Successful polyethylene glycol fusion(PEG-fusion)of severed axons following peripheral nerve injuries for PEG-fused axons has been reported to:(1)rapidly restore electrophysiological continuity;(2)prevent distal Walle...Successful polyethylene glycol fusion(PEG-fusion)of severed axons following peripheral nerve injuries for PEG-fused axons has been reported to:(1)rapidly restore electrophysiological continuity;(2)prevent distal Wallerian Degeneration and maintain their myelin sheaths;(3)promote primarily motor,voluntary behavioral recoveries as assessed by the Sciatic Functional Index;and,(4)rapidly produce correct and incorrect connections in many possible combinations that produce rapid and extensive recovery of functional peripheral nervous system/central nervous system connections and reflex(e.g.,toe twitch)or voluntary behaviors.The preceding companion paper describes sensory terminal field reo rganization following PEG-fusion repair of sciatic nerve transections or ablations;howeve r,sensory behavioral recovery has not been explicitly explored following PEG-fusion repair.In the current study,we confirmed the success of PEG-fusion surgeries according to criteria(1-3)above and more extensively investigated whether PEG-fusion enhanced mechanical nociceptive recovery following sciatic transection in male and female outbred Sprague-Dawley and inbred Lewis rats.Mechanical nociceptive responses were assessed by measuring withdrawal thresholds using von Frey filaments on the dorsal and midplantar regions of the hindpaws.Dorsal von Frey filament tests were a more reliable method than plantar von Frey filament tests to assess mechanical nociceptive sensitivity following sciatic nerve transections.Baseline withdrawal thresholds of the sciatic-mediated lateral dorsal region differed significantly across strain but not sex.Withdrawal thresholds did not change significantly from baseline in chronic Unoperated and Sham-operated rats.Following sciatic transection,all rats exhibited severe hyposensitivity to stimuli at the lateral dorsal region of the hindpaw ipsilateral to the injury.However,PEG-fused rats exhibited significantly earlier return to baseline withdrawal thresholds than Negative Control rats.Furthermore,PEG-fused rats with significantly improved Sciatic Functional Index scores at or after 4 weeks postoperatively exhibited yet-earlier von Frey filament recove ry compared with those without Sciatic Functional Index recovery,suggesting a correlation between successful PEG-fusion and both motor-dominant and sensory-dominant behavioral recoveries.This correlation was independent of the sex or strain of the rat.Furthermore,our data showed that the acceleration of von Frey filament sensory recovery to baseline was solely due to the PEG-fused sciatic nerve and not saphenous nerve collateral outgrowths.No chronic hypersensitivity developed in any rat up to 12 weeks.All these data suggest that PEG-fusion repair of transection peripheral nerve injuries co uld have important clinical benefits.展开更多
目的:观察小切口尺神经原位有限松解术治疗中重度肘管综合征的临床疗效和安全性。方法:2022年9月至2024年4月,采用小切口尺神经原位有限松解术治疗中重度肘管综合征患者34例。男17例,女17例;年龄35~70岁,中位数45岁;左侧15例,右侧19例;...目的:观察小切口尺神经原位有限松解术治疗中重度肘管综合征的临床疗效和安全性。方法:2022年9月至2024年4月,采用小切口尺神经原位有限松解术治疗中重度肘管综合征患者34例。男17例,女17例;年龄35~70岁,中位数45岁;左侧15例,右侧19例;顾玉东肘管综合征分型,中度16例、重度18例;病程1~9年,中位数5年。术中切开尺神经外膜松解尺神经,切开处不超过尺神经外膜周径的1/2。记录患者手术时间、术中出血量、切口长度及住院时间,观察切口愈合及并发症发生情况。分别于术前和末次随访时,检测患肢握力和拇示指捏力,测量肘关节活动度(0度法)和尺神经运动传导速度(肘上—肘下段),采用臂、肩、手功能障碍(disabilites of the arm,shoulder,and hand,DASH)评分评价患肢功能。末次随访时,依据顾玉东肘管综合征功能评定标准评价综合疗效。结果:本组34例患者均顺利完成手术,手术时间(36.24±5.89)min,术中出血量(5.50±1.71)mL,切口长度(3.76±0.52)cm,住院时间(5.47±1.07)d。所有患者均获随访,随访时间5~7个月,中位数6个月。切口均愈合。术后并发切口血肿1例,经抬高患肢、冷敷等对症处理后血肿消散;并发切口瘢痕增生1例,患者为瘢痕体质,未进行特殊处理。术前和末次随访时,患肢握力分别为(211.54±30.90)N、(290.81±28.33)N,拇示指捏力分别为(21.13±7.75)N、(40.91±9.43)N;肘关节最大伸直角度分别为20.64°±6.13°、13.64°±6.99°,肘关节最大屈曲角度分别为106.23°±11.23°、115.11°±11.95°;尺神经运动传导速度分别为(28.89±3.10)m·s^(-1)、(36.00±2.20)m·s^(-1);DASH评分分别为(53.39±10.49)分、(33.99±7.36)分。末次随访时,顾玉东肘管综合征功能评分(11.24±2.70)分,优15例、良17例、可1例、差1例。结论:采用小切口尺神经原位有限松解术治疗中重度肘管综合征,有利于提高尺神经运动传导速度,增加患肢握力、拇示指捏力和肘关节活动度,提高患者日常生活能力,且手术损伤小、并发症少。展开更多
