对侧外周神经移位到损伤手臂引起的体感皮层功能动态重组

单侧肢体的外周神经损伤通常导致对侧体感皮层的功能重组. 然而,接受了对侧颈 7 (C7) 外周神经移位手术治疗单侧手臂臂丛全撕脱的病人,在术后早期当其患手被触摸时,只在其健手产生感觉. 在术后晚期,病人才逐渐恢复其患手和健手的正常、独立的功能. 我们在模拟对侧颈 7 (C7) 外周神经移位手术病例的大鼠模型上,用记录体感诱发电位的方法研究了患手和健手的体感代表区. 患手的体感和运动功能由于 C7 神经的再生而逐渐恢复. 术后第 5 个月始, 13 只大鼠患手的体感代表区只出现在其同侧的皮层,同时患手和健手的代表区在该皮层内是高度重叠的 (除掉一个例外),虽然刺激它们产生的体感诱发电位的潜伏期和反应幅度有很大的不同. 结果表明,移位到患手的对侧外周神经能够导致同侧体感皮层动态的功能重组,提示身体另侧感觉输入的介入激发了大脑显著的可塑性.     

慢性不可预见性应激对大鼠恐惧条件反射和躯体感觉诱发电位的影响

目的:探讨慢性不可预见性应激对大鼠恐惧条件反射以及体感诱发电位的影响并分析可能的神经电生理机制。方法:26只雄性SD大鼠(190~200 g)随机分成两组(n=13):对照组和模型组。用慢性不可预见性应激刺激模型组大鼠,用恐惧条件反射实验检测两组大鼠的恐惧反应,用躯体感觉诱发电位检测大鼠脑电活动。结果:与对照组相比,模型组大鼠在恐惧记忆阶段不动时间百分比减小(56.64%±13.78%vs69.72%±18.10%,P<0.05),躯体感觉诱发电位的第二个正向波(P2)潜伏期也明显缩短(70.54±10.13 msvs78.46±7.80 ms,P<0.05)。相关性分析显示大鼠恐惧条件反射的不动时间与躯体感觉诱发电位潜伏期存在正相关(r=0.507,P<0.05)。结论:慢性不可预见性应激抑制大鼠恐惧反应,并缩短体表感觉诱发电位的潜伏期,恐惧反应行为与体感诱发电位潜伏期存在正相关,提示大鼠恐惧反应与体表感觉诱发电位可能有共同的神经递质机制。     

人体正中神经刺激的体感诱发电位观察

对30例正常成人,在 Erb 点、C_7处体表及大脑皮层相应体感区头皮(C_3或 C_4)记录正中神经刺激引起的体感诱发电位。测定了体感诱发电位各主要成分潜伏期,并计算出自腕部到 Erb 点之间正中神经外周传导速度(PCV)为70.80±2.60m/s。自 C_7到大脑皮层相应体感区之间中枢段(N_(18)-N_(13))传导时间(CCT)为5.90±0.65ms。左右两侧 PCV 和 CCT 均无显著差异(P>0.05),前者两侧之差的正常值上限为4.30m/s,后者为1.40ms。     

诱发电位评价脑组织血流量的实验研究

目的：观察实验性大鼠脑损伤后不同时相点大脑皮层体感诱发电位（sensorysomaticevoked potentials,ssep)和局部血流量（regional cerebral blood flow,rCBF)的变化。方法：用流体冲击装置制作中度脑损伤模型SYD4200型神经诱发电位诊断系统监测皮层体感诱发电位,氢清除测定大脑局部血流量。结果：中度脑损伤后rCBF明显低于伤前和正常对照组;大脑皮层体感诱发电位的潜伏期明显延长。结论：SEP的变化与脑血流量有着一定的关系,一定程度上SEP的变化可反映脑损伤后血流量的变化。     

