Objective To provide anatomy evidence of the simple injury of the deep branch of the unlar nerve for cl inical diagnosis and treatments. Methods Fifteen fresh samples of voluntary intact amputated forearms with no deformity were observed anatomically, which were mutilated from the distal end of forearm. The midpoint of the forth palm fingerweb wasdefined as dot A , the midpoint of the hook of the hamate bone as dot B, the ulnar margin of the flexor digitorum superficial is of the l ittle finger as OD, and the superficial branch of the unlar nerve and the forth common finger digital nerve as OE, dot O was the vertex of the triangle, dot C was intersection point of a vertical l ine passing dot B toward OE; dot F was the intersection point of CB’s extension l ine and OD. OCF formed a triangle. OCF and the deep branch of the unlar nerve were observed. From May 2000 to June 2007, 3 cases were treated which were all simple injury of the deep branch of the unlar nerve by glass, diagnosed through anatomical observations. The wounds were all located in the hypothenar muscles, and passed through the distal end of the hamate bone. Muscle power controlled by the unlar nerve got lower. The double ends was sewed up in 2 cases directly intra operation, and the superficial branch of radial nerve grafted freely in the other 1 case. Results The distance between dot B and dot O was (19.20 ± 1.30) mm. The length of BC was (7.80 ± 1.35) mm. The morpha of OCF was various, and the route of profundus nervi ulnaris was various in OCF. OCF contains opponens canales mainly. The muscle branch of the hypothenar muscles all send out in front of the opponens canales. The wounds of these 3 cases were all located at the distal end of the hook of the hamate bone, intrinsic muscles controlled by the unlar nerve except hypothenar muscles were restricted without sensory disorder or any other injuries. Three cases were followed up for 2 months to 4 years. Postoperation, the symptoms disappeared, holding power got well, patients’ fingers were nimble. According to the trial standard of the function of the upper l imb peripheral nerve establ ished by Chinese Medieal Surgery of the Hand Association, the synthetical evaluations were excellent.Conclusion Simple injuries of the deep branch of the unlar nerve are all located in OCF; it is not easy to be diagnosed at the early time because of the l ittle wounds, the function of the hypothenar muscles in existence and the normal sense .
Objective To evaluate the feasibil ity of direct anastomosis in the rat model of the brachial plexus extravertebral foramen nerve root division of C5-7. Methods Forty-eight SD rats (male or female) aging 4-6 months and weighing 250-300 g were selected to make the model of extravertebral foramen nerve root division of C5-7. The left C5-7 nerve roots, as the experimental sides, were separated to the brachial plexus nerve trunk and the transected roots were sutured to theproximal stump immediately after cutting off the brachial plexus extravertebral foramen nerve root division. The right C5-7nerve roots, as the control sides, received no operation. The general condition of rats after operation was observed. The gross observation, the histological observation and BDA nerve tracing technology were adopted to observe the wet weight of musculus biceps brachii, the cross section of biceps brachii and the spinal cord and distal nerve trunk at 3 weeks, 3 months and 6 months after operation. Results All rats survived well after operation. Claudication and unfold claw reflex were observed in the experimental sides, and the unfold claw reflex disappeared 3 months later. Comparatively, the control sides were normal. Nerve adhesion aggravated gradually and the neural stems were shriveled within 6 months after operation in the experimental sides. Comparatively, the control sides were normal. The wet weight of biceps brachii in the experimental sides and the control sides at 3 weeks, 3 months and 6 months after operation was (0.28 ± 0.12), (1.37 ± 0.33), (0.58 ± 0.10), (1.36 ± 0.35), (1.39 ± 0.31), (1.37 ± 0.38) g, respectively, indicating significant differences between two sides at 3 weeks and 3 months (P lt; 0.05), but no significant difference at 6 months (P gt; 0.05). The modified Marsland and the LFB staining of spinal cord and superior trunk of brachial plexus showed that the number of neurons, cell nuclear and Nissl body decreased and cell bodies changed from swell ing to shrinkage, dyeing nerve fibers increased, neural axone was thin and myel in sheath was sl ightly stained at each time point in experimental side. The number of motor neurons in cornu anterius medullae spinal is in the experimental side was 84.5% ± 3.2%, 74.4% ± 4.5%, 73.7% ± 3.8% of that in the control side at each time point, respectively. HE staining of biceps brachii detected thatthe muscle denaturation was very serious at 3 months after operation and then recovered. Neural tracing used BDA showed that the closer to the proximal of nerve trunk, the more obviously stained it was of myel in sheath and the more massive of axon at 6 months after operation. And there was almost no myel in and axon stained in musculocutaneous nerve. Conclusion In the rat model of brachial plexus extravertebral foramen nerve root division, the motoneuron in cornu anterius medullae spinal is necrosis rate reaches 20%-30%, and most of the residual neurons are pathologic. The regenerated fibers manifest as insufficient dynamic power and incomplete development, making no sense for the recovery of end organ function. Therefore, the exact mechanism of the recovery of biceps brachial muscle demands further study.
