臂丛根性撕脱伤激活脊髓表达磷酸化CaMKⅡ的时程及定位研究

目的研究大鼠臂丛根性撕脱伤后磷酸化CaMKⅡ的时间和空间定位。方法将SD大鼠（6-8周龄）在手术显微镜下做臂丛根性撕脱伤手术后,应用Western blot方法测定相应脊髓节段（C7、C8）磷酸化CaMKⅡ在1、2、3d时间点及正常大鼠的表达水平。同时应用免疫荧光染色方法检测目标蛋白在1d时间点大鼠脊髓节段的表达水平及空间定位。结果正常大鼠脊髓相应节段检测不到磷酸化CaMKⅡ,在臂丛根性撕脱伤后1～2d对应脊髓节段的磷酸化CaMKⅡ表达明显升高,撕脱伤后3d明显下降并接近正常水平;免疫荧光结果显示：臂丛根性撕脱伤后1d,损伤侧脊髓前角运动神经元和中间神经元明显表达磷酸化CaMKⅡ,对侧脊髓前角运动神经元和中间神经元也有表达。但强度较撕脱侧明显减弱。结论臂丛根性撕脱伤诱导磷酸化CaMKⅡ在损伤节段1d时高表达,然而在3d时逐步下降到正常水平。     

臂丛神经根性撕脱伤动物模型的研究

目的 研究臂丛神经根性撕脱伤实验动物模型。方法 选用Wistar大白鼠，取右下颌骨向下至胸大肌中部皮肤切口，显露胸大肌，分别切断胸大肌、胸小肌；暴露井剪断右锁骨，镜下解剖分离臂丛神经并紧贴近端根部将颈5至颈8剪断，造成臂丛神经根性撕脱伤模型，实验组用颈3、颈4神经修复臂丛中已损伤的颈5、颈6神经，对照组不做修复；用电生理及组织病理学观察神经肌肉组织变化，结果术后3个月病理检查发现，实验组中肌皮神经可见少量神经纤维长入，肱二共肌萎缩轻，失神经组之肌皮神经可见神经纤维变性、崩解、吸收，肱二头肌萎缩明显，电生理检查显示实验组与失神经组之诱发电位峰值电压与刺激电流比值及潜伏期时间与刺激电流强度之比值在统计学上有显著性差异（P〈0．05）。结论 该实验模型操作简单，科学，合理。为臂丛神经根性撕脱伤实验研究奠定了基础。     

臂丛根性撕脱伤激活脊髓表达磷酸化CaMKⅡ的时程及定位研究

目的研究大鼠臂丛根性撕脱伤后磷酸化CaMKⅡ的时间和空间定位。方法将SD大鼠(6～8周龄)在手术显微镜下做臂丛根性撕脱伤手术后,应用Western blot方法测定相应脊髓节段(C7、C8)磷酸化CaMKⅡ在1、2、3 d时间点及正常大鼠的表达水平。同时应用免疫荧光染色方法检测目标蛋白在1 d时间点大鼠脊髓节段的表达水平及空间定位。结果正常大鼠脊髓相应节段检测不到磷酸化CaMKⅡ,在臂丛根性撕脱伤后1～2 d对应脊髓节段的磷酸化CaMKⅡ表达明显升高,撕脱伤后3d明显下降并接近正常水平;免疫荧光结果显示:臂丛根性撕脱伤后1 d,损伤侧脊髓前角运动神经元和中间神经元明显表达磷酸化CaMKⅡ,对侧脊髓前角运动神经元和中间神经元也有表达,但强度较撕脱侧明显减弱。结论臂丛根性撕脱伤诱导磷酸化CaMKⅡ在损伤节段1 d时高表达,然而在3 d时逐步下降到正常水平。     

幼年大鼠臂丛根性损伤模型的构建及其评价

目的：构建幼年大鼠臂丛损伤动物模型并对该模型进行评价。方法：选取20只幼年（P18）SPF级SD大鼠，手术撕脱实验组大鼠左侧臂丛根（C5～C7），造成大鼠臂丛根性撕伤，观察大鼠行为学和脊髓前角运动神经元的组织病理学变化。结果：实验组SD大鼠行为学出现明显异常，并且脊髓前角运动神经元在数量上较对照组显著减少；透射电镜显示实验组脊髓前角运动神经元超微结构也出现明显变化。结论：该方法可成功构建幼年SD大鼠臂丛根性撕脱伤动物模型，为分娩性臂丛损伤研究提供了一个科学可行的实验平台。     