不同BMI腕管综合征患者的神经电生理特点

目的分析不同体重指数(BMI)的腕管综合征(CTS)患者的神经电生理特点。方法选择2018年2～8月我院神经内科收治的CTS患者60例,分析其临床资料,根据患者BMI分为A组(BMI 24kg/m2组,20例)、B组(BMI 24～28kg/m2组,23例)及C组(BMI28kg/m2组,17例)。采用肌电诱发电位仪检测患者神经电生理情况。比较3组的第3指正中神经感觉传导速度与第4指正中神经与尺神经感觉神经传导潜伏期差值。结果 3组第3指正中神经感觉传导速度、第4指正中神经与尺神经感觉传导潜伏期差值比较,差异均有统计学意义(F=16.800、9.694,P0.01)。B、C组第3指正中神经感觉传导速度均低于A组,第4指正中神经与尺神经感觉神经潜伏期差值高于A组(P0.01、P0.05)。C组第3指正中神经感觉传导速度低于B组,第4指正中神经与尺神经感觉神经潜伏期差值高于B组(P0.05)。结论神经电生理检测是诊断CTS的理想手段;BMI与CTS的损害程度呈正相关,可以预测CTS患者的严重程度。     

电针对椎间盘脱出模型犬体感诱发电位的影响

目的研究电针对椎间盘脱出模型犬脊髓损伤的修复作用及其对体感诱发电位(somatosensory evoked potential,SEP)的影响。方法比格犬随机分为三组,模型组和电针组采用球囊压迫法制作椎间盘脱出模型,电针组术后每天电针治疗;对照组进行假手术处理。术前(0 d)和术后1、4、7、14 d每只犬均使用德克萨斯犬脊髓损伤Texas Spinal Cord Injury Scale for Dogs(TSCIS)评分法评分,使用肌电诱发电位仪测量SEP并分析其潜伏期和波幅。结果术后1 d模型组和电针组与对照组TSCIS评分相比均显著降低(P0.01),术后14 d,电针组与模型组相比差异有显著性(P0.01);术后4 d模型组和电针组的SEP潜伏期相比显著降低(P0.05),术后14 d,电针组与模型组的潜伏期相比差异有显著性(P0.05);术后1 d模型组和电针组的SEP波幅与对照组相比显著降低(P0.05),术后14 d,电针组与模型组的波幅相比差异有显著性(P0.05)。结论电针能够有效促进椎间盘脱出模型犬的脊髓损伤修复,提高TSCIS评分,恢复SEP波形,缩短其潜伏期,提升其波幅;SEP能够在一定程度上反应脊髓损伤程度,评价电针治疗效果。     

针刺外周神经对中枢神经的电生理变化

目的:探索电针外周神经是否促进中枢神经损伤修复,为电针促进神经再生修复研究提供一点基础性参考.方法:24只SD成年雌性大鼠随机分成3组,即正常组,脊髓T11全横断损伤21天组和脊髓T11全横断后电针治疗2l天组.电针穴位选取外周足三里、悬钟和伏兔、三阴交,两组穴位隔日交替进行电针.2l天后,应用临床体感诱发仪比较三者的皮层体感诱发电位(CSEP).结果:CSEP检测发现电针21天与损伤21天比较,P1潜伏期及P1-N1波幅无统计学差异(P＞0.05);但二者与正常组相比,除P1-N1波幅未见明显差异外(P＞0.05),P1潜伏期存在明显的统计学差异(P＜0.05).结论:电针促进神经损伤修复的关键是根据损伤类型选择相应的电针穴位,同时说明针刺外周神经不利于中枢神经损伤修复.     

