Experimental Studies on the Reinnervation of Posterior Cricoarytenoid Muscle by the Upper Branch of Phrenic Nerve

The purpose of this work was to reestablish the respiratory abduction of theparalyzed vocal cord through reinnervation of the posterior cricoarytenoid(PCA)mus-cle by part of phrenic fibres.In fifteen adult cats the adductor branch of the recurrentlaryngeal nerve(RLN)of the right side was cut and its distal end ligated,while the pro -ximal end was implanted into the PCA muscle belly.The whole RLN was then transectedin the tracheoesophageal groove and its distal stump anastomosed to the upper branchof the phrenic nerve.Various techniques for observation were used on day 40,80 and 150after operation.Direct laryngoscopy showed that the inspiratory abduction of the para-lyzed vocal cord recovered within 40 d in all cats.Eighty days later,a larger abducentmotion of the glottis was observed on the reinnervated side.Abduction was caused byreinnervation of the PCA muscle from phrenic motoneurons,as demonstrated by laryn-geal electromyogram,and the function of diaphragm maintained as revealed by monito-ring of the intrathoracic pressure.

Transfer of the extensor indicis proprius branch of posterior interosseous nerve to reconstruct ulnar nerve and median nerve injured proximally:an anatomical study

Proximal or middle lesions of the ulnar or median nerves are responsible for extensive loss of hand motor function.This occurs even when the most meticulous microsurgical techniques or nerve grafts are used.Previous studies had proposed that nerve transfer was more effective than nerve grafting for nerve repair.Our hypothesis is that transfer of the posterior interosseous nerve,which contains mainly motor fibers,to the ulnar or median nerve can innervate the intrinsic muscles of hands.The present study sought to investigate the feasibility of reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve by transferring the extensor indicis proprius branch of the posterior interosseous nerve obtained from adult cadavers.The results suggested that the extensor indicis proprius branch of the posterior interosseous nerve had approximately similar diameters and number of fascicles and myelinated nerve fibers to those of the deep branch of ulnar nerve and the thenar branch of the median nerve.These confirm the feasibility of extensor indicis proprius branch of posterior interosseous nerve transfer for reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve.This procedure could be a novel and effective method for the functional recovery of the intrinsic muscles of hands after ulnar nerve or median nerve injury.

Mechanisms of change contraction of function of the muscles <i>in vitro</i>at allergic

In this work, mechanisms of influence of protein sensibility of an organism on contractile function of the isolated skeletal muscles of the mouse—“fast”—musculus extensor digitorum longus, “mixed”—musculus diaphragma and “slow”— musculus soleus are investigated. It is shown that at a protein sensitization all “fast”, “mixed” and “slow” skeletal muscles change the contractile properties. The vector of these changes for muscles with a various phenotypes carries opposite character. Force of the reduction caused carbacholine at a “slow” and “mixed” muscles increase, at “fast”—decreases. A vector of change of force of reduction on carbacholine at protein sensitization at these skeletal muscles correlates with changes of non-quantum secretion acetylcholine in a zone of a trailer plate. Opposite changes of functional properties of “fast” and “mixed” muscles and “slow” muscles of a shin of the mouse at protein sensitization are caused by dynamics cholinoceptive processes of excitation of membrane muscular fibers. It comes out with the assumption, that change of the contraction functions of skeletal muscles at protein sensitization is caused by changes of cholinoceptive processes of excitation of a membrane of muscular fibers, and other changes in system of electro-mechanical interface.

Motor Response of Mirror Therapy after Reconstruction of Extensor Mechanism Caused by Glass Cut Injury

Treatment by mirror therapy (MT) restores motion in injured limbs without invasive procedures. This process is widely accepted for rehabilitating patients with phantom limb pain, stroke victims, or patients who need therapy after nerve damage. The procedure is specifically useful in restoring motion to the hand after surgical repairs to the extensor muscle and tendons. Mirror therapy rewires the brain by making the restored limb remember hand motions by observing the motions of a normal hand. The concept of a mirror image is that the movement of the uninjured arm forms the illusion of the same movement in the affected arm. Efforts to repeat hand movements elicit the same reaction in the affected hand in what is referred to as Hebbian learning. This case study evaluated MT’s effectiveness in motion restoration after a glass injury. This case study showed restoration of normal hand motions in a patient following surgery to repair a glass cut to the arm. Surgery repaired the lacerated extensor tendon and radial nerve. The muscle belly was repaired, and a graft fixed the nerve gap. Once the arm healed, the patient underwent rehabilitation in mirror therapy to restore normal function in his hand. After conducting mirror therapy, the pain was eliminated, and the patient restored normal function of moving the hand and finger extension. In addition, the therapy could be conducted at home without needing a professional. The effectiveness of mirror therapy was seen in the functional restoration of hand and finger movement. The process is also less complicated as it can be performed at home.