目的回顾性分析肘外翻畸形导致肘管综合征的相关因素,为肘管综合征临床治疗提供理论依据。方法 2002年6月-2008年9月,对40例肘外翻畸形导致肘管综合征患者采用肘管尺神经松解前移术治疗,手术前后分别采用Yokohama City University肘管...目的回顾性分析肘外翻畸形导致肘管综合征的相关因素,为肘管综合征临床治疗提供理论依据。方法 2002年6月-2008年9月,对40例肘外翻畸形导致肘管综合征患者采用肘管尺神经松解前移术治疗,手术前后分别采用Yokohama City University肘管综合征评分标准对尺神经功能进行评分。采用logistic回归分析影响尺神经损害和预后的相关因素。结果 40例患者获随访12～75个月,平均27.5个月。影响尺神经损害严重程度的相关因素有:肘外翻畸形持续时间(OR=1.005,P=0.045)、肘外翻角度(OR=9.374,P=0.000)和肌肉萎缩持续时间(OR=4.358,P=0.010)。影响尺神经炎预后的相关因素有:肌肉萎缩持续时间(OR=8.489,P=0.000)、肘外翻角度(OR=2.802,P=0.030)和手术时患者年龄(OR=4.611,P=0.031)。结论影响尺神经损害严重程度的相关因素有肘外翻畸形持续时间、肘外翻角度和肌肉萎缩持续时间。影响尺神经炎预后的相关因素有手术时患者年龄、肘外翻角度和肌肉萎缩持续时间。对肘外翻畸形导致的肘管综合征患者应早诊断,并及早行肘管尺神经松解前移手术治疗。展开更多
基金supported by DOD AFIRMⅢW81XWH-20-2-0029 subcontract,UT POC19-1774-13Neuraptive Therapeutics Inc.26-7724-56+1 种基金NIH R01-NS128086 grantsLone Star Paralysis gift(to GDB)。
文摘Successful polyethylene glycol fusion(PEG-fusion)of severed axons following peripheral nerve injuries for PEG-fused axons has been reported to:(1)rapidly restore electrophysiological continuity;(2)prevent distal Wallerian Degeneration and maintain their myelin sheaths;(3)promote primarily motor,voluntary behavioral recoveries as assessed by the Sciatic Functional Index;and,(4)rapidly produce correct and incorrect connections in many possible combinations that produce rapid and extensive recovery of functional peripheral nervous system/central nervous system connections and reflex(e.g.,toe twitch)or voluntary behaviors.The preceding companion paper describes sensory terminal field reo rganization following PEG-fusion repair of sciatic nerve transections or ablations;howeve r,sensory behavioral recovery has not been explicitly explored following PEG-fusion repair.In the current study,we confirmed the success of PEG-fusion surgeries according to criteria(1-3)above and more extensively investigated whether PEG-fusion enhanced mechanical nociceptive recovery following sciatic transection in male and female outbred Sprague-Dawley and inbred Lewis rats.Mechanical nociceptive responses were assessed by measuring withdrawal thresholds using von Frey filaments on the dorsal and midplantar regions of the hindpaws.Dorsal von Frey filament tests were a more reliable method than plantar von Frey filament tests to assess mechanical nociceptive sensitivity following sciatic nerve transections.Baseline withdrawal thresholds of the sciatic-mediated lateral dorsal region differed significantly across strain but not sex.Withdrawal thresholds did not change significantly from baseline in chronic Unoperated and Sham-operated rats.Following sciatic transection,all rats exhibited severe hyposensitivity to stimuli at the lateral dorsal region of the hindpaw ipsilateral to the injury.However,PEG-fused rats exhibited significantly earlier return to baseline withdrawal thresholds than Negative Control rats.Furthermore,PEG-fused rats with significantly improved Sciatic Functional Index scores at or after 4 weeks postoperatively exhibited yet-earlier von Frey filament recove ry compared with those without Sciatic Functional Index recovery,suggesting a correlation between successful PEG-fusion and both motor-dominant and sensory-dominant behavioral recoveries.This correlation was independent of the sex or strain of the rat.Furthermore,our data showed that the acceleration of von Frey filament sensory recovery to baseline was solely due to the PEG-fused sciatic nerve and not saphenous nerve collateral outgrowths.No chronic hypersensitivity developed in any rat up to 12 weeks.All these data suggest that PEG-fusion repair of transection peripheral nerve injuries co uld have important clinical benefits.
