Objective:Trigeminal neuralgia (TN) is very common in the middle-aged and elderly population and seriously affects the normal life of patients. This study aims to analyze the therapeutic effect of percutaneous balloon compression (PBC) on TN and to explore the clinical significance of NOD-like receptor thermal protein domain associated protein 3 (NLRP3), which not only can provide a reference for the clinical treatment of TN in the future, but also can help the clinic to find a reliable indicator for the assessment of TN condition. Methods:The length of stay, total cost of hospitalization, and adverse reactions during treatment were compared between the two groups. Patients were subjected to assessments or investigations of the Barrow Neurological Institute (BNI) scale, Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) before and after treatment. In addition, NLRP3 in the peripheral blood of patients in the research group was measured, and the correlation of NLRP3 with BNI score and prognosis for recurrence was analyzed. Results:The length of stay and the total cost of hospitalization were respectively (12.10±2.20) d and (26445.96±5553.78) yuan in the research group, significantly reduced than those in the control group (P < .05). And the BNI score, PSQI and SAS/SDS were lower in the research group after treatment (P < .05), but the incidence of facial numbness, herpes orofacialis and masticatory muscle weakness were higher in the research group than in the control group (P < .05). After treatment, NLRP3 decreased in the research group, which was positively correlated with BNI score (P < .05). In addition, NLRP3 showed an excellent effect in predicting recurrence. Conclusion:PBC effectively improved the pain and negative psychological status of patients with TN, and NLRP3 was closely related to the pain of patients with TN. In the future, PBC is used in the clinic to treat TN and improve the prognosis of patients.

目的 探究老年重型颅脑损伤(severe traumatic brain injury,STBI)患者发生急性创伤性凝血病的影响因素及列线图模型的建立.方法 回顾性选取2020 年1 月—2023 年6 月在联勤保障部队第九〇九医院接受治疗的93 例老年ST-BI患者作为研究对象,依照7∶3的比例使用R软件将其随机分为建模队列(n =65)和模型验证队列(n =28);同时根据患者是否发生急性创伤性凝血病(ATC),将建模列队分为ATC组(n =39)和非ATC组(n =26).比较建模队列中 2 组的年龄、性别构成、BMI、ISS评分、收缩压、输液量、体温、动脉血PH、PT、APTT、FIB、D-DT、PLT值;采用二元多因素Lo-gistic回归分析方法分析老年STBI患者发生ATC的影响因素,建立路线图预测模型并验证,ROC评价模型预测效能,校准曲线评估预测事件与实际事件的一致性,DCA曲线评价模型的有效性.结果 建模队列ATC组ISS评分、输液量、PT、APTT及D-DT值显著高于非ATC组,而动脉血pH、GCS评分、PLT值显著低于非ATC组,差异均有统计学意义(P＜0.05).二元多因素Logistics回归分析结果显示,ISS评分、输液量、动脉血pH、GCS评分是老年STBI患者发生ATC的独立预测因子;模型公式:Logistic =-5.373+0.221 ISS评分+0.001 输液量+0.469 动脉血pH-0.232 GCS评分.采用R语言软件计算列线图模型的C统计量为:0.831,95%CI:0.778～0.879,标准误为0.025(P＜0.001),10 000 Bootstrap计算得出C统计量为0.822.所生成的列线图校准曲线斜率接近1,拟和度检验P值＞0.05,预测事件与实际事件的一致性较高;该模型的ROC曲线下面积为0.826(95%CI:0.720～0.933),决策分析曲线显示收益率较高,也进一步证实列线图预测模型的有效性.基于模型验证队列,对ATC风险列线图以ROC曲线进行外部验证,ROC曲线下面积为:0.829(95%CI:0.675～0.983),所生成的列线图校准曲线斜率接近1,Hosmer-Lemeshow检验结果:χ2 =9.362,P =0.303,且决策曲线显示,该模型的净收益较高,提示列线图模型在验证组中的有效性.结论 ISS评分、输液量、动脉血pH、GCS评分均可能是老年STBI患者发生ATC的独立预测因子;且进一步构建的老年STBI患者发生ATC的列线图预测模型表现出良好的预测能力,为临床识别老年STBI患者发生ATC的高风险人群提供了一定的帮助,有利于及时预防.

目的 探讨血管造影阴性蛛网膜下腔出血(SAH)病人预后的影响因素.方法 回顾性分析2019年10月至2021年10月经3D-DSA确诊的50例血管造影阴性SAH的临床资料.出血90 d,采用改良Rankin评分(mRS)评估预后,其中1～2分为预后良好,3～6分为预后不良.结果 50例中,预后不良10例,预后良好40例.单因素分析发现,高血压病、糖尿病、饮酒史、Hunt-Hess分级分级、WFNS分级与病人预后相关(P<0.05).多因素logistic回归分析发现,高血压病是病人预后不良的独立危险因素(OR=11.826;95％CI 1.240～112.801;P=0.032).结论 多数血管造影阴性SAH病人的预后良好;合并高血压病的病人,预后不良风险增加,应密切随访.