臂丛损伤脊髓运动神经元与神经根GAP-43 mRNA表达

目的：探讨臂丛根性撕脱伤后脊髓腹角运动神经元胞体及其神经根GAP-43 mRNA的表达变化及其影响因素,为臂丛损伤的修复治疗提供理论依据.方法：本实验创立三种臂丛根性撕脱伤模型：C7前根撕脱（Ⅰ组）;C7前根撕脱＋切断同侧C5～T1后根（Ⅱ组）;C7前根撕脱＋C5和C6之间作同侧脊髓半横断（Ⅲ组）.术后2周按CBS评分标准检查动物神经缺失症状,用SYBR Green荧光定量RT-PCR方法检测脊髓腹角运动神经元胞体及其神经根GAP-43 mRNA的表达改变.结果：根据CBS评分标准,对照组计为0分,Ⅰ组计分较低、Ⅲ组计分最高.对照组C7神经元胞体和C7神经根中GAP-43 mRNA表达量相近,但三种损伤组术后2周神经元胞体内GAP-43 mRNA表达均上调,而神经根内表达却下调.结论：（1）臂丛根性撕脱伤后脊髓腹角运动神经元胞体GAP-43 mRNA表达受突触前机制的调控;（2）臂丛损伤2周时神经元胞体内GAP-43 mRNA表达呈现高峰期,此时进行神经移位术将显著提高神经修复的效果.     

成年臂丛神经根性撕脱伤后脊髓前角运动神经元的死亡表型及其机制

正人类臂丛神经根性撕脱伤是临床上常见的一种周围神经损伤,但目前这类损伤尚缺乏有效的治疗手段。臂丛神经根性撕脱伤不仅导致损伤远侧段周围神经变性和相应靶器官的失神经支配,更为重要的是还造成了脊神经腹根和背根与脊髓的脱离~[1]。目前的外科手术修复虽然可以将撕脱的脊神经腹根和背根重新植入脊髓,但伤者的运动和感觉功能     

电针疗法对臂丛根性撕脱伤脊髓后角及中央管nNOS蛋白表达的影响

目的采用电针疗法干预大鼠臂丛神经撕脱伤模型,探索电针疗法对臂丛根性撕脱伤脊髓后角及中央管n NOS蛋白表达的影响。方法健康、雌性成年Sprague-Dawley(SD)大鼠共40只,行臂丛神经根性撕脱手术,随机分为撕脱伤组(AV组)和撕脱伤加电针治疗组(AV+EA组),AV+EA组动物隔日接受大椎(DU4)和手三里(LI10)电针治疗直至处死,每次治疗的输出脉冲波形为非对称双向疏密波,以20 Hz频率不间断治疗15 min。动物存活1周、2周、3周、6周处死,选取C7节段脊髓,行NADPH-d酶组织化学染色和中性红复染。结果脊髓后角,在AV组n NOS的微量表达;在AV+EA组2~3周n NOS在健侧的表达比伤侧增多,至6周脊髓后角n NOS阳性神经元表达AV组损伤侧;AV+EA组n NOS阳性神经元的表达与同时期的AV组。结论电针疗法导致脊髓后角及中央管n NOS阳性神经元的时空表达特异性。     

臂丛神经根性撕脱损伤后微环境变化的研究进展

正臂丛神经根性撕脱伤(Brachial plexus roots avulsion injury, BPRAI)是上肢臂丛神经根从脊髓附着处部分或完全撕脱造成的损伤,可导致患肢的感觉和运动功能障碍,并伴随神经病理性疼痛。美国每1000位存活的新生儿中大约1.5人出现新生儿臂丛神经麻痹~([1]),成人臂丛撕脱伤多由交通事故引起,常给患者家庭带来沉重的经济和精神负担。一系列的研     

治疗臂丛根性撕脱伤有新疗法

治疗臂丛根性撕脱伤有新疗法北京积水潭医院显微外科主任医师常万绅带领科研小组，采用正中神经及尺神经部分束支移位法治疗臂丛根性撕脱伤，２年多来治疗１０名患者全部成功。臂丛神经根性撕脱伤主要表现为肩外展及屈肘功能丧失。传统的治疗方法一般选用肋间神经、膈神经...     

