建立“人工面神经技术”恢复周围性面瘫兔的闭眼功能

目的：建立“人工面神经技术”以恢复单侧周围性面瘫兔的眼轮匝肌闭眼功能,为周围性面瘫提供一种新的治疗手段。方法：制备单侧周围性面瘫兔,建立健侧眼轮匝肌肌电信号采集、中枢信号处理模式识别、患侧电流刺激眼轮匝肌系统。当健侧眼轮匝肌采集的肌电信号经信号识别、提取以及电脑分析判断,符合其闭眼刺激阈值时,即对人工电刺激器发出指令,由刺激电极直接作用于惠侧眼轮匝肌,引起眼睑完全闭合。结果：以最小电流刺激患侧眼轮匝肌,引起眼睑完全闭合。刺激方式为正负矩形波,电流强度为0．30～0．50mA。结论：利用可植入式微机电技术,在单侧周围性面瘫模型建立“人工面神经反射弧”,恢复患侧眼轮匝肌闭眼收缩,可维持双侧闭眼功能的对称性和同步性。     

完全失神经面瘫I／t曲线的对数相关性及预后

肌电图检测完全失神经面瘫３０例,同时检测患侧额肌、口轮匝肌Ｉ／ｔ曲线６０条,有扭结１９条,直线４１条。计算额肌、口轮匝肌Ｉ／ｔ曲线对数回归直线方程分别为：ＬｏｇＹ＝－０．６４ＬｏｇＸ＋０．９８（ｒ＝０．９９９６,Ｐ＜０．００１）和ＬｏｇＹ＝－０．７６ｌｏｇＸ＋０．８４（ｒ＝０．９９８９,Ｐ＜０．００１）。３０例患者随访１至３年,Ｈｏｕｓｅ－ＢｒａｃｈｍａｎｎⅠ级３例,２３例留有后遗症和并发症,Ⅲ级１０例,Ⅳ级１３例。出现面部明显运动时间病后２至５个月,手术损份４例未恢复。结论：完全失神经面瘫Ｉ／ｔ曲线,随脉宽减小,强度值呈直线上升;两条曲线的建立对于评定面瘫的神经损伤程度、预后及比较不同治疗方法优越性提供了依据。     

特发性面神经麻痹患者的运动单位数目评估与临床

目的:通过对特发性面神经麻痹患者的运动单位数目估计,并与常规面神经传导速度相结合,评估病情的严重程度,以期指导临床治疗和评价预后。方法:纳入我院诊断的特发性面神经麻痹患者32例,分别于发病第3天、第7天、第14天、1个月、3个月给予电生理检查,包括面神经传导速度、眼轮匝肌和口轮匝肌的运动单位数目估计,并与健侧做对比。根据House-Brackmann面神经功能分级再将入组患者分为轻(Ⅱ级)、中(Ⅲ级)、重度(Ⅳ～Ⅵ级)三组。同时纳入10名健康成年人作对照组,检测方法相同。结果:发病第3天、第7天32例患者全部出现患侧运动波幅下降,与健侧对比差异有统计学意义(P0.05)。于发病第14天开始,患者运动波幅开始逐渐恢复,至3个月时,绝大部分患者运动波幅与健侧对比差异无统计学意义(P0.05)。而运动单位数目的减少在整个病程中与健侧相比较差异均具有统计学意义(P0.05),第14天、1个月、3个月运动波幅开始恢复时,运动单位数目并未随之恢复,且与运动波幅不呈线性关系,与临床症状也不成正比关系。面神经运动单位数目下降的程度与患者面神经运动波幅的恢复呈正相关。结论:运动单位数目估计检查应用于特发性面神经麻痹患者,可以反映病情的严重程度,并能在一定程度上评估预后。     

激光治疗加针灸刺激穴位治疗Bell's麻痹临床观察

Bell's麻痹即面神经炎,中医学称为"口眼喎斜",春秋两季发病率较高,临床分为周围性与中枢性两类,其中常见的为周围性面瘫.     