Objective To investigate the effect of serum soluble lectin-like oxidized low-density lipoprotein receptor-1（sLOX-1） on aneurysmal subarachnoid hemorrhage（aSAH）) value of patient prognosis assessment.Methods A total of 232 aSAH patients who visited our hospital’s neurosurgery department from March 2020 to March 2022 were selected as the analysis group, and 114 healthy subjects were selected as the control group.The general clinical data of the research subjects were collected, and the Hunt-Hess grade, modified Fisher grade, and aneurysm rupture size were evaluated and recorded.The venous blood of the patients admitted to the hospital within 24 hours was collected to detect the level of sLOX-1,and the mRS score was used to analyze and compare the good prognosis group and the poor group.For various clinical indicators, Spearman correlation test was used to analyze the correlation between sLOX-1 and the severity of aSAH;multivariate logistic regression was used to analyze the risk factors for the prognosis of patients with aSAH;receiver operating characteristic curve（ROC curve） was used to analyze the relationship between sLOX-1 Evaluation value in the prognosis of aSAH patients.Results The level of serum sLOX-1 in the aSAH group was significantly higher than that in the healthy control group（P＜0.05）,and the level of sLOX-1 in the poor prognosis group was significantly higher than that in the good prognosis group（P＜0.05）.Serum sLOX-1 level was positively correlated with Hunt-Hess classification and modified Fisher classification（P＜0.001）Logistic regression analysis showed that Hunt-Hess grade（grade 3-5）,aneurysm size（≥5 mm）,serum sLOX-1 concentration and modified Fisher grade（grade 3-4） were associated with poor postoperative prognosis in patients with aSAH Influencing factors（P＜0.05）,The AUC of serum sLOX-1 for evaluating the prognosis of aSAH patients was 0.739,the cutoff value was 1.68 ng/ml, the sensitivity was 67.82%,the specificity was 76.37%,（Youden index=0.659;95% CI 0.741-0.902）.Conclusion The level of serum sLOX-1 is related to the severity of aSAH patients, and is an independent influencing factor for patients with poor prognosis.

目的:回顾性对比神经内镜手术与小骨窗开颅手术治疗高血压脑出血(HICH)疗效.方法:回顾性选取2018年7月～2021年3月期间在联勤保障部队第909医院治疗的83例HICH患者的临床资料.根据手术方式的不同,将患者分为A组(n=41)和B组(n=42),A组患者采用小骨窗开颅手术治疗,B组患者采用神经内镜手术治疗,对比两组围术期指标、并发症发生率、神经功能、生活能力、神经损伤指标及预后.结果:与A组相比,B组的手术时间、住院时间明显缩短,术中出血量减少,血肿清除率升高(P＜0.05).B组术后1周美国国立卫生研究院卒中量表(NIHSS)评分低于A组,Barthel指数评分高于A组(P＜0.05).B组术后1周神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、髓鞘碱性蛋白(MBP)、胶质纤维酸性蛋白(GFAP)水平低于A组(P＜0.05).B组的并发症发生率小于A组(P＜0.05).B组的预后良好率高于A组(P＜0.05).结论:神经内镜手术、小骨窗开颅手术治疗HICH均可获得较好的疗效,其中神经内镜手术在缩短手术时间、住院时间,减少术中出血量和并发症发生率,提高血肿清除率,减轻神经功能损伤,促进患者生活能力改善,改善患者预后方面的效果更为显著.

目的 探讨3D打印钛网在颅部骨缺损修复术中的应用效果.方法 回顾性分析我院88例行去骨瓣减压术的患者临床资料,按照手术方式分为观察组和对照组,对照组49例患者采用手工裁剪钛网行修补术,观察组39例患者采用3D打印钛网行修补术.比较2组患者手术修补时间、围术期并发症、钛钉固定数目和钛网厚度,随访5～17个月,比较2组患者随访期间并发症发生率.结果 与对照组相比,观察组手术修补时间较短,围术期并发症发生率较低,钛钉固定数目较少,钛网厚度较小,差异均具有统计学意义(P<0.05).随访期间,观察组并发症发生率低于对照组,差异具有统计学意义(P<0.05).结论 3D打印钛网在颅部骨缺损修复术中有较好的近期临床疗效,并发症较少,可精准、个体化地定制骨缺损修补材料.