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正中神经内血管瘤一例
患者女,46岁.左手掌侧肿块1年余,近期逐渐增大伴胀痛、轻微麻木就诊.无相关部位损伤史.体检:左手掌桡侧近掌指关节掌侧面皮肤隆起,皮肤表面颜色正常,无破溃,其下触及条索状肿块,有压痛,肿块欠活动,质地中等,手指功能无明显受限.术前B超检查无明显阳性发现.以手部肿块,可疑脂肪瘤行肿块切除术.术中见肿块位置较深,沿正中神经生长,呈长条状,表面光滑,与神经尚可分离,质地中等,予以完全切除.术后胀痛及麻木症状消失,随访6个月,无复发.
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The distance between the two electrode tips can greatly inlfuence the parameters used for record-ing compound nerve action potentials. To investigate the optimal parameters for these recordings in the rat median nerve, we dissociated the nerve using different methods and compound nerve action potentials were orthodromically or antidromically recorded with different electrode spac-ings. Compound nerve action potentials could be consistently recorded using a method in which the middle part of the median nerve was intact, with both ends dissociated from the surrounding fascia and a ground wire inserted into the muscle close to the intact part. When the distance be-tween two stimulating electrode tips was increased, the threshold and supramaximal stimulating intensity of compound nerve action potentials were gradually decreased, but the amplitude was not changed signiifcantly. When the distance between two recording electrode tips was increased, the amplitude was gradually increased, but the threshold and supramaximal stimulating intensity exhibited no signiifcant change. Different distances between recording and stimulating sites did not produce signiifcant effects on the aforementioned parameters. A distance of 5 mm between recording and stimulating electrodes and a distance of 10 mm between recording and stimulating sites were found to be optimal for compound nerve action potential recording in the rat median nerve. In addition, the orthodromic compound action potential, with a biphasic waveform that was more stable and displayed less interference (however also required a higher threshold and higher supramaximal stimulus), was found to be superior to the antidromic compound action potential.
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Although ultrasound measurements have been used in previous studies on carpal tunnel syn-drome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately relfects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 pa-tients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Signiifcant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-section-al areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% speciifcity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% speciifcity. These results suggest that the inlet-to-outlet ratio relfected the severity of carpal tunnel syndrome.
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正中神经脂肪纤维瘤的诊治体会
正中神经脂肪纤维瘤临床上并不多见.1996年6月~2003年1月,我院共诊治4例,均行手术治疗.术后平均随访4.5年,肿瘤缩小,未见增大.
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正中神经颗粒细胞瘤一例
患者女,8岁.以右前臂包块伴手指麻木1年入院.患儿在1年前无意中发现右前臂包块生长,碰触后桡侧手指有麻木感.临床检查:右前臂远端桡侧腕屈肌及掌长肌间隙可扪及一约3.5锄×1.0 cm大小之包块,质软,边界清,可滑动,轻压痛;叩诊时向示、中指远端放射,拇指对掌、外展及屈、伸活动正常,各指间关节活动正常,肌力正常.
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Variation of brachial artery,median nerve and axillary nerve of unilateral upper limb:a case report
The anatomical variation of the blood vessels and brachial plexus of the upper limb is very complicated.In general population,the brachial artery divides into the radial artery and ulnar artery in cubital fossa.The median nerve consists of lateral and medial roots,and the axillary nerve divides into anterior and posterior branches after passing through the quadrangular space.Although variations in the vascular or neural pattern of the upper limb in humans are fairly common,it is very rare to see complex neurovascular variations in one limb.The present study reports complicated variation of unilateral upper limb,which aims at emphasizing the rare formation of brachial plexus and vessel.
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肱骨髁上骨折合并神经损伤64例临床报告
本文报告小儿肱骨髁上骨折合并神经损伤64例,除4例手术探查外,60例均行手法复位小夹板外固定治疗.全组疗效优良者占98.4%.作者认为,只要闭合复位满意,不宜早期探查.
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正中神经合并肌皮神经变异1例
笔者在解剖一具男尸时发现其右侧正中神经和肌皮神经变异较大,现报道如下.右侧正中神经为双支型,第一支由臂丛内侧束和外侧束神经纤维组成,与腋动脉和肱动脉伴行于喙肱肌内侧,起始处横径为3.1 mm;第二支由臂丛外侧束发出,穿经喙肱肌,起始处横径为5.2 mid,在距起点12.7cm处与第一支汇合,汇合后的横径为6.8 min.
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肌皮神经与正中神经外内侧交通1例
笔者在<局部解剖学>教学过程中时发现一老年女性尸体左侧肌皮神经从外侧束发出后,沿肱二头肌内侧下行,先发出肱二头肌支和肱肌支至两肌,后斜向下内,加入正中神经干.此种变异少见,现报道如下:
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肌皮神经与正中神经共干1例
作者在解剖一具30岁左右成年男性标本,发现其右侧肌皮神经变异,现报道如下:肌皮神经与正中神经外侧根共干,穿出喙肱肌沿肱动脉外侧下行,神经干横径4 mm,并于背阔肌下缘2.9 cm处发出一横径1.8mm肌支,此肌支再分支分别进入肱二头肌和肱肌.其中肱二头肌支横径1 mm,肱肌支横径0.8 mm.