目的 探讨躯体感觉诱发电位（SEP）在颈脊髓损伤术前、术中监测的意义。 方法 纳入2010年1月－2012年4月治疗的241例颈脊髓损伤患者，术前按美国脊柱脊髓损伤协会（ASIA）评分并分级，确定损伤平面。术前与术中SEP监测，分析不同损伤分级以及不同损伤平面术前的波幅及潜伏期的差异，术中SEP监测以波幅下降＞50%和或潜伏期延长＞10%为预警标准。 结果 各损伤分级组术前SEP监测：A级组SEP波消失，呈一直线，而B、C、D、E级组均测出SEP波形，根据是否可测出SEP波形，可将A级与B、C、D、E及组区别。B、C、D级组之间波幅和潜伏期均无统计学意义（P＞0.05）。E级组较B、C、D级组波幅增高、潜伏期缩短，差异有统计学意义（P＜0.05）；不完全性颈脊髓损伤组内不同损伤平面组之间波幅和潜伏期差异均无统计学意义（P＞0.05）。术中SEP对脊髓功能损伤监测的灵敏度83.3%、特异度98.7%。其中术中：SEP阳性8例，真阳性5例，4例术者处理后波幅及潜伏期回复至正常范围，术后无新的神经功能损伤，另1例术者采取各种处理后波幅及潜伏期无恢复，术后神经功能损伤较术前加重；假阳性3例，1例麻醉师给予升高血压后波形恢复至正常，另2例经麻醉师调整麻醉深度后波形恢复正常，此3例术后无新的神经功能损伤。SEP阴性233例，真阴性232例，术后无新的神经功能损伤；假阴性1例，患者术中、术后波形未见异常，术后运动功能损伤程度较术前加重。 结论 ① SEP能准确评估完全性和不完性颈脊髓损伤，但对不完全性颈脊髓损伤的损伤程度不能作出准确评估、也不能区分颈脊髓损伤的损伤平面；② 术中SEP监测能较好地反映颈脊髓功能完整性，对减少颈脊髓损伤术中发生医源性颈脊髓损伤风险具有重要意义。
Objective To evaluate the effect of sensory disturbance after the sagittal split ramus osteotomy (SSRO）on quality of life. Methods From September2004 to September 2005, 21 patients undergoing SSRO were studied by using questionnaires. There were 12 males and 9 females, aging 1927 years(mean 22.6 years).The patients were followed up at 4 weeks and 24 weeks after operation. The subjective questionnaire was completed by patient to evaluate the degree of living quality descending. Results At 4 weeks,19(90.48%) patients’ living quality descended because of postoperative sensory disturbance. Among them, 7(33.33%) patients had severe descending of living quality. The average effecting time of living accounted for total time 26.9%(about 6.5 h/d). At 24 weeks, 12(6316%) patients’ living quality descended because of postoperative sensory disturbance, 7(36.84%) patients could achieve preoperative living quality. The average effecting time of living accounted for total time 15.5%(about 3.7 h/d). Conclusion Most patients have descending of living quality after SSRO because of sensory disturbance. However, this condition can be improved during the followup and more than 1/3 patients canachieve their preoperative living quality.
Meige Syndrome (MS) is a neurological disorder characterized by blepharospasm, oromandibular dystonia, and spasmodic torticollis as its primary clinical manifestations. With advancements in neuroscience research and the accumulation of clinical experience, significant progress has been made in understanding the pathophysiological mechanisms, diagnostic criteria, and therapeutic strategies for MS both domestically and internationally. To standardize clinical practice and promote academic development, Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, in collaboration with Neuro-ophthalmology Society, Chinese Research Hospital Association, organized a panel of authoritative experts. This expert panel conducted a comprehensive review of the latest research evidence and clinical experiences. Through multiple rounds of expert consultations and in-depth discussions, the original consensus was thoroughly revised and updated. The new consensus aims to provide standardized diagnostic and treatment guidelines for clinicians, foster research innovation and the development of therapeutic techniques in the field of neuro-ophthalmology, address new challenges in the diagnosis and treatment of MS, and ultimately improve patients' quality of life.
Repairing degloving injury of fingers by transplantation of ateriolized venous network flap with sensory nerve for six cases (7 fingers). The flaps were all gotsurvived. The procedure of the operation was performed as following: 3～5 supperficial veins and the medial or lateral cutaneous nerve were separated on the palmar side of the forearm as pedicle. According to the defect, the corresponding flaps was designed and was transferred to the injuried finger. Anastomosed the veins with the two digital arteries and veins. Anastomosed the cutaneous nerve with the digital nerves. The patients were followed up for two years. The flaps were soft and wearresisting. The joint movements of the fingers were normal. The twopoints discrimination was 5 to 10mm. The contour of the fingers was satisfactory. The procedure has the following advantages: 1. carried out one operation; 2. good sensation, 3. good appearance and satisfactory function. The indications and factors affecting the survival of the flap were discussed.
