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.
Objective To know the possibility of nerveregeneration after artery sleeve anastomosis and end-to-side suture Methods Seventy-five SD rats were divided into 5 groups. First, the distal end ofsevered peroneal nerve was sutured end-to -side with artery sleeve anastomosis withnormal nerve tibial trunk in groups A, B, C and D. Second, the tibial epineurium at the suture site was not removed in group A; the epineurium at the suturesite was removed(windowing) in group B; the distal end of pre-injured peroneal nerve was sutured after 14 days and windowing was done in group C; and the neural growth factor was injected into artery sleeve and windowing was done in group D. While the distal end of severed peroneal nerve was sutured end to side directly with normal nerve tibial trunk and windowing was done in group E. The histological observation was made and the number of nerve fibers was recorded after 4, 8 and 12 weeks of operation.Results After 4 weeks, there existed the regeneration of axons and myeline sheaths in groups C, D, E, and no nerve fiber regeneration was seen in group A. After 8 weeks, the regenerating nerve fibers were significantly more in groups C, D and E than in group B and ingroup E than groups C and D(Plt;0.05). After 12 weeks, the regenerating nervefibers were significantly more in groups C，D and E than in group B(Plt;0.05).Conclusion End-to-side coaptation with artery sleeve anastomosis is a new valuable method in repair of peripheral nerve injuries.
【Abstract】 Objective To observe the distribution feature of nerve bundles in C7 nerve anterior and posterior division end. Methods The brachial plexus specimen was harvested from 1 fresh adult cadaver. After C7 nerve was confirmed, the distal end of anterior and posterior division was dissected and embedded by OCT. Then the samples were serially horizontally sliced with each 10 μm deep. After acetylcholinesterase (AChE) histochemical staining, the stain characteristics of different nerve fiber bundles were observed and amount of the nerve fiber bundles were counted under optic-microscope. At last, the imaging which were collected were three-dimensional (3-D) reconstructed by using Amira 4.1 software. Results There was no obvious difference in the stain between the anterior and posterior divisions. The running of the nerve fiber bundles were dispersive from proximal end of nerve to distal end of nerve. Nerve fiber bundles of anterior division were mainly sensor nerve fiber bundles, which located in medial side. Nerve fiber bundles of posterior division were mainly moter nerve fiber bundles, having no regularity in the distribution of nerve fiber bundles. The total number of nerve fiber bundles in distal end of anterior division was 7.85 ± 1.04, the number of motor nerve fiber bundles was 2.85 ± 0.36, and the number of sensor nerve fiber bundles was 5.13 ± 1.01. The total number of nerve fiber bundles in distal end of posterior division was 9.79 ± 1.53, the number of motor nerve fiber bundles was 6.00 ± 0.69, and the number of sensor nerve fiber bundles was 3.78 ± 0.94. There were significant differences in the numbers of motor and sensor nerve fiber bundles between anterior and posterior divisions (P lt; 0.05). The microstructure 3-D model was reconstructed based on serial slice through Amira 4.1. The intercross and recombination process of nerves bundles could be observed obviously. The nerve bundle distribution showed cross and combination. Conclusion Nerve fiber bundles of anterior division are mainly sensor nerve fiber bundles and locate in medial side. Nerve fiber bundles of posterior division are mainly motor nerve fiber bundles, which has no regularity in the distribution of nerve fiber bundles. The 3-D reconstruction can display the internal structure feature of the C7 division end.