Effects of transforming growth factor β2 and connective tissue growth factor on induction of epithelial mesenchymal transition and extracellular matrix synthesis in human lens epithelial cells

AIM:To Investigate the effects of transforming growth factorβ2(TGF-β2)and connective tissue growth factor(CTGF)on transdifferentiation of human lens epithelial cells(HLECs)cultured in vitro and synthesis of extracellular matrix(ECM).METHODS:HLECs were treated with TGF-β2(0,0.5,1.0,5,10μg/L)and CTGF(0,15,30,60,100μg/L)for different times(0,24,48,72h)in vitro and the expression ofα-smooth muscle actin(α-SMA),the main component of the extracellular matrix typeⅠcollagen(Col-1)and fibronectin(Fn)were measured by using real-time polymerase chain reaction(PCR)and western-blot.RESULTS:TGF-β2 and CTGF significantly increased expression ofα-SMA mRNA and protein(P【0.05,P【0.001),Fn mRNA and protein(P【0.001),Col-1 mRNA and protein(P【0.001).TGF-β2 could induce HLECs expression of CTGF mRNA and protein in dosedependent manner(P【0.05,P【0.001).TGF-β2 and CTGF could induce HLECs to expressα-SMA,Fn and Col-1 in time-dependent manner.Each time of TGF-β2and CTGF induced HELCs expression ofα-SMA,Fn,Col-1 mRNA and protein was significant increase compared with control(P【0.05,P【0.001).CONCLUSION:TGF-β2 and CTGF could induce HLECs epithelial mesenchymal transition and ECM synthesis.

Reliability Study on Quantitative Detection of Extensor Digi- torum Brevis Strength with Needle Electromyography and Nerve Conduction

Objective To study the objectivity and reliability of needle electromyography and nerve conduction for detection of musculus extensor digitorum brevis strength, which may provide a basis for establishing a quantitative detection of muscle strength in forensic clinical study. Methods Forty-four healthy people were enrolled as the subjects, and during toe dorsiflexion, the following items including needle electromyography indexes, motor unit potential(MUP) amplitude, MUP count, recruitment reaction type, and nerve conduction detection indexes, compound muscle action potential(CMAP) amplitude, CMAP latent period and motor nerve conduction velocity(MNCV), were simultaneously detected under the cooperation and disguise condition. Results Under the cooperation condition, regardless of the same operator or different operators, there were good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, while there were normal test-retest reliabilities in MUP count and recruitment reaction type and the repeatability of the same operator was slightly better than the repeatability between different operators. Under the disguise condition, test-retest reliabilities of MUP amplitude, CMAP amplitude, CMAP latent period and MNCV were relatively high, while test-retest reliabilities of MUP count and recruitment reaction type were relatively low. Conclusion There are good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, which can be conducive to comparison between different operators and results at various times; MUP count and recruitment reaction type, which can be easily affected by subjectivity of operators and examinees, can be used to differentiate whether an examinee disguises or not. The indexes used to objectively judge muscle strength remain to be further investigated.

The characteristics and correlative research of“Jin Shang”associated with chronic neck pain in young adults based on ultrasound imaging

Objective:To investigate the characteristics of'Jin Shang',a specialized term in traditional Chinese medicine(TCM)theory,in young adults with chronic neck pain(CNP)and investigated the correlation of'Jin Shang'with pain intensity and living disabilities using cross-section study.Methods:The thickness of the bilateral splenius capitis and semispinalis capitis were measured by ultrasound imaging(USI)as the objective performance of'Jin Shang'.The visual analogue scale(VAS)and Northwick Park Questionnaire(NPQ)were used to assess pain intensity and living disability.The Student's t test was used to investigate the difference in neck extensor muscle(NEM)thickness between CNP patients and healthy controls.Pearson's correlation and multiple linear regression were applied to investigate the relationship between NEM thickness,pain intensity and disability.Results:Fifty-nine young adult CNP patients and 16 healthy controls were recruited in this study,in accordance with specific inclusion and exclusion criteria.The student's t test showed that in CNP patients,the thickness of the semispinalis capitis during isometric contraction was significantly thinner than that of healthy controls(P=.04).Pearson's correlation analysis also revealed significant relationships between NEM thickness,VAS,and NPQ,while multiple linear regression showed that the thickness of the NEM in CNP patients was a significant predictor of pain intensity and disability.Conclusion:There was a significant difference in the thickness of the NEM in young adults with CNP when compared to healthy controls.Alterations in the NEM thickness in both rest and contraction are moderately related to neck pain and living disabilities.Our results investigated the characteristics of'Jin Shang'using USI and revealed a correlation between'Jin Shang'and CNP symptoms,which demonstrates that NEM plays an important role in CNP.