外加稳恒直流电场对兔腹主动脉周围电势差的影响

目的:观察外加稳恒直流电场对兔腹主动脉周围电势差的影响.方法:在兔腹主动脉两侧腰大肌埋置刺激电极,在血管外膜、血管内外膜间安置测量电极,给予稳恒直流电场刺激,电场强度采用3V或4V,记录电场刺激前后血管周围电势差的变化情况.结果:①通电后即刻,血管周围电势差与通电前相比无变化(P>0.05).②通电后30min,血管外膜间和血管内外膜间电势差均明显增加,4V组增加更为明显.③断电后30min,两外膜间电势差基本恢复至通电前水平,而血管内外膜间电势差仍高于通电前,两刺激电极间仍有较高电势差存在.结论:将铂电极置入兔腰大肌,连接稳恒直流电源后构成的是一个RC电路,应用3V电压或者4V电压刺激都可以引起血管周围电势的变化.     

改良手术方法在腮腺肿瘤手术中的运用

目的:改良腮腺肿瘤手术方法,以期最大程度恢复术后患者美容及功能。方法:采用以下改良术式:①采用隐蔽的面部除皱切口,避免了常规术式的颈部切口;②采用总干法解剖面神经,减少了面神经周围支损伤的机率;③保留耳大神经,避免术后耳垂麻木;④采用口腔修复膜,减少了术后Frey综合征的发生;⑤采用蒂在上方的胸锁乳突肌肌瓣填塞腮腺切除后的凹陷区,避免了常规术式后的面部畸形。结果:采用该方法对36例患者行腮腺切除术,术后随访6月～4年,患者面部疤痕不明显,外形恢复良好,无面瘫,无Frey综合征出现。结论:改良的腮腺切除术克服了传统术式的缺陷,值得进一步推广和普及。     

研究中国人术中喉返神经监测肌电信号的正常值范围

目的:应用术中神经监测技术(intraoperative neuromonitoring IONM),探讨国人喉返神经肌电信号的正常值范围。方法:烟台毓璜顶医院甲状腺外科自2009年11月到2012年1月对300例甲状腺开放手术行术中喉返神经实时监测,术中一根回路电极斜行刺入同侧切口外缘直径约2 cm范围皮肤,两根记录电极斜行刺入环甲肌,手持刺激探针垂直刺激神经,发出"嘟嘟嘟"提示音,同时监测仪显示器显示肌电波形,并记录潜伏期及波幅值。结果:285例(386条)清晰显示肌电波形;15例未引出肌电波形,其中10例因机器故障和麻醉因素造成假阴性,5例因肿瘤浸润环甲肌,无法插入记录电极造成。无永久性喉返神经损伤,暂时性神经损伤2例,术后1月内恢复。V1 95%可信区间482.66～574.28μV,R1 95%可信区间521.85～615.05μV,V2 95%可信区间440.92～531.84μV,R2 95%可信区间489.25～582.05μV,T可信区间19.88～20.12ms。结论:明确喉返神经肌电信号正常值范围,为识别、确认喉返神经及通过肌电信号判断神经功能完整性提供依据,降低喉返神经损伤率,利于判断喉返神经非离端性损伤,并寻找损伤原因。     

前庭代偿中双侧前庭内侧核对输入刺激响应的敏感性变化及其离子机制

前庭代偿是研究前庭疾病防治策略和成年后由外周损伤导致的中枢神经系统可塑性的重要模型。脑干中的前庭内侧核(medial vestibular nucleus, MVN)是实现前庭代偿的重要中枢。MVN神经元的兴奋性和敏感性对前庭功能的正常执行十分关键,但先前的研究集中关注于单侧外周迷路切除(unilateral labyrinthectomy, UL)这一前庭代偿模型中患侧MVN中神经元兴奋性活动的变化,对双侧MVN神经元动态响应输入刺激的敏感性变化仍知之甚少。本研究采用实时荧光定量PCR、离体脑片全细胞膜片钳记录和行为学方法,观察到UL后6 h,大鼠表现出显著的自发运动障碍,且其患侧而非健侧MVN中B型神经元的兴奋性活动显著降低。但与之相反,健侧而非患侧MVN中的B型神经元对斜坡和阶跃电流刺激的敏感性则显著升高。UL后1周,大鼠基础运动行为得到代偿,其患侧MVN神经元的兴奋性和健侧MVN神经元的敏感性均恢复至正常水平。此外,参与B型MVN神经元敏感性调控的小电导钙激活钾通道(small conductance Ca2+-activated K+channel, SK) UL后6 h在健...     