肌电图检查评估腕管综合征手术效果的临床分析

目的:探讨采用肌电图检查评估腕管综合征的手术治疗效果。方法:选取35例(患侧手共39侧)临床确诊为腕管综合征并接受腕管切开减压术治疗的患者,于手术前后分别行肌电图检查,应用正中神经传导检查和拇短展肌针极肌电图检查,分析患者手术前和手术后腕部正中神经功能的变化情况。结果:手术后,患者正中神经感觉传导潜伏期异常率(33%)、正中神经运动传导潜伏期异常率(36%)较手术前(72%、74%)明显下降(P0.05),正中神经感觉传导波幅(7.40±5.05)较手术前(4.86±3.60)显著降低(P0.001),拇短展肌静息状态下失神经电位的异常率(69%)、重收缩时募集电位异常率(13%)均较手术前(85%、26%)明显下降(P0.05)。患者手术前后正中神经感觉传导速度和运动传导速度对比差异无统计学意义(P0.05)。结论:腕管切开减压术可解除正中神经卡压状态,明显恢复正中神经功能,增强拇短展肌肌力,临床治疗效果好。肌电图检查可为腕管综合征患者手术治疗效果的评估提供客观的依据。     

保留肋间臂神经的改良乳癌根治术24 例

目的：探讨乳腺癌改良根治术中保留肋间臂神经的临床价值。方法：在24例乳腺癌改良根治术中完整保留肋间臂神经16例,切除肋间臂神经8例。术后对24例患者上臂内侧感觉功能进行随访观察。结果：24例患者在随访第1、6、24个月期间局部均未发现癌肿复发、转移。保留肋间臂神经16例中术后患侧上臂内侧及腋部皮肤感觉正常14例（87．5％）,感觉异常2例（12．5％）;而切除肋间臂神经的8例病人均有感觉异常。结论：在乳腺癌改良根治术中保留肋间臂神经可明显减少术后患侧上臂内侧感觉障碍的发生率,有助于提高病人的生活质量。     

电针治疗轻中度腕管综合征患者的疗效及对电生理参数的影响

目的:探讨电针治疗轻度、中度腕管综合征(CTS)患者的临床疗效及对患者电生理参数的影响。方法:将2015年1月~2017年5月本院收治的86例轻度、中度CTS患者随机分为电针组(43例)和对照组(43例),给予对照组患者常规方案治疗,电针组患者在对照组常规治疗的基础上增加穴位电针进行治疗,治疗后比较两组的临床疗效,于治疗前、治疗后比较两组患者症状及功能评分、电生理参数及超声检查结果。结果:电针组的临床总有效率为97.67%,明显高于对照组的81.40%(P0.05)。治疗后电针组症状及功能评分分别为(15.28±2.35)分和(9.92±1.42)分,均明显低于对照组的(20.73±3.18)分和(14.28±2.26)分(P0.05);治疗后电针组正中神经末梢运动潜伏时(DML)低于对照组,拇指展肌肌肉复合动作电位(CMAP)波幅、拇指-腕正中神经感觉传导速度(SCV)、中指-腕SCV、拇指-腕正中神经感觉动作电位(SNAP)波幅、中指-腕SNAP波幅均高于对照组(P0.05)。治疗后电针组腕管正中神经近端肿胀≥10 mm~2的比例为27.91%,明显低于对照组的55.81%(P0.05)。结论:电针治疗轻中度CTS可进一步提高临床疗效,能够改善腕部症状和功能,同时明显改善患者的电生理参数。     

“Sensory Switching” in Elbow Reconstruction

In the treatment of the soft tissue defect of the elbow, flap reconstruction is necessitated in many cases because of thinness of soft tissue at this region. In addition, reacquirement of tactile sensation is desirable because of the anatomical and specific functions of the elbow. Of three cases treated for elbow defects, one was reconstructed with a pedicled island forearm flap containing the lateral cutaneous nerve of the forearm, another was reconstructed with a venoneuro-accompanying artery fasciocutaneous flap (VNAF flap) containing the basilic vein, and the third with the VNAF flap containing the cephalic vein. The three cases demonstrated a sudden change of sensory territory 4 to 6 months after surgery, which was confirmed by touching the reconstructed region with patients'' eye-closed: from its original territory to the elbow in a “switching”-like action. Here we describe and discuss the concept of “sensory switching.”     

