the dry period and the flood period; the average concentrations of Cu, Pb, Zn, Cd and Hg were 32.1 ± 17.5, 36.1 ± 10.0, 107.0 ± 37.4, 0.26± 0.15 and 0.109 ± 0.073 mg·kg-1, respectively; the organic carbon and total sulfides contents were 1.33 ± 0.53 % and 140.13 ± 136.42 mg·kg-1, respectively; surface sediments were dominated by clayey silt and sand, and their mean grain size was 4.62 ± 2.36 φ and in the range 0.52-7.55 φ; there existed obvious correlation between the concentrations of Cu, Pb, Zn and Hg, and among Cu, Pb, Zn and Hg concentrations, organic carbon contents and grain size of sediments.

Microstructure and tensile properties of AM50A magnesium alloy prepared by recrystallisation and partial melting process

Prior to thixoextrusion, the microstructural evolution of semi-solid AM50A magnesium alloy prepared by the recrystallisation and partial remelting (RAP) route was investigated.The effect of compressive ratio on microstructure of semi-solid AM50A magnesium alloy was studied.Furthermore, tensile properties of thixoextruded components were determined.The results showed that the occurrence of recrystallised grains was closely associated with the location of the first liquid formed above the solidus.With prolonging holding time, deformed microstructure was penetrated, causing fragmentation, which resulted in the decrease of average grain size.Moreover, prolonging holding time was favorable for the improvement of the degree of spheroidization due to the increase in the amount of liquid.With the increase in compressive ratio, the size of solid grain decreased, the degree of spheroidization was improved during partial remelting, and the tensile properties of thixoextruded AM50A components were improved.The tensile properties for AM50A magnesium alloy thixoextruded from starting material produced by the RAP route were better than those of the same alloy produced by die-casting and thixomolding.