Double Arthrodesis, Postero-Medial Release and Posterior Tibial Transfer in One Step in Paralytic Inveterate Equine Varus Foot

Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory results. To our knowledge, no study has been performed on the simultaneous association of double arthrodesis, posteromedial release, and posterior tibial transfer in a single operation in inveterate paralytic varus equines feet. The purpose of this work was to evaluate the results obtained. Patients and Method: This was a retrospective descriptive study from January 01, 2018 to December 31, 2021. It concerned inveterate paralytic varus equines feet operated on by the simultaneous association in a single operative time of double arthrodesis of the foot, posteromedial release of the back foot and transfer of the posterior tibial muscle to the lateral cuneiform. We identified seven patients with a mean age of 22.1 years with extremes of 11 years and 36 years. There were three males and four females. The cause of the deformity was neurological in all cases. All patients had painful walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of 4 and 25 years. The chronology of the interventional steps was posteromedial release, arthrodesis, and transfer of the posterior tibial muscle to the lateral cuneiform. The average postoperative follow-up was 21.7 months with extremes of 6 and 48 months. The parameters studied were the duration of the procedure, complications related to the procedure, muscle strength at the last recoil, consolidation of the arthrodesis, residual pain, patient activity, gait perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion of the transferred tendon, and the possibility of walking on the heel. Final results were graded according to the Angus and Cowell criteria. Results: No intraoperative complications were noted. An early superficial infection of the surgical site was noted. It was treated with local care and healed without sequel. Residual pain was present in one case. Tibiotalar osteoarthritis was observed in one case, which required a tibiotalar arthrodesis. At the last follow-up, consolidation of the arthrodesis was effective in all patients. The posterior tibial muscle was side 5 (n = 4) and 4 (n = 3). The patients’ activity was normal without assistance in all cases. The walking perimeter was greater than 1 km in six patients. Patient activity was normal without assistance in all cases. Stepping was absent in all patients. No difficulty with footwear was noted. According to the Angus and Cowell criteria, the result was good (n = 6), i.e. 85.7% and bad (n = 1), i.e. 14.3% of cases. Conclusion: This study suggests that double arthrodesis associated with posteromedial release and transfer of the posterior tibial in one step in inveterate paralytic varus equines feet, gives satisfactory results. It allows for easy shoeing and plantigrade walking without stepping. Complications are essentially represented by the absence of fusion of the arthrodesis and tibiotalar arthrosis.

基于颈后伸肌肌容积及颈椎矢状位参数评价浮针治疗颈型颈椎病的临床疗效

目的基于颈后伸肌肌容积及颈椎矢状位参数评价浮针治疗颈型颈椎病的效果及其与疗效的相关性。方法回顾性选择2023年1—8月收治的50例颈型颈椎病患者。所有患者均采用浮针治疗,治疗前后行颈椎核磁共振成像(MRI)和侧位X线检查。采用影像归档和通信系统(PACS)在颈椎侧位片上测量颈椎矢状位参数序列。采用Image J软件测量MRI轴向图像上C 3~7上终板的浅伸肌面积(SEA)和深伸肌面积(DEA)。测量并分析DEA与相应的颈椎体面积(CBA)之比。比较治疗前后颈椎矢状位参数及颈后伸肌肌容积的差异。采用Pearson相关分析颈后伸肌肌容积与颈椎矢状位参数和颈椎功能(JOA)评分及疗效的关系。结果相比治疗前,治疗后的颈椎矢状位参数的变化差异显著,C 2~7 SVA和C 7 S明显减小,而C 0~2 Cobb角和C 2~7 Cobb角均明显增大。相比治疗前,治疗后患者DEA/CBA比值明显增加,其中,差异最为显著的指标为C 3、C 4、C 5;C 3水平DEA/CBA比值与C 2~7 SVA(r=-0.380)和C 7 S呈弱负相关(r=-0.322),且C 4水平DEA/CBA比值与C 2~7 SVA、C 7 S呈中度负相关(r=-0.489,r=-0.477)。SEA/CBA比值与颈椎矢状位参数呈无或极弱相关。颈后伸肌肌容积及颈椎矢状位参数与JOA评分、疗效均呈正的强或中相关性关系(P<0.05)。结论浮针治疗颈型颈椎病的效果显著,颈后伸肌肌容积及颈椎矢状位参数与JOA评分、疗效均呈正的强或中相关性关系。