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.
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.
ObjectiveTo investigate the management strategies of clavicular fracture combined with brachial plexus injury and its effectiveness. MethodsBetween January 2006 and January 2012, 27 cases of clavicular fracture combined with brachial plexus injury were treated. There were 18 males and 9 females, aged 18-42 years (mean, 25.3 years). The causes of injury were traffic accident in 12 cases, falling from height in 10 cases, bruise in 3 cases, machinery injury in 2 cases. According to the Robinson classification, the clavicular fractures were rated as type Ⅰ in 2 cases, as typeⅡin 20 cases, and as type Ⅲ in 5 cases; there were 12 cases of total brachial plexus root avulsion injury, 10 cases of bundle branch injury, and 5 cases of hematoma formation and local nerve compression or injury. The injury to operation time was 6 hours to 14 days (mean, 4 days). Brachial plexus injury was repaired by epineurium neurolysis, nerve anastomosis, or nerve transposition after the exploration of the plexus; and fracture was fixed after open reduction. Sensory grading standard (S0-S4) by UK Medical Research Council (MRC) was used to evaluate the recovery of sensory function, and muscle strength grading standard (M0-M5) by MRC to evaluate the innervating muscle strength. ResultsThe incisions healed by first intention. All patients were followed up 18-36 months (mean, 26.3 months). All fracture achieved cl inical healing at 12-17 weeks (mean, 15 weeks). No complication of loosening or breakage of internal fixation occurred. The patients had no pain of shoulder in abduction. At 18 months after operation, the shoulder abduction was more than or equal to 60° in 8 cases, 30-60° in 8 cases, and less than 30° in 11 cases. The recovery of biceps muscle strength was more than or equal to M3 in 18 cases and less than M3 in 9 cases; the recovery of wrist flexion or flexor muscle strength was more than or equal to M3 in 13 cases and less than M3 in 14 cases. The sensory function recovery of median nerve was S3 in 14 cases, S1-S2 in 9 cases, and S0 in 4 cases. The shoulder abduction, elbow and wrist flexor motor function did not recover in 2 patients with total brachial plexus root avulsion injury. ConclusionIt is beneficial to the recovery of nerve function to early repair of the brachial plexus injury by exploration of the plexus combined with open reduction and fixation of clavicular fractures, the short-term effectiveness is good.
ObjectiveTo investigate the mechanisms,diagnosis,and surgical procedures of simultaneous lesions of the rotator cuff and the brachial plexus. MethodsBetween July 2006 and June 2012,7 patients with rotator cuff tear associated with brachial plexus injury were treated.There were 3 males and 4 females with a mean age of 47.3 years (range,37-72 years).The reasons of injury were traumatic shoulder dislocation in 6 cases and falling injury from height in 1 case,with a mean disease duration of 17 days (range,5-31 days).The average American Shoulder and Elbow Surgeons (ASES) score was 55.86±9.42,and visual analogue scale (VAS) score was 7.14±1.35.There were 3 cases of large rotator cuff tears (>3 cm) and 4 cases of massive rotator cuff tears (>5 cm) according to Gerber standard;1 case had upper trunk injury of the brachial plexus and 6 cases had bundle branch injury of the brachial plexus according to GU Yudong's classification.The functional score of brachial plexus score was 7.43±1.27 according to the functional assessment standard by Hand Surgery Branch of Chinese Medical Association.All patients accepted arthroscopic rotator cuff repairing,and 1 case received surgical neurolysis of brachial plexus. ResultsAll incisions healed by first intention without complication.All the 7 patients were followed up 18 to 25 months (mean,20.4 months).The function,muscle strength,and sensation of the shoulder were improved obviously.The shoulder ASES score was 84.71±8.06 and was significantly better than preoperative score (t=-8.194,P=0.000).The VAS score was 2.71±1.50 and was significantly better than preoperative score (t=7.750,P=0.000).The functional score of brachial plexus was 14.00±1.16 and was significantly better than preoperative score (t=-11.500,P=0.000). ConclusionIt is difficult to simultaneously diagnose lesions of the rotator cuff and the brachial plexus;orthopedists should pay attention to possible patients to avoid missed diagnosis and diagnostic errors.Nerve nutrition,physical therapy,and arthroscopic rotator cuff repair can achieve good effectiveness.