肌电生物治疗联合运动康复在桡神经损伤治疗中的临床应用及疗效评价

目的:探究肌肉电刺激生物疗法联合运动疗法对于治疗桡神经损伤患者的临床疗效及运动恢复效果评价。方法:选择2013年5月至2016年5月我院收治的100例桡神经损伤患者。采用随机数字表法随机分为研究组和对照组各50例。对照组采用常规治疗(营养神经药物+针灸)和运动疗法,研究组在此基础上联合肌电生物治疗。治疗时间均为12周。治疗结束后应用统计学方法对两组患者的治疗有效率、腕伸肌和指总伸肌恢复情况、伸腕角度和伸肘角度以及神经传导速度和波幅等方面进行疗效对比。结果:治疗12周后,研究组治疗有效率66.00%高于对照组的50.00%,差异有统计学意义(P0.05)。研究组肌力恢复至4-5级的比例和表面肌电信号(s EMG)增幅均高于对照组,差异均有统计学意义(P0.05)。经治疗后,研究组伸腕角度和伸肘角度的优良率分别为84.00%、80.00%,明显高于对照组的66.00%、68.00%,差异均有统计学意义(P0.05)。两组患者胫神经运动传导速度(MCV)及波幅的均有改善,但研究组的改善效果明显优于对照组,差异有统计学意义(P0.05)。结论:常规治疗联合肌电生物反馈和运动疗法的治疗方案明显能使得患者受益更多,能更好地恢复患者的患肢运动功能,值得临床推广。     

颈内动脉海绵窦瘘的临床表现及影像学诊断

目的:探讨颈内动脉海绵窦瘘(CCF)的临床症状及影像学表现,提高影像医师对CCF的诊断能力.方法:回顾性分析19例具有完整,临床资料的并经DSA证实的颈内动脉海绵窦瘘患者的CTA、MRI的表现.结果:CCF的临床表现主要为搏动性突眼、复视、视力障碍、眼球活动障碍,临床体征为颅内杂音、结膜水肿和充血等.CT及MRI平扫表现为眼球突出、海绵窦扩大、眼外肌增粗,眼球边缘模糊、眼睑肿胀.CTA及MRA可观察其瘘口所在位置、大小及侧枝循环建立的情况.DSA表现为造影剂从颈内动脉沿瘘口进入海绵窭,形成该处造影剂浓聚,静脉系统旱显而动脉系统充盈不佳造成"盗血现象".结论:根据颈内动脉海绵窦瘘的临床和影像学表现可确诊颈动脉海绵窦瘘,为患者的进一步治疗提供准确有效的依据.     

家兔迟发性面瘫模型建立及药物干预研究

目的:优化迟发性面瘫的建模方法,并对药物的神经保护作用进行观察。方法:家兔48只共96侧面神经,分A、B、C、D 4个实验组,以一侧面神经进行实验处理,另一侧为自身对照。A组:直视下钳夹损伤桥池段面神经;B组:直视下向桥小脑角注射动脉血,以诱导血管痉挛;C组:处理因素=A组+B组;D组:在C组基础上,应用药物(强的松+丹参+维生素B1+维生素B12)干预。观察家兔面瘫,并做面神经病理切片,比较各组间迟发性面瘫发生率、面瘫持续时间及预后。结果:面瘫发生情况:A组6只家兔(6/11,54.5%)出现迟发性面瘫;平均面瘫持续时间为13.2天。B组有2只(2/12,16.7%)出现迟发性面瘫,平均持续8天。C组6只(6/12,50%)家兔出现迟发性面瘫,平均持续14.3天。D组4只(4/12,33.33%)出现迟发性面瘫,平均持续6天。所有自身对照侧均无面瘫发生。病理:各组均见神经纤维水肿;A、C两组呈高度水肿改变,神经束周围结构紊乱;B组见神经内血管细小,而水肿较A、C两组轻微;D组呈轻度水肿改变。结论:C组出现迟发性面瘫几率高,是较好的模型;联合应用强的松、丹参、维生素B1、维生素B12虽不能防止迟发性面瘫发生,但可使迟发性面瘫病程明显缩短。     