针刀对颈椎病兔颈后深肌硬度和纤维化的影响

目的:观察针刀干预对颈椎病兔颈后深肌群硬度和纤维化的影响。方法:健康新西兰大白兔15只(雄性)随机分为空白组、模型组和针刀组,每组5只。采用改良的长期头低位法制作兔颈椎病模型,造模周期持续8周。建模成功后,针刀组每周接受一次针刀干预治疗,共4次。治疗结束1周后,进行兔颈椎MRI成像、颈后深肌超声检查、HE和Masson染色观察颈后深肌的形态学改变。结果:普通超声显示:模型组颈后深肌的横截面积与纵向肌肉厚度均较空白组缩小(P<0.05),而针刀组则较模型组增大(P<0.01)。弹性超声可见:空白组颈后深肌肌肉轮廓相对清晰,弹性成像多呈绿色,同时伴有少量红色的低弹性图像;模型组肌肉轮廓模糊,弹性图像以蓝色为主,弹性较高;针刀组颈后深部肌肉轮廓趋于正常,弹性成像显示为中弹性图像,以蓝、绿色为主。Masson染色观察:与空白组相比,模型组颈后深肌撕裂明显,形态不规则,伴大量蓝色胶原充斥在肌细胞内,纤维间隙增大;针刀组可有效改善上述表现,且显著降低胶原容积分数(P<0.05)。另外,与空白组相比,模型组HE染色的细胞形态较混乱,胞质染色不均,细胞核增多,排列不规则,可见部分炎性细胞的浸润,伴大量肌纤维的撕裂等;而针刀组较模型组的形态学明显好转。结论:针刀干预可有效改善颈椎病兔颈后深层肌肉的组织硬度,促进慢性损伤纤维化的修复,这可能是针刀治疗颈椎病的关键所在。

重复外周磁刺激作用于上肢不同位置对亚急性期脑卒中患者腕关节运动功能的影响:一项随机对照试验

背景腕关节运动功能障碍是脑卒中后常见遗留症,而腕关节在提高手部实用性方面具有重要作用。因此,提高患者的腕关节运动能力可以有效地促进其日常生活参与度,尽管重复外周磁刺激(rPMS)已被证明对改善该问题具有显著效果,但针对不同位点的治疗效果仍需深入探究。目的探索rPMS分别作用于伸腕肌、桡神经时对亚急性期脑卒中患者腕关节运动功能的影响。方法选取2022年10月—2023年10月在福建中医药大学附属康复医院住院治疗且存在腕关节运动功能障碍的亚急性期脑卒中患者60例作为研究对象。采用随机数字表法将患者分为对照组(20例)、肌肉刺激组(20例)和神经刺激组(20例),对照组接受常规的康复训练,肌肉刺激组和神经刺激组分别在对照组的治疗方案上增加rPMS,且分别作用于伸腕肌和桡神经上,于干预前、后(10次治疗)分别采集伸腕肌表面肌电的积分肌电值(iEMG)、均方根植(RMS)和中位频率(MF),Fugl-Meyer评定量表上肢部分(FMA-UE)、手臂动作调查测试(ARAT)、改良Barthel指数(MBI)进行患侧上肢功能评估。结果干预期间由于主动要求退出试验、被迫终止试验等原因导致数据丢失2例,最终纳入对照组20例、肌肉刺激组19例、神经刺激组19例。治疗前三组患者伸腕肌表面肌电的iEMG、RMS、MF比较,差异无统计学意义(P>0.05)。治疗后肌肉刺激组、神经刺激组患者伸腕肌表面肌电的iEMG、RMS、MF高于对照组(P<0.05);神经刺激组患者伸腕肌表面肌电的iEMG、RMS、MF高于肌肉刺激组(P<0.05)。三组患者治疗后伸腕肌表面肌电的iEMG、RMS、MF均高于组内治疗前(P<0.05)。治疗前三组患者FMA-UE、ARAT、MBI评分比较,差异无统计学意义(P>0.05);治疗后肌肉刺激组、神经刺激组患者FMA-UE、ARAT、MBI评分高于对照组(P<0.05);神经刺激组患者FMA-UE、ARAT、MBI评分高于肌肉刺激组(P<0.05)。三组患者治疗后FMA-UE、ARAT、MBI评分均高于组内治疗前(P<0.05)。结论rPMS分别作用于伸腕肌、桡神经,对脑卒中后腕关节运动功能障碍均有改善,且作用于桡神经较伸腕肌疗效更显著。

