Ten cases of neurotmesis of posterior interosseous nerve of the forearm were treated with mierosurgical technique from Aug, 1988 to Oct. 1990, of which, 4 cases by autogenous nerve graft and 6 cases by direct neurosuture. Eight cases have been followed-up from 4 months to 1 year after operation concerning with satisfactory results. Some questions the diagnosis, the points for attention in operation, and the relation of the results and the time when the operation done were discussed. The comparison of the results and the recovery time between the autogenous-nerve graft and direct neurosuture was made.
Since Ⅰ982, Twenty-five cases of birth injuries of brachial plexus have been treated by microsurgical technipue. The satisfactory result has been obtained. The excellent and good rate are 76 per cent. The operative method included endoneurolysis, anastomosis of nerve, supraclavicular nerve grafting and transposition of phrenic nerve, accessory nerve and cervix motor nerve. In this article, the early diagnosis and differentiel diagnosis, practical physical examination method, and operative technipue were descused.
Objective To study an effect of the peripheral nerve allograft with subcutaneous preservation at different times on the sciatic nerve regenerationin rats. Methods Fifty-five Wistar rats were used in this experiment, which were randomly divided into the following 5 groups: the experimental groups (Groups A, B, C, 10 rats), the control group (Group D, 10 rats), and the donorgroup (Group E, 15 rats). In the experimental groups, a 15-mm segment of the sciatic nerve harvested from the donors was separately inserted into the subcutaneous compartment on the left thigh after the 1week (Group A), 2-week (Group B), and 3week (Group C) preservation; the segment of the sciatic nerve in the subcutaneous compartment was removed and transplanted into a 10-mm defect of theright sciatic nerve, which was made immediately. In Group D, a 10-mm sciatic nerve defect was made and immediately repaired in situ on the right thigh. The function of the sciatic nerve was evaluated by the sciatic functional index (SFI) at 2, 4, 6, 8, 10 and 12 weeks after operation. The histological and electrophysiological examinations were performed at 12 weeks after operation. Results After operation, SFI decreased gradually at 12 weeks afteroperation, SFI inGroups A and D was at the minimal level and had a significant difference compared with that in Groups B and C (Plt;0.05).There was no significant difference between Group A and Group D. A large number of the myelinated nerve fibers and a small number of the unmyelinated nerve fibers were regenerated in Groups A and D. The number and the structure of the regenerated nerve were similar to the normal ones. The number and the size of the regenerated axon had a significant difference compared with those in Groups B and C (Plt;0.05). There was no significant difference between Group A and Group D. The conduction velocity and the latent period of the motor nerve had significant differences between Groups A and D and Groups B and C (Plt;0.05), and there was no significant difference betweenGroupA and Group D. Conclusion The nerve allograft with a 1-weeksubcutaneous preservation can promote nerve regeneration better.
ObjectiveTo review and analyze the long-term results of delayed repair of median nerve injury. MethodsBetween January 2004 and December 2008, 228 patients with median nerve injury undergoing delayed repair were followed up for more than 4 years, and the clinical data were retrospectively analyzed. There were 176 males (77.19%) and 52 females (22.81%), aged 2-71 years (median, 29 years). The main injury reason was cutting injury in 159 cases (69.74%);203 cases had open injury (89.04%). According to the injury level, injury located at area I (upper arm) in 38 cases (16.67%), at area II (elbow and proximal forearm) in 53 cases (23.25%), at area III (anterior interosseous nerve) in 13 cases (5.70%), and at area IV (distal forearm to wrist) in 124 cases (54.39%). The delayed operations included delayed suture (50 cases, 21.93%), nerve release (149 cases, 65.35%), and nerve graft (29 cases, 12.72%). ResultsFor patients with injury at area I and area II, the results were good in 23 cases (25.27%), fair in 56 cases (61.54%), and poor in 12 cases (13.18%) according to modified Birch and Raji’s median nerve grading system;there was significant difference in the results between 3 repair methods for injury at area II (χ2=6.228, P=0.044), but no significant difference was found for injury at area I (χ2=2.241, P=0.326). Twelve patients (13.18%) needed musculus flexor functional reconstruction. Recovery of thenar muscle was poor in all patients, but only 5 cases (5.49%) received reconstruction. Thirteen cases of nerve injury at area III had good results, regardless of the repair methods. For patients with injury at area IV, the results were excellent in 6 cases (4.84%), good in 22 cases (17.74%), fair in 72 cases (58.06%), and poor in 24 cases (19.35%) according to Birch and Raji’s grading system;there was significant difference in the results between 3 repair methods (χ2=12.646, P=0.002), and the result of delayed repair was better. ConclusionThe results of delayed repair is poor for all median nerve injuries, especially for high level injury. The technique of repair methods vary with injury level. For some delayed median nerve injuries, early nerve transfer may be a better choice for indicative patients.
