Lower extremity nerve transposition repair has become an important treatment strategy for peripheral nerve injury;however, brain changes caused by this surgical procedure remain unclear. In this study, the distal stum...Lower extremity nerve transposition repair has become an important treatment strategy for peripheral nerve injury;however, brain changes caused by this surgical procedure remain unclear. In this study, the distal stump of the right sciatic nerve in a rat model of sciatic nerve injury was connected to the proximal end of the left sciatic nerve using a chitin conduit. Neuroelectrophysiological test showed that the right lower limb displayed nerve conduction, and the structure of myelinated nerve fibers recovered greatly. Muscle wet weight of the anterior tibialis and gastrocnemius recovered as well. Multiple-model resting-state blood oxygenation level-dependent functional magnetic resonance imaging analysis revealed functional remodeling in multiple brain regions and the re-establishment of motor and sensory functions through a new reflex arc. These findings suggest that sciatic nerve transposition repair induces brain functional remodeling. The study was approved by the Ethics Committee of Peking University People's Hospital on December 9, 2015(approval No. 2015-50).展开更多
This study aimed to investigate the reconstruction of the thumb and finger extension function in patients with middle and lower trunk root avulsion injuries of the brachial plexus. From April 2010 to January 2015, we ...This study aimed to investigate the reconstruction of the thumb and finger extension function in patients with middle and lower trunk root avulsion injuries of the brachial plexus. From April 2010 to January 2015, we enrolled in this study 4 patients diagnosed with middle and lower trunk root avulsion injuries of the brachial plexus via imaging tests, electrophysiological examinations, and clinical confirmation. Muscular branches of the radial nerve, which innervate the supinator in the forearm, were transposed to the posterior interosseous nerve to reconstruct the thumb and finger extension function. Electrophysiological findings and muscle strength of the extensor pollicis longus and extensor digitorum communis, as well as the distance between the thumb tip and index finger tip, were monitored. All patients were followed up for 24 to 30 months, with an average of 27.5 months. Motor unit potentials（MUP） of the extensor digitorum communis appeared at an average of 3.8 months, while MUP of the extensor pollicis longus appeared at an average of 7 months. Compound muscle action potential（CMAP） appeared at an average of 9 months in the extensor digitorum communis, and 12 months in the extensor pollicis longus. Furthermore, the muscle strength of the extensor pollicis longus and extensor digitorum communis both reached grade Ⅲ at 21 months. Lastly, the average distance between the thumb tip and index finger tip was 8.8 cm at 21 months. In conclusion, for patients with middle and lower trunk injuries of the brachial plexus, transposition of the muscular branches of the radial nerve innervating the supinator to the posterior interosseous nerve for the reconstruction of thumb and finger extension function is practicable and feasible.展开更多
To report a method and remote therapeutic effect of early nerve transposition in treatment of obstetrical brachial plexus palsy. Methods: From May 1995 to August 1996, 12 patients who had no recovery of biceps 3 month...To report a method and remote therapeutic effect of early nerve transposition in treatment of obstetrical brachial plexus palsy. Methods: From May 1995 to August 1996, 12 patients who had no recovery of biceps 3 months after birth were treated with nerve transposition. Eight had neuroma at the upper trunk and 4 had rupture or avulsion of the upper trunk. Mallet test was used to evaluate the results. Results: The follow up of 40 52 months showed that excellent and good recovery in functions was found in 75% of the patients and the excellent rate of phrenic nerve and accessory nerve transposition was 83.3 % and 66.7 % respectively. A complete recovery in shoulder and elbow joint function was in 3 patients and Mallet Ⅳ was in 6 patients. Conclusions: Satisfactory outcome can be obtained by using early nerve transposition in treating obstetrical brachial plexus.展开更多
Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in pa...Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients（65 elbows） diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the Mc Gowan scale as modified by Goldberg： 18 patients（28%） had grade IIA neuropathy, 20（31%） had grade IIB, and 27（42%） had grade III. Postoperatively, according to the Wilson ＆ Krout criteria, treatment outcomes were excellent in 38 patients（58%）, good in 16（25%）, fair in 7（11%）, and poor in 4（6%）, with an excellent and good rate of 83%. A negative correlation was found between the preoperative Mc Gowan grade and the postoperative Wilson ＆ Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.展开更多
OBJECTIVE:To explore the optimal surgery in treating moderate-severe cubital tunnel(CuTS) syndrome by comparing the clinical efficiency of decompression and anterior subcutaneous transposition of ulnar nerve and decom...OBJECTIVE:To explore the optimal surgery in treating moderate-severe cubital tunnel(CuTS) syndrome by comparing the clinical efficiency of decompression and anterior subcutaneous transposition of ulnar nerve and decompression and anterior submuscular transposition of ulnar nerve,and to provide a theoretical basis for the appropriate surgical programs in treating moderate-severe Cu TS.METHODS:47 consecutive cases of moderate-severe Cu TS were surgically treated in our department from January 2014 to January 2017.All patients were divided into two groups by the doctor in our department.21 Cu TS cases were treated with decompression and anterior subcutaneous transposition of ulnar nerve,and other 26 cases were treated with decompression and anterior submuscular transposition of ulnar nerve.All the patients were followed 1 month,3 months and 6 months after operation to evaluate the recovery degree of ulnar nerve function and the clinical efficiency of the two methods was compared.RESULTS:Clinical symptoms of two groups were significant alleviated.There was no significant statistical difference between two groups in the clinical efficiency.CONCLUSION:Completely releasing of nerve truck is the most important step in treating mediate-severe Cu TS.Theclinical results of the two methods are similar,but the anterior subcutaneous transposition of ulnar nerve is more easy to operate and can be widely used.展开更多
Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,...Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,the epitrochlear-olecranon channel and Osborne’s arcade are the most common.An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion,partially or completely,causing nerve friction and constriction leading to chronic neuropathic pain.Failure after primary surgery is generally secondary to procedural errors or technical omissions,frequently represented by incomplete nerve decompression,failure to recognize nerve instability after nerve decompression,loosening of the nerve anchor after superficial nerve transposition with consequent spontaneous nerve relocation in the epitrochlear-olecranon channel,perineural fibrosis and neurodesis,which creates new nerve compression.In association with the clinical evaluation,electromyography studies,magnetic resonance imaging and ultrasound are useful tools that may aid in the decision-making process when considering revision surgery.Superficial anterior transposition is the most commonly employed technique but also has a high failure rate,as opposed to anterior deep transposition that is the method of choice for many surgeons despite being more technically demanding.The results of revision surgery following recalcitrant ulnar nerve compression at the elbow are inferior to those obtained after primary surgery.Nonetheless,the clinical advantages remain relevant provided that the revision surgery is performed by an expert surgeon.To avoid misinterpretation,the patient is completely informed of the quality of results.展开更多
Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnor...Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnormal axonal regeneration without an appropriate distal target following nerve injury results in the formation of end-neuromas,often leading to significant pain.Conservative management is centered around a combination of pharmacological interventions and therapeutic modalities.In the setting of failed conservative management,surgical intervention is employed with the goals of excising the neuroma and redirecting axonal growth into healthy tissue.This article focuses on painful digital neuromas and options for both nonoperative and operative management.展开更多
基金supported by the National Natural Science Foundation of China,Nos.31771322,81671215(to PXZ)the Beijing National Science Foundation,Nos.7212121(to PXZ)+6 种基金the National Key Research and Development Plan of China,No.2018YFB1105504(to PXZ)Shenzhen Science and Technology Plan Project,No.JCYJ20190806162205278(to PXZ)Sanming Project,No.SZSM202011001(to PXZ)the Fundamental Research Funds for the Central Universities,Clinical Medicine Plus X-Young Scholars Project of Peking University China,No.PKU2020LCXQ020(to YHK)the Key Laboratory of Trauma and Neural Regeneration(Peking University)the Ministry of Education China,No.BMU2019XY007-01the Ministry of Education Innovation Program of China,No.IRT_16R01。
文摘Lower extremity nerve transposition repair has become an important treatment strategy for peripheral nerve injury;however, brain changes caused by this surgical procedure remain unclear. In this study, the distal stump of the right sciatic nerve in a rat model of sciatic nerve injury was connected to the proximal end of the left sciatic nerve using a chitin conduit. Neuroelectrophysiological test showed that the right lower limb displayed nerve conduction, and the structure of myelinated nerve fibers recovered greatly. Muscle wet weight of the anterior tibialis and gastrocnemius recovered as well. Multiple-model resting-state blood oxygenation level-dependent functional magnetic resonance imaging analysis revealed functional remodeling in multiple brain regions and the re-establishment of motor and sensory functions through a new reflex arc. These findings suggest that sciatic nerve transposition repair induces brain functional remodeling. The study was approved by the Ethics Committee of Peking University People's Hospital on December 9, 2015(approval No. 2015-50).
文摘This study aimed to investigate the reconstruction of the thumb and finger extension function in patients with middle and lower trunk root avulsion injuries of the brachial plexus. From April 2010 to January 2015, we enrolled in this study 4 patients diagnosed with middle and lower trunk root avulsion injuries of the brachial plexus via imaging tests, electrophysiological examinations, and clinical confirmation. Muscular branches of the radial nerve, which innervate the supinator in the forearm, were transposed to the posterior interosseous nerve to reconstruct the thumb and finger extension function. Electrophysiological findings and muscle strength of the extensor pollicis longus and extensor digitorum communis, as well as the distance between the thumb tip and index finger tip, were monitored. All patients were followed up for 24 to 30 months, with an average of 27.5 months. Motor unit potentials（MUP） of the extensor digitorum communis appeared at an average of 3.8 months, while MUP of the extensor pollicis longus appeared at an average of 7 months. Compound muscle action potential（CMAP） appeared at an average of 9 months in the extensor digitorum communis, and 12 months in the extensor pollicis longus. Furthermore, the muscle strength of the extensor pollicis longus and extensor digitorum communis both reached grade Ⅲ at 21 months. Lastly, the average distance between the thumb tip and index finger tip was 8.8 cm at 21 months. In conclusion, for patients with middle and lower trunk injuries of the brachial plexus, transposition of the muscular branches of the radial nerve innervating the supinator to the posterior interosseous nerve for the reconstruction of thumb and finger extension function is practicable and feasible.