灯盏花素穴位注射联合针灸对腰椎间盘突出症患者腰背伸肌群表面肌电指标及血清MMP3、PGE_(2)、IL-1β表达的作用

目的探讨灯盏花素穴位注射联合针灸对腰椎间盘突出症(Lumbar disc herniation,LDH)患者腰背伸肌群表面肌电指标及血清基质金属蛋白酶3(Matrix metalloproteinase 3,MMP3)、前列腺素E2(Prostaglandin E_(2),PGE_(2))、白细胞介素-1β(Interleukin-1β,IL-1β)表达的作用。方法应用前瞻性随机对照研究方法选取2020年3月—2022年5月收治的LDH患者186例,以随机数字表法分为观察组(62例)、对照A组(62例)、对照B组(62例)。对照A组予以灯盏花素穴位注射,对照B组予以针灸,观察组予以灯盏花素穴位注射联合针灸,均治疗1个月。比较3组疗效、不良反应与治疗前、治疗1个月后疼痛程度评分(Visual Analogue Scale/Score,VAS)、日本骨科协会下腰痛功能评价表评分(Japanese Orthopaedic Association Scores,JOA)、日常生活能力评分(Barthel,BI)、腰背伸肌群表面肌电指标(积分肌电值、平均功率频率)、血液流变学指标、血清免疫功能指标[免疫球蛋白G(Immunoglobulin G,IgG)、免疫球蛋白M(Immunoglobulin M,IgM)、补体C_(3)]、MMP3、PGE_(2)、IL-1β水平。结果观察组治疗1个月后总有效率93.55%(58/62)高于对照A组7742%(48/62)、对照B组80.65%(50/62)(P<0.05);3组治疗1个月后VAS评分较治疗前降低,且观察组低于对照A组、对照B组,JOA、BI评分与积分肌电值、平均功率频率较治疗前增高,且观察组高于对照A组、对照B组(P<0.05);3组治疗1个月后全血低切黏度、全血高切黏度、血浆黏度、红细胞压积、红细胞聚集指数较治疗前降低,且观察组低于对照A组、对照B组(P<0.05);3组治疗1个月后血清IgG、IgM、补体C_(3)、MMP3、PGE_(2)、IL-1β水平较治疗前降低,且观察组低于对照A组、对照B组(P<0.05);3组治疗期间不良反应发生率相比,差异无统计学意义(P>0.05)。结论应用灯盏花素穴位注射联合针灸治疗LDH可缓解疼痛程度与腰背伸肌群疲劳程度,提升腰背伸肌群肌肉收缩性,改善腰椎功能及日常生活能力,改善血液流变学、免疫功能,下调血清MMP3、PGE_(2)、IL-1β表达,疗效显著,且安全性好。

补阳还五汤联合解痉平衡针刺法治疗脑卒中后偏瘫疗效观察及对血清HDAC3水平的影响

目的:观察补阳还五汤联合解痉平衡针刺法治疗脑卒中后偏瘫的临床疗效及对血清组蛋白去乙酰化酶3(HDAC3)水平的影响。方法:将120例脑卒中后偏瘫患者随机分为对照组和治疗组各60例。对照组给予常规西医疗法治疗,治疗组在对照组基础上联合补阳还五汤治疗。观察2组临床疗效、躯干屈伸肌群肌力、步态及血清HDAC3水平变化。结果:治疗组总有效率为86.67%,对照组为68.33%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组健侧腹直肌力、竖脊肌的肌力表面肌电均方根(RMS)值与治疗前变化不大(P>0.05);2组患侧腹直肌、竖脊肌的肌力RMS值均较治疗前升高(P<0.05),且治疗组患侧腹直肌、竖脊肌的肌力RMS值均高于对照组(P<0.05)。治疗后,2组步频、步速、跨步长比例均较治疗前增加(P<0.05),且治疗组上述3项指标值均高于对照组(P<0.05)。治疗后,2组血清HDAC3水平均较治疗前降低(P<0.05),且治疗组HDAC3水平低于对照组(P<0.05)。结论:补阳还五汤联合解痉平衡针刺法治疗脑卒中后偏瘫效果较好,能够明显改善躯干屈伸肌群肌力及步态,降低血清HDAC3水平。