Objective To investigate the anatomic foundation of using main branch of posterior femoral nerve to restore the sensation function of distal basedsural island flap. Methods Thirty cases of adult human cadaver legs fixed by 4%formaldehyde were used. Anatomical investigation of the posterior femoral nerves of lower legs was conducted under surgical microscope to observe their distribution, branches and their relationship with small saphenous vein. Nerve brancheswith diameter more than 0.1 mm were dissected and accounted during observation.The length and diameter of the nerves were measured. Results The main branch of posterior femoral nerve ran downwards from popliteal fossa within superficial fascia along with small saphenous vein. 70% of the main branch of the posterior femoral nerves lay medially to small saphenous vein, and 30% laterally. They wereclassified into 3 types according to their distribution in lower legs: typeⅠ (33.3%) innervated the upper 1/4 region of lower leg (region Ⅰ), type Ⅱ (43.3%) had branches in upper 1/2 region (region Ⅰ and Ⅱ), and type Ⅲ (23.3%) distributed over the upper 3/4 region (region Ⅰ, Ⅱ and Ⅲ). In type Ⅱ, the diameter of the main branches of posterior femoral nerves in the middle of popliteal tossa was 10±04 mm and innervated the posterior upper-middle region (which was the ordirary donor region of distal based sural island flaps) of lower legs with 2.0±0.8 branches, whose diameter was 0.3±0.2 mm and length was 3.5±2.7 mm. The distance between the end of these branches and small saphenous vein was 0.8±0.6 mm. In type Ⅲ, their diameter was 1.2±0.3 mm and innervated the posterior upper-middle region of lower legs with 3.7±1.7 branches, whose diameter was 0.4±0.1 mm and length was 3.7±2.6 mm. The distancebetween the end of these branches and small saphenous vein was 0.8±0.4 mm. Conclusion 66.6% of human main branch of posteriorfemoral nerves (type Ⅱ and type Ⅲ) can be used to restore the sensation of distal based sural island flap through anastomosis with sensor nerve stump of footduring operation.
Objective To evaluate the effectiveness of the innervated medial plantar flap for reconstructing soft tissue defects, particularly in the weight-bearing zone, after resection of foot tumors. MethodsA retrospective analysis was conducted on 12 patients with malignant skin and soft tissue tumors of the foot treated between October 2023 and December 2024. The cohort included 8 males and 4 females, aged 42-67 years (mean, 57.5 years). Tumor types comprised malignant melanoma (5 cases), squamous cell carcinoma (4 cases), arsenical keratosis (2 cases), and tumor-induced osteomalacia (1 case). Soft tissue defects located in the heel weight-bearing region in 10 cases and non-weight-bearing ankle region in 2 cases, with defect sizes ranging from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. Preoperative photon-counting CT angiography (PC-CTA) was performed to assess the medial plantar artery and its perforators. All patients underwent radical tumor resection with confirmed negative margins. The resulting defects were reconstructed using a innervated medial plantar flap incorporating sensory branches of the medial plantar nerve. The flap donor site was covered with a split-thickness skin graft harvested from the ipsilateral inguinal region. Results The operation was successfully completed in all 12 patients. All flaps survived completely without vascular compromise, partial necrosis, or total loss. Incisions healed primarily without dehiscence or infection. Minor skin graft necrosis occurred at the donor site in 3 patients, which healed within 2-3 weeks with routine dressing changes. No donor site complication (e.g., tendon or nerve injury) occurred. Patients were followed up 2-16 months (mean, 10.3 months). At last follow-up, there was no tumor recurrence. Flaps exhibited good color and texture match with surrounding tissue, restored sensation, and all feet achieved normal weight-bearing activity. Conclusion The innervated medial plantar flap, precisely designed based on PC-CTA localization, provides reliable blood supply and effective sensory restoration. It is an ideal method for reconstructing soft tissue defects after foot tumor resection, especially in the heel weight-bearing region.
Objective To study the application effect of Snyder hope theory combined with Satir model in the rehabilitation therapy of young and middle-aged patients with stroke. Methods A total of 224 young and middle-aged patients with stroke admitted to Zhongshan Hospital of Fudan University between August 2018 and August 2020 were divided into four groups (control group, Satir group, Snyder group, and combined group) according to the random number table method by taking admission time as sequence. All patients were given rehabilitation training on the basis of conventional treatment, and the Satir group was given group guidance of Satir model, the Snyder group was given hope therapy based on Snyder hope theory, and the combined group was given intervention combined Snyder hope theory with Satir model. All patients were continuously treated for six weeks. The scores of Herth Hope Index (HHI), Self-perceived Burden Scale (SPBS), exercise rehabilitation willingness questionnaire, Health Promoting Lifestyle Profile Ⅱ (HPLP Ⅱ), and Simplified Coping Style Questionnaire (SCSQ) were compared among the four groups before and after intervention. Results There were 53, 52, 54, and 52 patients enrolled in the control group, the Satir group, the Snyder group, and the combined group, respectively. The differences among the four groups in basic information such as sex, age, and type of stroke and the scores of the above scales before intervention were not statistically significant (P>0.05). After intervention, the total scores of HHI scale (27.65±6.34, 30.54±6.85, 32.79±7.12, 35.08±7.63), scores of exercise rehabilitation willingness (39.85±8.16, 40.52±7.93, 40.17±8.25, 43.81±7.46), total scores of HPLP Ⅱ scale (149.87±26.08, 159.32±26.73, 165.89±28.01, 173.18±28.54), and scores of positive coping style of SCSQ scale (19.65±5.08, 22.46±5.29, 25.04±4.91, 28.45±5.12) of the four groups significantly increased compared with those before intervention (P<0.05), while the total scores of SPBS scale (27.35±4.92, 23.74±5.02, 25.16±4.98, 21.49±5.27) and scores of negative coping style of SCSQ scale (4.83±1.25, 3.71±1.02, 3.94±1.08, 4.13±0.96) significantly decreased compared with those before intervention (P<0.05); the scores of HHI scale, exercise rehabilitation willingness, HPLP Ⅱ scale, and positive coping style of SCSQ scale of the combined group were higher than those of the other three groups (P<0.05), while the score of SPBS scale was lower than that of the other three groups (P<0.05). Conclusions Snyder hope theory combined with Satir model for rehabilitation therapy of young and middle-aged patients with stroke can help to improve the hope level, reduce the self-perceived burden, and improve the exercise rehabilitation willingness, health behaviors and coping styles. In addition, it is of great significance for promoting the rehabilitation of patients.