大鼠初级感觉神经外周末梢间信息传递的观察

实验切断麻醉大鼠一侧Ｔ５－Ｌ１脊神经背部皮支的中枢端,用５０Ｈｚ,０．２ｍｓ,总时间为２ｓ的方波逆行刺激其中一皮支的外周端,记录其相邻皮支的电活动。结果发现刺激停止后２５ｓ内被记录皮支的放电迅速增加,继而逐渐恢复到刺激前的水平;４１４个序列实验结果的累积时程分析表明：被记录皮支的放电频率在刺激停止后的第２秒达最大值,并持续３ｓ,从第５秒开始逐渐下降,第２５秒及以后恢复到刺激前的水平;放电频率的增加     

呼吸道迷走神经感受器概述

肺以及气道与外界环境之间存在着巨大的界面,因此需要有效的防御反射机制。呼吸道感受器是肺部神经反射的起始点,其重要性不言而喻,采用组织,解剖与电生理学方法,经过一个世纪的研究,我们对于呼吸道感受器的认识,特别对其结构的认识,仍然有限,据电生理实验结果,肺部感受器至少可被分为三大类;慢适应感受器,快适应感受器以及C纤维感受器,按血供来源,后者又可分为气道（体循环）与肺（肺循环）两类,近来发现呼吸道中存在着第四类感受器,它们由迷走神经的Aδ传入纤维传递冲动,其放电活动不同于上述各类,对肺充气反应阈值高,故称之为高阈值Aδ感受器,功能上前两类基本属于机械性感受器,而后两类可归为化学敏感性感受器,另外,用组织学方法,观察到气道内有一些神经内分泌细胞,它们可以散在分布,亦可集聚成小体。这些神经上皮小体受多种神经支配,其结构复杂,形态酪似感受器,虽然我们对其形态了解颇深,但对其放电形式一无所知,本文对以上各类感受器进行了评述与探讨。     

Organization of the sensory system of the earthworm Lumbricus terrestris (Annelida,Clitellata) visualized by DiI

The anatomical organization of the peripheral and central sensory structures of the earthworm Lumbricus terrestris was investigated applying a fluorescent carbocyanine dye (DiI) as a neuronal tracer. Using whole‐mount preparations and confocal laser scanning microscopy, the pattern of primary sensory cells and pathways of their processes were traced and reconstructed in three‐dimensions. Our study shows that a ventral nerve cord ganglion receives sensory fibers from at least two adjacent segments suggesting that the peripheral nervous system is not segmental in its arrangement and the receptive‐fields of the body wall overlap in earthworms. Furthermore, our result suggests an integrative function of the basiepidermal plexus consists of sensory and motor fibers. J. Morphol., 2012. © 2012 Wiley Periodicals, Inc.     

Time Course and Characteristics of the Capacity of Sensory Nerves to Reinnervate Skin Territories outside Their Normal Innervation Zones

Factors involved in the outcome of regeneration of the saphenous nerve after a cut or crush lesion were studied in adult rats with electrophysiological recordings of low-threshold mechanoreceptor activity and plasma extravasation of Evans blue after electrical nerve stimulation that activated C fibers.

In the first series of experiments, saphenous and sciatic nerve section was combined with anastomosis of the transected proximal end of the saphenous nerve to the distal end of the cut tibial nerve. Regeneration of saphenous nerve fibers involved in plasma extravasation and low-threshold mechanoreceptor activity in the glabrous skin was observed 13 weeks after nerve anastomosis. Substance P-, calcitonin gene-related peptide-, and protein gene product 9.5 (PGP-9.5)-immunoreactive (IR) thin epidermal and dermal nerve endings, as well as coarse dermal PGP-9.5-IR nerve fibers and Meissner corpuscles and Merkel cell-neurite-like complexes, were observed in the reinnervated glabrous skin at this time.

In a second series of experiments, the time course of the regeneration of saphenous nerve axons to the permanently sciatic-nerve-denervated foot sole was examined. Saphenous-nerve-induced plasma extravasation and low-threshold mechanoreceptor activity in the saphenous nerve were found in the normal saphenous nerve territory 2, 3, 4, and 6 weeks after sciatic nerve cut combined with saphenous nerve crush in the left hindlimb. Saphenous-nerve-induced plasma extravasation was also present in the glabrous skin normally innervated by the sciatic nerve 3, 4, and 6 weeks after the sciatic cut/saphenous crush lesion. However, no low-threshold mechanoreceptor activity was detected in the saphenous nerve when the glabrous skin area was stimulated.