家兔迟发性面瘫模型建立及药物干预研究

目的：优化迟发性面瘫的建模方法,并对药物的神经保护作用进行观察。方法：家兔48只共96侧面神经,分A、B、C、D4个实验组,以一侧面神经进行实验处理,另一侧为自身对照。A组：直视下钳夹损伤桥池段面神经;B组：直视下向桥小脑角注射动脉血,以诱导血管痉挛;C组：处理因素=A组＋B组;D组：在C组基础上,应用药物（强的松＋丹参＋维生素BI＋维生素B12）干预。观察家兔面瘫,并做面神经病理切片,比较各组间迟发性面瘫发生率、面瘫持续时间及预后。结果：面瘫发生情况：A组6只家兔（6／11,54．5％）出现迟发性面瘫;平均面瘫持续时间为13．2天。B组有2只（2／12,16．7％）出现迟发性面瘫,平均持续8天。C组6只（6／12,50％）家兔出现迟发性面瘫,平均持续14.3天。D组4只（4／12,33．33％）出现迟发性面瘫,平均持续6天。所有自身对照侧均无面瘫发生。病理：各组均见神经纤维水肿;A、c两组呈高度水肿改变,神经束周围结构紊乱;B组见神经内血管细小,而水肿较A、C两组轻微;D组呈轻度水肿改变。结论：C组出现迟发性面瘫几率高,是较好的模型;联合应用强的松、丹参、维生素B1、维生素B12虽不能防止迟发性面瘫发生,但可使迟发性面瘫病程明显缩短。     

针药结合治疗糖尿病并发周围性面瘫的临床疗效及对氧化应激的影响

目的:探讨在降糖药的基础上联合应用电针治疗糖尿病并发周围性面瘫的临床疗效及对氧化应激的影响。方法:选取2017年1月至2017年12月我院收治的糖尿病并发周围性面瘫患者78例作为研究对象,随机分为观察组39例与对照组39例,对照组采取常规控制血糖处理及补充维生素,观察组在对照组的基础上联合应用电针疗法,比较两组患者的临床疗效、治疗前后电生理指标以及氧化应激指标水平的变化。结果:治疗后,观察组的总有效率为94.87%,显著高于对照组(71.79%,P0.05);两组患者的CMAP波幅均较治疗前显著提高,且观察组明显高于对照组(P0.05);两组患者的R1波潜伏期均较治疗前明显缩短,且观察组显著短于对照组(P0.05);两组患者的MDA均较治疗前显著降低,且观察组明显低于对照组(P0.05);两组患者的SOD、GSH-Px均较治疗前显著升高,且观察组明显高于对照组(P0.05)。结论:在降糖药的基础上联合应用电针治疗糖尿病并发周围性面瘫的疗效显著优于单用降糖药治疗,可能与其显著减轻机体氧化应激水平有关。     

Induction of Urokinase-Type Plasminogen Activator in Rat Facial Nucleus by Axotomy of the Facial Nerve

Abstract: The response of plasminogen activator activity in the CNS to peripheral nerve axotomy was examined in vivo. After transection of the rat facial nerve, a transient increase in plasminogen activator activity was observed in the facial nucleus on the operated side with maximal activity 3–5 days after lesion. This activity was inhibited by the urokinase-specific inhibitor amiloride but not by antibodies against tissue plasminogen activator. The molecular mass of the induced form of plasminogen activator was estimated to be ∼48 kDa. An in vitro assay of plasminogen hydrolysis also demonstrated an increase in amiloride-sensitive plasminogen activator activity in facial nerve extracts following facial nerve axotomy. These data indicate that the plasminogen activator activity induced in the facial nucleus following axotomy of facial motoneurons is of the urokinase type. It is suggested that the urokinase-type plasminogen activator might play a role in the events accompanying injury and regeneration in the facial nucleus following motoneuron lesion.     

星状神经节阻滞联合针刺治疗特发性面神经麻痹临床观察

目的:观察星状神经节阻滞联合针刺治疗对特发性面神经麻痹的临床疗效。方法:将62例特发性面神经麻痹患者分为两组,对照组30例采用药物治疗+针灸理疗等常规治疗,治疗组32例采用常规治疗+星状神经节阻滞(SGB)疗法,疗程30天。采用House-Brackmann面神经功能分级评定及临床疗效指标判定。结果:治疗前两组H-B面神经功能分级具有可比性。治疗后,两组H-B评分比较差异有统计学意义(P<0.05);临床疗效指标比较显示两组总有效率分别为:治疗组96.9%,对照组80.00%,治疗组优于对照组,两组差异有统计学意义(P<0.05)。结论:星状神经节阻滞联合针刺治疗对急性特发性面神经麻痹有效。     

