The results of nerve transposition for root avulsion of brachial plexas in 21 cases were reported. The methods of the nerve transposition were divided into four groups as followings: By transfer of phrenic nerve, accesory nerve, the motor branches of cervical plexus and intercostal nerves in cease; By transfer of phrenic nerve, accessory nerve and the motor branches of cervical plexus in 6 cases; By transfer of phrenic nerve and accessory nerve in 9 cases, and by transfer of phrenic nerve or the motor branches of cervical plexus or intercostal nerve in 5 cases. During operation, in 1 cases variation of the brachial plexus was found. Injury to the subclavian artery occurred in 4 cases and they were repaired, which is good for the blood circulation of the upper arm and nerve regeneration. Nineteen cases were followed up with good results. The overall excellent and good rate was 73.7%. It was considered that transposition of nerve should be a routine operation for the treatment of root avulsion of brachial plexus and the accompanied arterial injury should be repaired at the same time during operation, and the latter would be advantageous to enhance functional recovery of nerve.
OBJECTIVE: To investigate the variation of neurotrophic factors expression in spinal cord and muscle after root avulsion of brachial plexus. METHODS: Forty-eight Wistar rats were involved in this study and according to the observing time in 1st day, 1st week, 4th week, 8th week, and 12th week after avulsion, and the control, were divided into 6 groups. By immunohistochemical and hybridization in situ assays, the expression of nerve growth factor (NGF) on muscle, basic fibroblast growth factor(bFGF) and its mRNA on the neurons of corresponding spinal cord was detected. Computer image analysis system was used to calculate the result. RESULTS: After the root avulsion of brachial plexus occurred, expression of NGF increased and reached to the peak at the 1st day. It subsided subsequently but was still higher than normal control until the 12th week. While expression of bFGF and its mRNA increased in the neurons of spinal cord and reached to the peak at the 1st week. Then it dropped down and at the 12th week it turned lower than normal control. CONCLUSION: After root avulsion of brachial plexus, neurotrophic factors expression increase on target muscle and neurons of corresponding spinal cord. It maybe the autoregulation and may protect neuron and improve nerve regeneration.
OBJECTIVE: To evaluate the clinical application of primary transfer of pectoralis major to reconstruct the elbow flexion and shoulder abduction. METHODS: 12 cases of old injury of branchial plexus with dysfunction of both elbow and shoulder joints were received surgical operation to reconstruct the palsy joints by primary transfer of pectoralis major, shoulder abduction was reconstructed by clavicular head and elbow flexion by sternal head respectively. All cases were followed up for 5 to 18 months. RESULTS: The function of both joints recovered obviously, the total superior rate is 91.7%. CONCLUSION: Only if the palsy joints, shoulder or elbow, remained normal or almost normal passive motion, and the muscle power of pectoralis major over 4 degrees, the primary transfer of pectoralis major should be a simple, reliable and convenient technique to reconstruct the palsy joints.
Objective To investigate the latest development in diagnosis and treatment of the injury to the peripheral nerve. Methods The literature at home and abroad was reviewed, and the research findings with clinical experience in diagnosis and treatment for the injury to the peripheral nerve were summarized. Results The treatment for the total brachial plexus avulsion injury was successfully performed by the extra-plexus nerve transfer. The avulsion of the brachial plexus could be directly repaired by the healthy C7 nerve root transfer through the anterior spinal approach. The forearm flexors could bereinforced by the neurovascularized gracilis transplantation. MRI and CTM werethe best methods of early diagnosis for the brachial plexus injury. The pure upper or lower root avulsion of the brachial plexus injuries could be repaired by the intraplexus nerve transfer, which involved a transfer of part of the ulnarnerve in the arm to the motor nerve of the biceps for C5-C6 avulsion of the brachial plexus,and a transfer of selective fascicles of the healthy C7 nerve root or brachial muscle branch to the flexors muscle fascicles of the median nerve or anterior interosseous nerve. The thoracic outlet syndrome always occurred in this position when the neck muscle fatigue occurred in the typists or the gameplayers after their longstanding looking forwards. The C5 and C6 rootswere rolled by the tendenofibrotic tissue at the origin of the scalenus. After a procain block, the symptom subsided. Radiation neuropathy was a series of pathological changes caused by overdoses of the radiation therapy. The pathologic findings consisted of a series of vessel damages and final coagulation necrosis, which induced clusters of abnormally-dilated, thin-walled telangiectasias. Radiation neuropathy could be detected by MRI and could be differentiated from tumor. Once the diagnosis was established, the therapy should be begun early, including the systemic use of steroids, anticoagulation, and hyperbaric oxygen. Conclusion Great progress has been made in diagnosis and treatment of the injury to the peripheral nerve, but a further study should be performed topromote regeneration of the nerves and reconstruction of the related functions.