经会阴盆底超声不同状态下肛提肌裂孔前后径对压力性尿失禁女性盆底病变的诊断价值

目的分析经会阴盆底超声不同状态下肛提肌裂孔前后径(LHap)对压力性尿失禁女性盆底病变的诊断价值。方法选取2020年8月至2022年4月赣州市人民医院收治的105例压力性尿失禁患者作为患者组,另选取本院同期100名健康体检女性作为健康组,均行经会阴盆底三维(3D)超声、四维(4D)超声检查,比较两组不同状态下LHap,不同状态下LHap对压力性尿失禁女性盆底病变的诊断效能。结果静息状态、最大Valsalva状态下3D、最大Valsalva状态下4D模式,患者组LHap均长于健康组,差异有统计学意义(P<0.05);两组最大Valsalva下3D、4D模式LHap均长于静息状态,差异有统计学意义(P<0.05)。静息状态、最大Valsalva状态下3D、最大Valsalva状态下4D模式LHap诊断诊断压力性尿失禁的截断值分别为2.69、3.95、3.90 cm;不同状态下LHap诊断压力性尿失禁女性盆底病变的AUC、灵敏度比较差异有统计学意义(P<0.05),特异度比较差异无统计学意义;最大Valsalva 状态下3D模式与最大Valsalva 状态下4D模式LHap 诊断压力性尿失禁女性盆底病变的AUC均大于静息状态,灵敏度均高于静息状态,差异有统计学意义(P<0.05),但二者比较差异无统计学意义;最大Valsalva 下4D模式LHap诊断压力性尿失禁女性盆底病变的特异度高于静息状态,差异有统计学意义(P<0.05),最大Valsalva状态下3D模式与最大Valsalva 状态下4D模式、静息状态与最大Valsalva 状态下3D模式LHap诊断压力性尿失禁女性盆底病变的特异度比较差异无统计学意义。结论经会阴盆底3D超声、4D超声模式下LHap水平对压力性尿失禁女性盆底病变的诊断效能相似,临床可结合医院实际情况、医师诊断技能等进行综合选择。

不同入路减压内固定术对胸腰椎爆裂骨折患者椎管占位率及神经功能的影响

目的:比较不同入路减压内固定术中对胸腰椎爆裂骨折患者椎管占位率及神经功能的影响。方法:选取厦门市中医院2019年1月—2023年1月收治的80例胸腰椎爆裂骨折患者作为研究对象,根据手术入路不同分为后正中组和椎旁肌组,每组40例。后正中组实施后正中入路减压内固定术,椎旁肌组实施经椎旁肌间隙入路减压内固定术。比较两组手术指标、椎体压缩率、后凸Cobb角、日常生活活动量表(ADL)评分、视觉模拟评分法(VAS)评分、椎管占位率、脊髓神经功能分级。结果:椎旁肌组手术时间较后正中组短,术中失血量较后正中组少(P<0.05)。两组住院时间及术后椎体压缩率、后凸Cobb角、椎管占位率、脊髓神经功能分级比较,差异均无统计学意义(P>0.05)。椎旁肌组术后ADL评分较后正中组高,VAS评分较后正中组低(P<0.05)。结论:后正中入路、经椎旁肌间隙入路减压内固定术均可有效恢复胸腰椎爆裂骨折患者椎体高度,降低后凸Cobb角、椎管占位率,改善脊髓神经功能,但经椎旁肌间隙入路具有耗时短、术中出血少、术后疼痛感轻的优点。