Facial Nerve Axotomy in Mice: A Model to Study Motoneuron Response to Injury

The goal of this surgical protocol is to expose the facial nerve, which innervates the facial musculature, at its exit from the stylomastoid foramen and either cut or crush it to induce peripheral nerve injury. Advantages of this surgery are its simplicity, high reproducibility, and the lack of effect on vital functions or mobility from the subsequent facial paralysis, thus resulting in a relatively mild surgical outcome compared to other nerve injury models. A major advantage of using a cranial nerve injury model is that the motoneurons reside in a relatively homogenous population in the facial motor nucleus in the pons, simplifying the study of the motoneuron cell bodies. Because of the symmetrical nature of facial nerve innervation and the lack of crosstalk between the facial motor nuclei, the operation can be performed unilaterally with the unaxotomized side serving as a paired internal control. A variety of analyses can be performed postoperatively to assess the physiologic response, details of which are beyond the scope of this article. For example, recovery of muscle function can serve as a behavioral marker for reinnervation, or the motoneurons can be quantified to measure cell survival. Additionally, the motoneurons can be accurately captured using laser microdissection for molecular analysis. Because the facial nerve axotomy is minimally invasive and well tolerated, it can be utilized on a wide variety of genetically modified mice. Also, this surgery model can be used to analyze the effectiveness of peripheral nerve injury treatments. Facial nerve injury provides a means for investigating not only motoneurons, but also the responses of the central and peripheral glial microenvironment, immune system, and target musculature. The facial nerve injury model is a widely accepted peripheral nerve injury model that serves as a powerful tool for studying nerve injury and regeneration.     

康复护理对面瘫患者的影响

目的探讨面瘫患者实施康复护理的效果。方法选择2013年1月~2015年12月我院神经科收治的面瘫患者80例为研究对象,随机分为对照组和观察组各40例,对照组给予常规护理,观察组在常规护理基础上实施康复护理,观察比较两组患者的治疗效果。结果观察组临床总有效率明显高于对照组,差异有统计学意义(P0.05)。结论面瘫患者实施康复护理可提高临床效果,促进面神经的恢复,值得临床应用。     

Quantitative analysis of movements in facial nerve palsy with surface electromyography and kinematic analysis

Facial nerve paralysis (FNP) has a significant effect on a person’s quality of life. In individuals with FNP undergoing facial rehabilitation, methods to analyze the loss of function are useful in diagnosis, treatment and follow up.To propose a protocol with kinematic analysis coupled with sEMG to evaluate the outcomes of FNP, quantifying the excursion degrees of the facial muscles and symmetry of voluntary movements.10 patients (Group A) were followed by diagnosis until the end of the rehabilitation program. Kinematic analysis of 20 healthy adults (group B) was performed as a starting point to have a normality range and to test intra-subject and inter- intra rater reliability. An optoelectronic system and sEMG wireless electrodes were used. In Group A, a significant improvement in the movement of frontalis muscle (P = 0.0118) after 4-week treatment from the beginning (T0) 9.8 ± 4.5 mm to the end of rehabilitation (T1) 16.3 ± 5.8 mm and orbicularis oris (P = 0.0143) from T0 14.8 ± 5.5 mm to T1 20.3 ± 3.3 mm and, a reduction of % of maximum voluntary contractions (MVC) at T1 for frontalis and orbicularis compared to T0.This protocol provides meaningful data in a simple, reliable and objective way for the functional assessment of patients with PNF.     

Facial electromyography: responses of children to odor and taste stimuli

The study investigated the potential for facial electromyography (EMG) to be used as a clinical tool for measuring the responses of children to pleasant and unpleasant smell and taste stimuli. Responses in the zygomaticus major and levator labii muscles to 4 odorants and 4 tastants were recorded from 34 children aged 6-9 years. The results indicated that EMG activities in the 2 muscles discriminated between pleasant and unpleasant stimuli within each modality in a manner that indicated that the children perceived the hedonic qualities of the stimuli in a manner similar to that reported for adults. Importantly, there was unanimous agreement across the children as regards the differential nature of the activities exhibited. These outcomes together with the results of earlier facial expression studies suggest that facial EMG may provide an objective procedure that could be suitable for the clinical assessment of taste and smell function in newborns and young infants.