臂丛根部的显微解剖学研究及其临床意义

目的:对臂丛根部及其周围组织进行显微解剖,为臂丛撕脱伤的诊治提供解剖学基础。方法:在15例防腐成人尸体的颈胸段标本上,观测臂丛根部的形态特点及其与周围组织的关系,2例新鲜标本行组织学检查,观察臂丛根部穿椎间孔时与周围组织的联系。结果:①臂丛前后根之间有齿状韧带相间隔;相应的后根比前根粗,后根间存在着复杂的纤维联系。②臂丛C5、C6神经根分出角小于前支分出角,C7、C8、T1神经根分出角大于前支分出角。③臂丛C5、C6神经根在椎间孔处与前、中斜角肌起点处的腱性组织交织,并与上半椎韧带融合,且有薄层纤维筋膜鞘样结构,将椎动脉、椎静脉与之包裹一起;C7、C8、T1少见或未见与前述结构的联系。结论:臂丛神经根解剖结构的差异是臂丛C5、C6神经根较C7、C8、T1神经根不易形成根性撕脱的主要原因,熟悉臂丛根部的显微解剖有助于临床臂丛根性撕脱伤的诊治。     

Ideal intraspinal implantation site for the repair of ventral root avulsion after brachial plexus injury in humans. A preliminary anatomical study

The advances made to date in root reimplantation for avulsion of the brachial plexus are modest considering that there are only reports from ten patients in the literature. However, the results are promising and should be applauded. The problem with reimplantation, in addition to the difficult surgical exposure, is to determine the ideal intraspinal implantation site for the graft. Given the non-permissive substrate properties of the CNS white matter, the outcome of grafts elsewhere in the spinal cord need to be evaluated. An inappropriate implantation site might explain the still modest recovery in this challenging group of patients. Consequently the microscopic anatomy of the cervical spinal cord segments C5 to T1 was studied. The aims were to 1- determine the relationships between the ventral gray horn and the ventrolateral sulcus of the spinal cord, and 2-analyse the location and course of the motoneuron fibres passing through the white matter to reach the ventral root. On the basis of the present findings it is proposed that reimplantation of nerve grafts or rootlets should be performed directly through the ventral root exit zone in contact with the ventromedial region of the ventral gray horn at a depth of 2 mm, rather than into the white matter of the lateral aspect of the cord. Initially we used a posterior approach with total facetectomies. An anterior approach is now evaluated for current use.     

Anatomical Study of the Brachial Plexus in the Common Marmoset (Callithrix Jacchus)

To elucidate the forelimb phylogeny of primates, anatomical analysis of the brachial plexus in platyrrhines is beneficial. In the present study, six brachial plexuses and the surrounding arteries of four common marmosets were dissected. In five specimens, the brachial plexus consisted of five ventral rami from the fifth cervical nerve (C5) to the first thoracic nerve (T1). In one specimen, the ventral ramus of the fourth cervical nerve joined with the brachial plexus. In five specimens, the upper trunk was composed of C5 and the sixth cervical nerve (C6). In one specimen, the ventral division of C6 merged with the ventral branch of the middle trunk to constitute the lateral cord. The seventh cervical nerve constituted the middle trunk, and the eighth cervical nerve and T1 formed the lower trunk in all specimens. The lateral cord gave rise to the musculocutaneous nerve, and the remaining component merged with the medial cord. The confluence of the lateral and medial cords immediately bifurcated into the median and ulnar nerves. These branching patterns of the musculocutaneous, median, and ulnar nerves were consistent and similar to the human counterparts. In the dorsal division, the single posterior cord as observed in the human brachial plexus was not observed. The axillary artery did not pass between the medial and lateral roots of the median nerve, and the axillary artery bifurcated into the brachial artery and the superficial brachial artery. Anat Rec, 300:1299–1306, 2017. © 2017 Wiley Periodicals, Inc.     