通督扶阳推拿联合核心肌群训练对腰椎间盘突出症的临床效果

目的研究通督扶阳推拿联合核心肌群训练对腰椎间盘突出症(LDH)的临床效果。方法根据随机数字表法将2020年8月至2022年9月中国人民解放军联勤保障部队第九一〇医院接收的腰椎间盘突出病人(150例)分为对照组(75例,常规基础治疗)和联合组(75例,常规基础治疗+通督扶阳推拿和核心肌群训练)。对两组治疗前后生活功能障碍、疼痛程度以及腰背伸肌群力学性能进行比较。结果联合组的总有效率(94.67%比80.00%)高于对照组(P<0.05)。治疗后,联合组病人日本整形外科学会(JOA)评分[(22.98±3.77)分比(18.98±3.56)分]、平均功率[(44.03±11.09)W比(38.98±10.79)W]、腰背伸状态下峰力矩[(88.65±15.42)Nm比(79.99±15.66)Nm]明显高于对照组,VAS评分[(1.78±0.56)分比(2.39±0.67)分]、腰背屈伸比[(69.53±9.15)%比(74.42±9.52)%]明显低于对照组(P<0.05)。结论通督扶阳推拿与核心肌群训练联合治疗LDH病人的效果较好,可减轻病人疼痛,改善病人腰背伸肌群力学性能,减少其生活功能障碍。

内直肌截除联合外直肌后徙术治疗集合不足型间歇性外斜视效果观察

目的:观察单眼内直肌截除术联合外直肌后徙术治疗集合不足型间歇性外斜视(Convergenceinsuficency-type intermittent exotropia,CI-IXT)矫治效果。方法:回顾性分析2018年1月-2021年1月笔者医院收治的104例CI-IXT患者的临床资料,根据手术方式不同分为对照组(n=52)和观察组(n=52),对照组采用双眼外直肌后徙术治疗,观察组采用单眼内直肌截除联合外直肌后徙术治疗,比较两组患者术后6个月眼位矫正效果,并统计手术前后视远度、视近度、平均斜视度及视功能、融合功能、并发症发生率和复发率。结果:观察组术后1周、术后3个月的正位率均高于对照组,过矫率低于对照组(P<0.05),两组欠矫率比较,差异无统计学意义(P>0.05)。且两组术后6个月的正位率、过矫率及欠矫率比较,差异无统计学意义(P>0.05)。术后6个月,两组视远度、视近度及平均斜视度均降低,且观察组视远度、视近度及平均斜视度均显著低于对照组(P<0.05)。术后6个月,两组无、Ⅰ级视功能阳性率均降低,Ⅲ级视功能阳性率均升高(P<0.05),但Ⅱ级视功能阳性率与术前比较,差异无统计学意义(P>0.05),且术后6个月两组无、Ⅰ级、Ⅱ级、Ⅲ级视功能阳性率比较,差异无统计学意义(P>0.05)。术后6个月,两组融合范围、集合性融合、离散性融合均升高(P<0.05),但两组比较,差异无统计学意义(P>0.05)。两组观察组并发症发生率比较,差异无统计学意义(P>0.05)。观察组复发率低于对照组(1.92%vs13.46%)(P<0.05)。结论:内直肌截除联合外直肌后徙术治疗CI-IXT矫治效果较好,且复发率较低,值得临床推广应用。

颈前路椎间盘切除减压植骨融合术后患者颈长肌和颈伸肌的影像观察

目的观察脊髓型颈椎病患者接受颈前路椎间盘切除减压植骨融合术(anterior cervical discectomy and fusion,ACDF)术后的颈长肌和颈伸肌变化情况,并分析颈长肌和颈伸肌的术后变化与ACDF手术疗效的相关性。方法以该科2016年6月~2021年6月开展单节段ACDF手术的62例脊髓型颈椎病患者作为研究对象,分别于术前、术后3个月、术后1年和末次随访时,进行VAS评分、mJOA评分和NDI指数等疗效指标评价;同时,采用颈椎MRI T2加权像检查并测量其颈长肌和颈伸肌的横截面积(cross section area,CSA),颈长肌的最长径/最短径比值(ratio of long and short lines,RLS)以及颈长肌和颈伸肌的容积。采用Pearson相关性系数对颈长肌和颈伸肌容积与上述疗效指标进行相关性分析。结果62例患者均成功完成单节段ACDF手术且获访24~30个月、平均25.9个月。与术前相比,患者术后3个月、1年和末次随访时的颈肩痛VAS评分、mJOA评分和NDI指数均显著改善(P<0.05)。末次随访时采用Odom标准评价,优38例,良22例,可2例。与术前相比,所有患者术后3个月、1年和末次随访时的颈长肌CSA和颈长肌容积均显著减少(P<0.05),术后3个月、1年和末次随访时的颈长肌RLS均显著增加(P<0.05);颈伸肌CSA和颈伸肌容积在手术前和术后各时间的变化无显著性差异(P>0.05)。经Pearson相关性分析显示,术后3个月、术后1年和末次随访的颈长肌容积与同时期的VAS评分和NDI指数均呈负相关性(P<0.05),与mJOA评分无明确相关性(P>0.05);而颈伸肌容积与同时期的VAS评分、NDI指数和mJOA评分均无明确的相关性(P>0.05)。结论脊髓型颈椎病患者行ACDF手术后,颈长肌可出现一定程度退变,颈伸肌的退变并不显著。颈长肌的退变可对手术预后产生不利影响。