【摘要】 目的 观察密集型银质针松解术结合臂丛神经阻滞麻醉治疗老年肩周炎的疗效。 方法 2007年4月-2008年6月，将120例老年肩周炎患者（gt;60岁）随机分为治疗组、对照组各60例；治疗组采用密集型银质针松解术结合臂丛神经阻滞麻醉治疗，对照组则用单纯密集型银质针松解术治疗。 结果 治疗组痊愈43例、显效15例、好转2例；对照组痊愈41例、显效16例、好转3例。总有效率均为100%。两组疗效差异无统计学意义（Pgt;0.05），治疗组心率血压变化值及疼痛评分均低于对照组，差异有统计学意义（Plt;0.05）。 结论 密集型银质针松解术结合臂丛神经阻滞为治疗老年肩周炎的安全、有效方法。【Abstract】 Objective To investigate the effect of dense silver needle acupuncture therapy combined with brachial plexus nerve block for old patients with shoulder periarthritis. Methods A total of 120 patients with shoulder periarthritis diagnosed in our hospital between April 2007 and June 2008 were randomly divided into treatment group and control group with 60 in each group. Patients in the treatment group were treated with dense silver needle acupuncture therapy combined with brachial plexus nerve block, while patients in the control group were only treated with dense silver needle acupuncture therapy. Results In the treatment group, 43 patients were cured, the treatment produced effect in 15 patients, and improvement could be found in two patients. For the control group, those three numbers were respectively 41, 16 and 3. The effectice rate was 100% in both groups. The difference of effect between the two groups was not statistically significant (Pgt;0.05), while the variation of blood pressure and heart rate and the visual analogue scales in the treatment group were significant lower than these in the control gvroup (Plt;0.05) Conclusion The dense silver needle acupuncture therapy combined with brachial plexus nerve block is safe and effective in treating old patients with shoulder periarthritis.
ObjectiveTo evaluate the methods and effectiveness of contralateral C7 nerve root and multiple nerves transfer for the treatment of brachial plexus root avulsion. MethodsBetween June 2006 and June 2010, 23 patients with brachial plexus root avulsion were treated. There were 20 males and 3 females, aged 17 to 42 years (mean, 27.4 years). The time from injury to operation was 4 to 12 months (mean, 5.9 months). In 16 patients having no associated injury, the first stage procedure of contralateral C7 nerve root transfer and accessory nerve transfer to suprascapular nerve or phrenic nerve transfer to anterior upper trunk was performed, and the second stage procedure of the contralateral C7 nerve root transfer to median nerve and intercostal nerve transfer to axillary nerve was performed. In 4 patients having phrenic nerve and accessory nerve injuries, the first stage procedure of the contralateral C7 nerve root transfer and second stage procedure of the contralateral C7 nerve root transfer to median nerve and musculocutaneous nerve were performed. In 3 patients having hemothorax, pneumothorax, and rib fractures, the first stage procedure of the contralateral C7 nerve root transfer and accessory nerve transfer to suprascapular nerve, and the second stage procedure of the contralateral C7 nerve root transfer to median nerve and musculocutaneous nerve were performed. The British Medical Research Council (MRC) sensory grading (S0-S4) and modified muscle strength grading standard (M0-M5) were used for comprehensive assessment of limb and shoulder abduction, elbow/biceps muscle strength, flexor wrist and finger muscle strength and median nerve sensory recovery. ResultsTwenty-three patients were followed up 3-4.5 years (mean, 3.4 years). At 3 years after operation, the shoulder abduction reached 0-82°(mean, 44°). In 16 patients having no associated injuries, the shoulder abduction was more than 30°in 13 cases, and was more than 60°in 3 cases; in 3 patients having hemothorax, pneumothorax, and rib fractures, the shoulder abduction was more than 30°; and in 4 patients having phrenic nerve and accessory nerve injuries, the shoulder abduction was 0°. The muscle strength of elbow/biceps was M3 or more than M3 in 9 cases, was M1-M2 in 8 cases, and was M0 in 6 cases; the muscle strength of flexor wrist or finger was M3 or more than M3 in 7 cases, was M1-M2 in 11 cases, and was M0 in 5 cases. Median nerve sensory recovery was S3 or more than S3 in 11 cases, was S1-S2 in 7 cases, and was S0 in 5 cases. After 3 years, affected limb had locomotor activity in 11 patients, affected limb had activities driven by the contralateral latissimus dorsi muscle contraction in 12 patients. ConclusionContralateral C7 nerve root and multiple nerves transfer is a good method to treat brachial plexus root avulsion.