文摘To report a method and remote therapeutic effect of early nerve transposition in treatment of obstetrical brachial plexus palsy. Methods: From May 1995 to August 1996, 12 patients who had no recovery of biceps 3 months after birth were treated with nerve transposition. Eight had neuroma at the upper trunk and 4 had rupture or avulsion of the upper trunk. Mallet test was used to evaluate the results. Results: The follow up of 40 52 months showed that excellent and good recovery in functions was found in 75% of the patients and the excellent rate of phrenic nerve and accessory nerve transposition was 83.3 % and 66.7 % respectively. A complete recovery in shoulder and elbow joint function was in 3 patients and Mallet Ⅳ was in 6 patients. Conclusions: Satisfactory outcome can be obtained by using early nerve transposition in treating obstetrical brachial plexus.
基金supported by grants from the National Program on Key Basic Research Project of China(973 Program),No.2014CB542200a grant from Innovation Program of Ministry of Education,No.IRT1201+1 种基金the National Natural Science Foundation of China,No.31271284,31171150,81171146,30971526,31100860,31040043,31371210Program for New Century Excellent Talents in University of Ministry of Education of China,No.BMU20110270
文摘Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients（65 elbows） diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the Mc Gowan scale as modified by Goldberg： 18 patients（28%） had grade IIA neuropathy, 20（31%） had grade IIB, and 27（42%） had grade III. Postoperatively, according to the Wilson ＆ Krout criteria, treatment outcomes were excellent in 38 patients（58%）, good in 16（25%）, fair in 7（11%）, and poor in 4（6%）, with an excellent and good rate of 83%. A negative correlation was found between the preoperative Mc Gowan grade and the postoperative Wilson ＆ Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.
文摘OBJECTIVE:To explore the optimal surgery in treating moderate-severe cubital tunnel(CuTS) syndrome by comparing the clinical efficiency of decompression and anterior subcutaneous transposition of ulnar nerve and decompression and anterior submuscular transposition of ulnar nerve,and to provide a theoretical basis for the appropriate surgical programs in treating moderate-severe Cu TS.METHODS:47 consecutive cases of moderate-severe Cu TS were surgically treated in our department from January 2014 to January 2017.All patients were divided into two groups by the doctor in our department.21 Cu TS cases were treated with decompression and anterior subcutaneous transposition of ulnar nerve,and other 26 cases were treated with decompression and anterior submuscular transposition of ulnar nerve.All the patients were followed 1 month,3 months and 6 months after operation to evaluate the recovery degree of ulnar nerve function and the clinical efficiency of the two methods was compared.RESULTS:Clinical symptoms of two groups were significant alleviated.There was no significant statistical difference between two groups in the clinical efficiency.CONCLUSION:Completely releasing of nerve truck is the most important step in treating mediate-severe Cu TS.Theclinical results of the two methods are similar,but the anterior subcutaneous transposition of ulnar nerve is more easy to operate and can be widely used.
文摘Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,the epitrochlear-olecranon channel and Osborne’s arcade are the most common.An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion,partially or completely,causing nerve friction and constriction leading to chronic neuropathic pain.Failure after primary surgery is generally secondary to procedural errors or technical omissions,frequently represented by incomplete nerve decompression,failure to recognize nerve instability after nerve decompression,loosening of the nerve anchor after superficial nerve transposition with consequent spontaneous nerve relocation in the epitrochlear-olecranon channel,perineural fibrosis and neurodesis,which creates new nerve compression.In association with the clinical evaluation,electromyography studies,magnetic resonance imaging and ultrasound are useful tools that may aid in the decision-making process when considering revision surgery.Superficial anterior transposition is the most commonly employed technique but also has a high failure rate,as opposed to anterior deep transposition that is the method of choice for many surgeons despite being more technically demanding.The results of revision surgery following recalcitrant ulnar nerve compression at the elbow are inferior to those obtained after primary surgery.Nonetheless,the clinical advantages remain relevant provided that the revision surgery is performed by an expert surgeon.To avoid misinterpretation,the patient is completely informed of the quality of results.
文摘Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnormal axonal regeneration without an appropriate distal target following nerve injury results in the formation of end-neuromas,often leading to significant pain.Conservative management is centered around a combination of pharmacological interventions and therapeutic modalities.In the setting of failed conservative management,surgical intervention is employed with the goals of excising the neuroma and redirecting axonal growth into healthy tissue.This article focuses on painful digital neuromas and options for both nonoperative and operative management.