腰痹通胶囊联合浮针对腰椎间盘突出症患者腰椎活动度及腰背肌表面肌电信号的影响

【目的】探讨腰痹通胶囊联合浮针针刺治疗对腰椎间盘突出症(LDH)患者腰椎活动度及腰背肌表面肌电信号的影响。【方法】将80例LDH血瘀证患者随机分为研究组和对照组,每组各40例。对照组给予服用腰痹通胶囊治疗,研究组在对照组基础上给予浮针针刺治疗,疗程为2周。观察2组患者治疗前后腰椎活动度、疼痛程度视觉模拟量表(VAS)评分、改进汉化的Oswestry功能障碍指数(ODI)评分、Roland-Morris腰椎功能障碍问卷(RMDQ)评分及腰背肌表面肌电信号的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面,治疗2周后,研究组的总有效率为97.50%(39/40),对照组为80.00%(32/40),组间比较(χ^(2)检验),研究组的临床疗效明显优于对照组(P<0.05)。(2)腰椎活动度方面,治疗后,2组患者的腰椎屈伸、旋转活动度均较治疗前明显改善(P<0.05),且研究组对腰椎屈伸、旋转活动度的改善幅度均明显优于对照组(P<0.05或P<0.01)。(3)腰椎功能评分方面,治疗后,2组患者的ODI评分和RMDQ评分均较治疗前明显下降(P<0.05),且研究组对ODI评分和RMDQ评分的下降幅度均明显优于对照组(P<0.01)。(4)疼痛程度评分方面,研究组治疗1周、2周和1个月后及对照组治疗2周和1个月后的疼痛程度VAS评分均较治疗前明显下降(P<0.05),且研究组在治疗1周、2周和1个月后对疼痛程度VAS评分的下降幅度均明显优于对照组(P<0.01)。(5)腰背肌表面肌电参数方面,治疗后,2组患者的腰背肌表面肌电信号积分肌电值(IEMG)和平均功率频率(MPF)均较治疗前明显升高(P<0.05),且研究组对腰背肌表面肌电信号MPF和IEMG的升高幅度均明显优于对照组(P<0.01)。【结论】腰痹通胶囊联合浮针针刺治疗可显著提升LDH患者的疗效,改善患者腰椎活动度,提高腰背肌群表面肌电信号,缓解肌肉疲劳和疼痛症状。

双侧竖脊肌平面阻滞在腰椎后入路手术后的镇痛效果观察

目的:分析双侧竖脊肌平面阻滞用在腰椎后入路手术后的镇痛效果。方法:选取萍乡市中医院2021年7月—2023年7月萍乡市中医院入院诊断为腰椎退行性疾病或腰椎骨折患者,需要手术治疗60例作为研究对象。按随机数字表法分为观察组和对照组,各30例。对照组选择静吸复合全身麻醉,观察组选择超声引导下双侧竖脊肌平面阻滞+静吸复合全身麻醉,两组术后都安装静脉自控镇痛泵。对比两组术中术后阿片类药物和术中肌松药物的使用量,根据视觉模拟评分法(visual analogue scale,VAS)对比两组患者术后6、12、24、48 h随访中疼痛的分数,记录术后患者自控按压镇痛泵补救性镇痛给药次数及不良反应。结果:观察组术中术后使用的舒芬太尼、术中瑞芬太尼、术中阿曲库铵药物用量均少于对照组(P<0.05)。观察组各时间段术后VAS评分均比对照组低(P<0.05)。术后补救性镇痛给药次数少于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下双侧竖脊肌平面阻滞在腰椎后入路手术患者中的镇痛效果更好,既减少了阿片类药物、肌松药物的使用,又减轻了患者术后的疼痛,患者术后静脉补救性镇痛给药次数和不良反应减少,临床应用安全可靠。