In a third series of experiments, the fate of the expansion of the saphenous nerve territory after saphenous nerve crush was examined when the crushed sciatic nerve had been allowed to regenerate. Nerve fibers involved in plasma extravasation were observed in the glabrous skin of the hindpaw after saphenous nerve, as well as after tibial nerve, C-fiber stimulation 3, 12, and 43 weeks after the saphenous crush/sciatic crush lesion.

Low-threshold mechanoreceptors from the regenerated saphenous nerve, which primarily innervates hairy skin, seem to be functional in the glabrous skin if the axons are guided by the transected tibial nerve by anastomosis. Furthermore, the results indicate that fibers from the regenerating saphenous nerve that have extended into denervated glabrous skin areas can exist even if sciatic nerve axons are allowed to grow back to their original territory.     

Strategies to repair lost sensory connections to the spinal cord

Failure of injured axons to regenerate in the central nervous system (CNS) is the main obstacle for repair of stroke and traumatic injuries to the spinal cord and sensory roots. This regeneration failure is high-lighted at the dorsal root transitional zone (DRTZ), the boundary between the peripheral (PNS) and central nervous system where sensory axons enter the spinal cord. Injured sensory axons regenerate in the PNS compartment of the dorsal root but are halted as soon as they reach the DRTZ. The failure of regenerating dorsal root axons to re-enter the mature spinal cord is a reflection of the generally nonpermissive nature of the CNS environment, in contrast to the regeneration supportive properties of the PNS. The dorsal root injury paradigm is therefore an attractive model for studying mechanisms underlying CNS regeneration failure in general and how to overcome the hostile CNS environment. Here we review the main lines that have been pursued to achieve growth of injured dorsal root axons into the spinal cord: (i) modifying the inhibitory nature of the DRTZ by breaking down or blocking the effect of growth repelling molecules, (ii) stimulate elongation of injured dorsal root axons by a prior conditioning lesion or administration of specific growth factors, (iii) implantation of olfactory ensheathing cells to provide a growth supportive cellular terrain at the DRTZ, and (iv) replacing the regeneration deficient adult dorsal root ganglion neurons with embryonic neurons or neural stem cells.     

三叉神经对去运动神经支配面肌肌萎缩的影响

本文用组织化学、电镜以及肌球蛋白和肌动蛋白电泳分析了在单纯性面神经切断和三叉神经、面神经同时切断后面肌萎缩的病理改变--肌纤维的显微结构改变以及面肌收缩蛋白质在手术后不同时期的降解变化。实验证明,面部肌肉在不同的神经切断情况下其病理改变不同,正常的三叉神经支配可以延缓面瘫后肌肉蛋白质的降解,减少胶原纤维结缔组织的增生,较好地保护肌纤维的显微结构,延缓和减轻去运动神经支配面肌肌萎缩。本研究结果可以为临床治疗面瘫提供一定的理论指导。     

电刺激大鼠脊神经皮支对远距离机械感受单位电活动的影响

实验采用分离神经细束的方法,观察逆行电刺激大鼠脊神经背侧皮支后,在相距较远的神经细束上记录到的Aδ和C类机械感受单位电活动的变化。刺激T9脊神经背侧皮支,在T12神经细束上记录到59.3%（16/27）的Aδ和71.2%(37/52）的C类单位在刺激后90～120s放电显著增加。刺激T8脊神经背侧皮支,在T12神经细束上记录到47.8%(11/23）的Aδ单位和36.6%(15/41）的C类单位在刺激后120～150s放电显著增加。大多数单位（18/23）的机械感受阈值在电刺激远距离脊神经背侧皮支后降低。结果表明,逆行电刺激外周感觉神经,可以使相距较远的Aδ和C类机械感受单位致敏,其传入放电增加。