Objective To investigate the quantity and distribution of motor fiber of rat’s C7 nerve root. Methods Motor fiber quantity and section area in the main nerves of the upper extremity and the fascicles of C7 in 30 SD rats were analyzed.Results Fascicles and certain amount (207) of motor fibers from the anterior division of C7 were distributed to musculocutaneous nerve and median nerve, the orientation of these fibers were not clear. The ones (323) from posterior division were to the axillary, radial, and dorsal thoracic nerves, thus the orientation of these fascicles was relatively definite. Conclusion Thedistribution of the motor fibers and fascicles in the divisions of C7 in rat is similar to human beings, so rat is a relatively good model for the study of selective C7 nerve root transfer.
OBJECTIVE To explore the regularity of the change of S-100 protein in degenerative nerve after different pathological brachial plexus injuries. METHODS Eighty SD rats were randomly divided into two groups, right C5, C6 preganglionic injury, and postganglionic injury. The distribution and content of S-100 protein in distal degenerative nerve were detected after 1, 2, 3 and 6 months of injury by immunohistochemical methods. RESULTS The S-100 protein was mainly distributed along the axons. The S-100 protein positive axons of each time interval decreased after operation, with significant difference from normal nerves (P lt; 0.01). There was no statistically significant difference among 1, 2, 3 and 6 months group (P gt; 0.05). The S-100 protein stain of postganglionic group was negative. CONCLUSION In preganglionic injury, the functional expression of Schwann’s cells in the distal stump keeps at a certain level and for a certain period. Since Schwann’s cell has inductive effect on nerve regeneration, it suggests that the distal nerve stump in preganglionic injury can be used as nerve grafts.
摘要:目的: 探讨臂丛神经磁共振成像的技术方法及其可行性。 方法 :对15例正常志愿者行双侧臂丛神经成像:包括常规快速自旋回波序列T1加权(T1W/TSE)、快速自旋回波序列T2加权(T2W/TSE)、快速自旋回波序列T2加权加SPIR脂肪抑制(T2W/SPIR)冠状位扫描以及弥散加权背景抑制成像序列(DWIBS)轴位扫描。 结果 :T1W/TSE、T2W/TSE、及T2W/SPIR对臂丛节后神经同层显示率分别为533%、567%和833%;DWIBS MIP重建图像对臂丛神经的全貌显示较为完整、清晰、直观;T1W/TSE、T2W/TSE、T2W/SPIR及DWIBS MIP重建图像的对比噪声比分别为109±09、107±13、185±68和299±133,T2W/SPIR序列和DWIBS MIP重建图像的对比噪声比明显高于T1W/TSE和T2W/TSE序列。 结论 :T2W/SPIR序列对臂丛神经的同层显示率及图像的对比噪声比明显高于常规T1W/TSE、T2W/TSE序列, DWIBS MIP重建图像能够显示臂丛神经的全貌,两者为臂丛神经成像较为有效的技术方法,对于臂丛神经病变的诊断即具有十分重要的意义。Abstract: Objective: To determine the optimal sequences of brachial plexus with MRI. Methods : Fifteen volunteers were underwent MRI on 15T scanner, the Sequences of T1W/TSE/COR, T2W/TSE/COR, T2W/SPIR/COR and Diffusionweighted imaging with background body signal suppression were performed. Results : The display rates of brachial plexus postganglionic segment nerve showing at the same slice were 533%, 567% and 833% on T1W/TSE/COR, T2W/TSE/COR, T2W/SPIR/COR. Brachial plexus on DWIBS MIP were clear and complete. Contrastnoise ratio of four sequences was 109±09, 107±13, 185±68 and 299±133,respectively. Contrastnoise ratio of T2W/SPIR/COR and DWIBS MIP was significantly higher than that of the other two sequences. Conclusion : Display rate of brachial plexus and contrastnoise ratio of images on T2W/SPIR/COR were higher than those of routine sequences. Image of DWIBS MIP can show the outline of brachial plexus clearly. The two sequences were reliable and effetive techoniquic in diagnosis of brachial plexus lesion.
The report of brachial plexus injuries following radical mastectomy in patients with breast cancer was rare even though the operation was a main measure in treating with breast cancer. Nine patients treated from Oct. 1989 to Feb.1991 were summarized. The results were not ideal.