文摘目的:观察小切口尺神经原位有限松解术治疗中重度肘管综合征的临床疗效和安全性。方法:2022年9月至2024年4月,采用小切口尺神经原位有限松解术治疗中重度肘管综合征患者34例。男17例,女17例;年龄35~70岁,中位数45岁;左侧15例,右侧19例;顾玉东肘管综合征分型,中度16例、重度18例;病程1~9年,中位数5年。术中切开尺神经外膜松解尺神经,切开处不超过尺神经外膜周径的1/2。记录患者手术时间、术中出血量、切口长度及住院时间,观察切口愈合及并发症发生情况。分别于术前和末次随访时,检测患肢握力和拇示指捏力,测量肘关节活动度(0度法)和尺神经运动传导速度(肘上—肘下段),采用臂、肩、手功能障碍(disabilites of the arm,shoulder,and hand,DASH)评分评价患肢功能。末次随访时,依据顾玉东肘管综合征功能评定标准评价综合疗效。结果:本组34例患者均顺利完成手术,手术时间(36.24±5.89)min,术中出血量(5.50±1.71)mL,切口长度(3.76±0.52)cm,住院时间(5.47±1.07)d。所有患者均获随访,随访时间5~7个月,中位数6个月。切口均愈合。术后并发切口血肿1例,经抬高患肢、冷敷等对症处理后血肿消散;并发切口瘢痕增生1例,患者为瘢痕体质,未进行特殊处理。术前和末次随访时,患肢握力分别为(211.54±30.90)N、(290.81±28.33)N,拇示指捏力分别为(21.13±7.75)N、(40.91±9.43)N;肘关节最大伸直角度分别为20.64°±6.13°、13.64°±6.99°,肘关节最大屈曲角度分别为106.23°±11.23°、115.11°±11.95°;尺神经运动传导速度分别为(28.89±3.10)m·s^(-1)、(36.00±2.20)m·s^(-1);DASH评分分别为(53.39±10.49)分、(33.99±7.36)分。末次随访时,顾玉东肘管综合征功能评分(11.24±2.70)分,优15例、良17例、可1例、差1例。结论:采用小切口尺神经原位有限松解术治疗中重度肘管综合征,有利于提高尺神经运动传导速度,增加患肢握力、拇示指捏力和肘关节活动度,提高患者日常生活能力,且手术损伤小、并发症少。
文摘目的回顾性分析肘外翻畸形导致肘管综合征的相关因素,为肘管综合征临床治疗提供理论依据。方法 2002年6月-2008年9月,对40例肘外翻畸形导致肘管综合征患者采用肘管尺神经松解前移术治疗,手术前后分别采用Yokohama City University肘管综合征评分标准对尺神经功能进行评分。采用logistic回归分析影响尺神经损害和预后的相关因素。结果 40例患者获随访12～75个月,平均27.5个月。影响尺神经损害严重程度的相关因素有:肘外翻畸形持续时间(OR=1.005,P=0.045)、肘外翻角度(OR=9.374,P=0.000)和肌肉萎缩持续时间(OR=4.358,P=0.010)。影响尺神经炎预后的相关因素有:肌肉萎缩持续时间(OR=8.489,P=0.000)、肘外翻角度(OR=2.802,P=0.030)和手术时患者年龄(OR=4.611,P=0.031)。结论影响尺神经损害严重程度的相关因素有肘外翻畸形持续时间、肘外翻角度和肌肉萎缩持续时间。影响尺神经炎预后的相关因素有手术时患者年龄、肘外翻角度和肌肉萎缩持续时间。对肘外翻畸形导致的肘管综合征患者应早诊断,并及早行肘管尺神经松解前移手术治疗。