Objective o study the feasibility of homologous vascularized nerve transplantation after ultra deep cryopreservation. Methods Vascularized sciatic nerve from 12 female dogs was transplanted after ultra deep cryopreservation. Fortyeight male dogs were divided into 4 groups: ultra deep cryopreservation homologous vascularized nerve (group A), ultra deep cryopreservation homologous nerve (group B), fresh homologous vascularized nerve (group C), and fresh autologous vascularized nerve (group D). The gross appearance, patency rate of arteryand morphological transplanted nerve were observed 1, 4 and 12 weeks after transplantation respectively. Immunological analysis was performed using IL 2 assay and T lymphocyte subpopulations assay after 4 weeks. Image pattern analysis andelectromyogram were observed after 12 weeks. Results In groups A and D, no toe ulcer occurred, the atrophy of later limb and the sense of pain from skin of calf were restore significantly in the postoperative 12th week. In groups B and C, toe ulcer occurred, the atrophy of later limb and the sense of pain from skin of calf were not restored significantly in the postoperative 12thweek. The vessel patency rate of groups A and D was 83.3%, which was significantly higher than that of group C (50%,Plt;0.05). The changes of IL2 and Th, Ts in group C were significantly higher than that in groups A,B,D(Plt;0.01). There were increased vessel and regenerated nerve in transplanted nerve under optical microscope and image pattern analysis in groups A and D. There were shorter latent period of motor evoked potential, greater amplitude of action potenlial and faster motor nerve conducting velocity in groups A and D after 12 weeks. Conclusion The antigenicity of the homologous never and vessel may be reduced significantly by being frozen, and cryopreserved vascularized nerve can transferred successfully without the use of immunosuppressive agents. Vascularized nerve may restore good significantly for the thick nerve.
ObjectiveTo investigate the effects of the first neuron connection for the reconstruction of lower extremity function of complete spinal cord injury rats. MethodsForty adult female Sprague Dawley rats of 300-350 g in weight were selected to prepare the models of L1 transverse spinal cord injury. After 2 weeks of establishing model, the rats were randomly divided into control group (n=20) and experimental group (n=20). In the experimental group, the right hind limb function was reconstructed directly by the first neuron; in the control group, the other treatments were the same to the experimental group except that the distal tibial nerve and the proximal femoral nerve were not sutured. The recovery of motor function of lower extremity was observed by the Basso-Beattie-Bresnahan (BBB) scoring system on bilateral hind limbs at 7, 30, 50, and 70 days after operation. The changes of the spinal cord were observed by HE staining, neurofilament 200 immunohistochemistry staining, and the technique of horseradish peroxidase (HRP) tracing. ResultsAfter establishing models, 6 rats died. The right hind limb had no obvious recovery of the motor function, with the BBB score of 0 in 2 groups; the left hind limb motor function was recovered in different degrees, and there was no significant difference in BBB score between 2 groups (P>0.05). In the experimental group, HE staining showed that the spinal cord was reconstructed with the sciatic nerve, which was embedded in the spinal cord, and the sciatic nerve membrane was clearly identified, and there was no obvious atrophy in the connecting part of the spinal cord. In the experimental group, the expression of nerve fiber was stained with immunohistochemistry, and the axons of the spinal cord were positively by stained and the peripheral nerve was connected with the spinal cord. HRP labelled synapses were detected by HRP retrograde tracing in the experimental group, while there was no HRP labelled synapse in the control group. ConclusionDirect reconstruction of the first neurons is sufficient in the regeneration of corresponding neural circuit by the growth of residual axon; but the motor function recovery of the target muscles innervated by peripheral nerve is not observed.