Some aspects of the communicating branch between the musculocutaneous and median nerves in man

Fascicular arrangement of the human brachial plexus is examined on 2 common cases and 3 peculiar cases in which a communicating branch was observed between the median and the musculocutaneous nerve. The musculocutaneous nerve consitss of spinal nerves from C.5, 6 and 7. The branch to the coracobrachialis receives its fibers from C.7 before it leaves the musculocutaneous nerve in 3 cases and after it leaves the musculocutaneous nerve in one case. In one case, C.7 does not send a branch to the coracobrachialis. The median nerve arises by two roots, one from the lateral cord, and the other from the medial cord of the brachial plexus. In a case in which a communicating branch was observed from the median nerve to the musculocutaneous, the fibers from C.7 join to the median nerve via the medial cord. Thus the median nerve involved all elements of the spinal nerve from C.5 to T.1. The elements of the median and the musculocutaneous nerves, therefore, are not affected by appearance of the communicating branch. The communicating branch between the median and the musculocutaneous nerves, consists of the fibers arose from C.5 and C.6, in all examined cases.     

Different functional reorganization of motor cortex after transfer of the contralateral C7 to different recipient nerves in young rats with total brachial plexus root avulsion

Clinically, contralateral C7 transfer is used for nerve reconstruction in brachial plexus injuries. Postoperatively, synchronous motions at the donor limb are noteworthy. This study studied if different recipient nerves influenced transhemispheric functional reorganization of motor cortex after this procedure. 90 young rats with total root avulsion of the brachial plexus were divided into groups 1–3 of contralateral C7 transfer to anterior division of the upper trunk, to both the musculocutaneous and median nerves, and to the median nerve, respectively. After reinnervation of target muscles, number of sites for forelimb representations in bilateral motor cortices was determined by intracortical microstimulation at 1.5, 3, 6, 9, and 12 months postoperatively. At nine months, transhemispheric reorganization of nerves neurotized by contralateral C7 was fulfilled in four of six rats in group 1, one of six in group 2 and none in group 3, respectively; at 12 months, that was fulfilled in five of six in group 1, four of six in groups 2 and 3, respectively. Logistic regression analysis showed that rate of fulfilled transhemispheric reorganization in group 1 was 12.19 times that in group 3 (95% CI 0.006–0.651, p = 0.032). At 12 months, number of sites for hindlimb representations which had encroached upon original forelimb representations on the uninjured side was statistically more in group 3 than in group 2 (t = 9.5, p < 0.0001). It is concluded that contralateral C7 transfer to upper trunk or to both the musculocutaneous and median nerves induces faster transhemispheric functional reorganization of motor cortex than that to median nerve alone in rats.     

周围神经损伤后脊髓前角运动神经元内游离Ca2+的浓度

背景：神经损伤后可引起细胞膜上Ca²⁺通道的开放,使细胞外Ca²⁺内流,造成细胞内的钙超载。 目的：观察臂丛神经根切断伤后相应脊髓前角运动神经元内游离Ca²⁺浓度的变化。 方法：健康成年雄性Wistar大鼠84只,分为3组：假手术组暴露臂丛神经不切断;对照组臂丛神经切断伤后不做其他处理;实验组臂丛神经切断伤后,给予腹腔注射Ca2+阻带剂维拉帕米4 mg/(kg•d)。于切断伤后12 h,24 h,48 h,72 h,1周,2周,4周每组随机以4只取材。 结果与结论：周围神经损伤开始,对照组及实验组大鼠损伤侧脊髓前角运动神经元细胞内Ca²⁺浓度开始升高,至伤后48 h达高峰,此后逐渐下降,伤后1周,实验组已基本回至正常水平,但仍较假手术组高。说明神经损伤后相应神经元细胞膜上L型Ca²⁺通道开放,Ca2+内流进入细胞内,导致神经细胞内游离Ca²⁺浓度增加,L型Ca²⁺通道可以被维拉帕米阻断,减少神经损伤后的Ca²⁺内流,减少神经细胞凋亡的数量。     