Objective To investigate the research advance in repair of the peripheral nerve defect with an acellular nerve allograft. Methods The recent related literature was extensively and comprehensively reviewed. The methods and the effects of the allografts with acellular nerves were analyzed. Results The immunogenicity of the allograft was more significantly relieved by the chemical treatment than by the physicaltreatment. The effect of the chemical treatment on the axon regeneration was better than that of the physical treatment. Conclusion Because of the limitation of the host Schwann cell translation in the longsegment acellular nerve allografts, the effect of Schwann cells is not satisfactory and regeneration of the nerve is limited. So, the recellularized treatment with some related measures can enhance the host Schwann cell translation so that this problem can be solved.
Objective To observe the revascularization process of transplanted nerve after transplantation of long nerve and accompanying peri pheral vessels, to investigate its relationship with nerve regeneration. Methods The mediannerve defect models of the left forelimb (3 cm in length) were made in 60 New Zealand rabbits (aged 6-8 months, weighing 2.0-2.5 kg, and male or female), which were randomly divided into 2 groups (n=30). In situ anastomosis of the median nerves was performed in the control group; in situ anastomosis of the median nerves was made in parallel to the surrounding elbow veins, the transplanted epineurium and the adventitia were sutured with nerve anastomosis l ine in the experimental group. After operation, the gross observation, electrophysiological testing, and histopathology observation was performed at 1, 2, 4, 8, and 12 weeks, and transmission electron microscope at 12 weeks to observe the revascularization of nerve grafts, nerve fiber regeneration, and functional recovery. Results In the experimental group, revascularization was observed at 1 week after operation, and the degree of revascularization was significantly higher than that in the control group at 2, 4, 8, and 12 weeks. At 8 and 12 weeks, the nerve fiber regeneration speed, quality, and quantity in the experimental group were better than those in the control group. At 2, 4, 8, and 12 weeks, the nerve conduction velocities were (10.32 ± 0.94), (13.14 ± 1.22), (22.68 ± 1.16), and (24.09 ± 1.27) m/ s respectively in the experimental group, and were (9.18 ± 1.07), (11.12 ± 1.03), (19.81 ± 1.37), and (20.67 ± 1.19) m/s in the control group, showing significant difference at 12 weeks after operation (t=3.167, P=0.001). At 12 weeks in the experimental group, the myel in sheath had similar size, less sheath plate delamination, normal Schwann cells and rich organelles, in which normal microfilaments, microtubules and axonal mitochondria were observed; axonal mitochondria had clear crestfilm and no swelling and vacuolization, and the neurofibrils basically became normal. The myelinated nerve fibers area, myelin thickness, and axon diameter were (5.93 ± 0.94) mm2, (0.72 ± 0.12) μm, and (3.12 ± 0.12) μm respectively in the experimental group, and were (5.28 ± 0.72) mm2, (0.65 ± 0.09) μm, and (2.98 ± 0.16) μm respectively in the control group, all showing significant differences (t=3.736, P=0.002; t=3.271, P=0.002; t=4.533, P=0.001). Conclusion The transplanted nerves in parallel to large blood vessels can promote angiogenesis of the transplanted nerve, and accelerate the regeneration and functional recovery of the nerves.