Two rare anomalies of the brachial plexus

Morphological variations of the brachial plexus and variants in the distribution of the anterior division of the middle trunk are relatively frequent. Two of the rarest anomalies occurred in the left brachial plexus of a 62-y-old Japanese male, 1 of 104 plexuses dissected between 1996 and 1997 at Kanazawa University Faculty of Medicine. The superior trunk of the brachial plexus was formed by the anterior primary division of C5 and C6 and a thin branch (0.5 mm in diameter) from C4, the middle trunk by the C7, and the inferior trunk by C8 and T1 (Fig.). We could not determine whether there was a branch derived from T2 to T1, since the subject had died of lung carcinoma. The entire anterior division of the middle trunk crossed the axillary artery and joined the medial root of the median nerve which was the continuation of the medial cord after the cord branched off the ulnar nerve. The lateral cord pierced coracobrachialis and divided into the musculocutaneous nerve and the lateral root of the median nerve just after emerging from the muscle, finally joining the medial root of the median nerve superficial to the brachial artery ∼115 mm distal to the lower border of latissimus dorsi to form the median nerve. The musculocutaneous nerve gave rise to the nerves to biceps brachii, brachialis, and the long head of biceps brachii and finally continued as the lateral cutaneous nerve of the forearm. The branch to coracobrachialis had already been cut and its course could not be traced.     

葛根素对臂丛根性撕脱后脊髓MMP-9蛋白表达的影响

目的　探讨大鼠臂丛根性撕脱后脊髓基质金属蛋白酶-9（MMP-9）蛋白的表达变化以及葛根素对其表达的影响。 方法　成年雄性SD大鼠174只，随机分为正常组、模型组、葛根素低、中、高处理组。模型组和葛根素处理组行右侧C5~C7脊神经前根撕脱术，术后腹腔注射给药。Western Blot法检测C5~C7节段脊髓MMP-9蛋白的表达。 结果　与正常组比较，臂丛神经根性撕脱后1 d时MMP-9蛋白表达达高峰，3 d降至接近正常，1周后下降至较低水平。葛根素处理组脊髓组织MMP-9蛋白表达在1 d时比模型组显著降低。 结论　MMP-9可能参与臂丛根性撕脱后早期损伤反应，且葛根素可能有助于减轻该种损伤。     

The spinal root origins and clinical implications of the lower subscapular nerve

The purpose of this study was to define the spinal root origins of the lower subscapular nerve and the amounts of participating nerve fibers from each spinal root and to discuss the clinical implications. Using a method of separating the nerve fascicles that traces the particular nerve fibers at the intrafascicular level, the spinal root origins of the lower subscapular nerve appeared as two types. The first type comprised 76.9% and was composed of the C5, C6, and C7 roots; the second type comprised 23.1% and was composed of the C6 and C7 roots. The number of nerve fibers was 357.2 +/- 139.7 (mean +/- SD) derived from C5, 1070.4 +/- 390.6 from C6, and 500.0 +/- 285.4 from C7. The nerve fascicles comprising the lower subscapular nerve traveled within the partially common fascicles composed of the axillary nerve. Therefore, injury of the lower subscapular nerve may be accompanied by a lesion of the axillary nerve, which generally consists of C5 and C6 roots composing the posterior cord of the brachial plexus.     

A novel extradural nerve transfer technique by coaptation of C4 to C5 and C7 to C6 for treating isolated upper trunk avulsion of the brachial plexus

The study aimed to demonstrate the feasibility of an extradural nerve anastomosis technique for the restoration of a C5 and C6 avulsion of the brachial plexus. Nine fresh frozen human cadavers were used. The diameters, sizes, and locations of the extradural spinal nerve roots were observed. The lengths of the extradural spinal nerve roots and the distance between the neighboring nerve root outlets were measured and compared in the cervical segments. In the spinal canal, the ventral and dorsal roots were separated by the dura and arachnoid. The ventral and dorsal roots of C7 had sufficient lengths to anastomose those of C6. The ventral and dorsal of C4 had enough length to be transferred to those of C5, respectively. The feasibility of this extradural nerve anastomosis technique for restoring C5 and C6 avulsion of the brachial plexus in human cadavers was demonstrated in our anatomical study