阻断部分臂丛神经下干分支对健侧颈7移位下干后神经再生的影响

Objective To explore the changes of the nerve fibers from median and ulnar nerves after cutting the branches of lower trunk which was repaired by the contralateral C7.Methods Forty female SD rats were divided into A, B, C and D groups randomly.In group A,the contralateral C7 root was transferred to lower trunk directly, and the posterior division of lower trunk, medial anterior thoracic nerve and the medial antebrachial cutaneous nerve were severed at the beginning of them;In group B, the contralateral C7 root was trarsferred to lower trunk directly, and the posterior division of lower trunk, medial anterior thoracic nerve and the medial antebrachial cutaneous nerve were severed at the point which was 1 cm away from the beginning of above branches;In group C, the contralateral C7 root was transferred to lower trunk directly, and the posterior division of lower trunk was severed at the beginning of it;In group D, control group.After the operation, myelinated fiber count, nerve fiber density, the percentage of the number of nerve fiber from branch accounting for that from lower trunk, nerve fiber diameter,the percentage of nerve fibers with different diameters and N Ratio were carried out to evaluate the outcome of each group.Results Myelinated fiber count, nerve fiber density, the percentage of the number of nerve fiber from branch accounting for that from lower trunk, nerve fiber diameter,the percentage of nerve fibers with different diameters and N Ratio in ulnar and median nerve, there were no difference between group A, group B and group C ( P ＞ 0.05).Conclusion After the medial anterior thoracic nerve and medial antebrachial cutaneous nerve, repaired by the contralateral C7, were severed at the beginning and at the point which was 1 cm away from the beginning of above branches, the changes of the quantity and quality of the nerve fibers from median and ulnar nerves were not significant.     

阻断部分臂丛神经下干分支对健侧颈7移位下干后神经再生的影响

Objective To explore the changes of the nerve fibers from median and ulnar nerves after cutting the branches of lower trunk which was repaired by the contralateral C7.Methods Forty female SD rats were divided into A, B, C and D groups randomly.In group A,the contralateral C7 root was transferred to lower trunk directly, and the posterior division of lower trunk, medial anterior thoracic nerve and the medial antebrachial cutaneous nerve were severed at the beginning of them;In group B, the contralateral C7 root was trarsferred to lower trunk directly, and the posterior division of lower trunk, medial anterior thoracic nerve and the medial antebrachial cutaneous nerve were severed at the point which was 1 cm away from the beginning of above branches;In group C, the contralateral C7 root was transferred to lower trunk directly, and the posterior division of lower trunk was severed at the beginning of it;In group D, control group.After the operation, myelinated fiber count, nerve fiber density, the percentage of the number of nerve fiber from branch accounting for that from lower trunk, nerve fiber diameter,the percentage of nerve fibers with different diameters and N Ratio were carried out to evaluate the outcome of each group.Results Myelinated fiber count, nerve fiber density, the percentage of the number of nerve fiber from branch accounting for that from lower trunk, nerve fiber diameter,the percentage of nerve fibers with different diameters and N Ratio in ulnar and median nerve, there were no difference between group A, group B and group C ( P ＞ 0.05).Conclusion After the medial anterior thoracic nerve and medial antebrachial cutaneous nerve, repaired by the contralateral C7, were severed at the beginning and at the point which was 1 cm away from the beginning of above branches, the changes of the quantity and quality of the nerve fibers from median and ulnar nerves were not significant.     

Osmic acid staining of myelin sheath in normal and regenerated peripheral nerves

Objective: To introduce a practical, economical, and time-saving method to stain (with osmic acid) the myelin sheath in normal and regenerated peripheral nerves. Methods: A total of 12 Sprague Dawley rats, weighing 250-320 g (mean =276 g±38 g), were divided into two groups: a normal nerve group (n=6) and a regenerated nerve group (n=6). In the normal nerve group, the ventral and dorsal roots of L4 to L6 and their sciatic nerves were harvested for histological analysis. While in the regenerated nerve group, the right sciatic nerves were severed and then repaired with an epineurial microsuture method. The repaired nerves were harvested 12 weeks postoperatively. All the specimens were fixed in 4% paraformaldehyde and transferred to 2% osmic acid for 3-5 days. Then the specimens were kept in 75% alcohol before being embedded in paraffin. The tissues were cut into sections of 3μm in thickness with a conventional microtome. Results: Under a light microscope, myelin sheaths were clearly visible at all magnifications in both groups. They were stained in clear dark colour with a light yellow or colorless background, which provided high contrast images to allow reliable morphometric measurements. Morphological assessment was made in both normal and regenerated sciatic nerves. The ratios of the myelin area to the fibre area were 60. 28%±7. 66% in the normal nerve group and 51. 67%±6. 85% in the regenerated nerve group, respectively (P<0.01). Conclusions: Osmic acid staining is easy to perform and a very clear image for morphometrical assessment is easy to obtain. Therefore, it is a reliable technique for quantitative evaluation of nerve morphology.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

改良型腋窝顶定位穿刺锁骨下位点阻滞麻醉的临床研究

Objective To study the feasibility of subclavicular brachial plexus block with localized puncture at the apex of the axilla.Methods 520 adult patients who underwent upper limb emergency surgery were randomly assigned to receive subclavicular brachial plexus block with localized puncture at the apex of the axilla ( experimental group) and block anesthesia with intraclavicular route ( control group).Patients in both groups received 0.375% ropivacaine, volume (40.0± 2.7)ml.During the 30 minutes after the blockade, the onset and effect of motor and sensory block, the sensory block effect of each nerve branches and integrated effect of nerve block were recorded.The VAS score and acesodyne duration with tourniquet were compared between the two groups at 2, 4, 6 and 8 hours after the drug had been used for 30 minutes.Results Within 30 minutes after the drug was delivered, the onset of motor and sensory block in the experimental group was evidently shorter than that in the control group, while the duration of motor and sensory block was evidently longer ( P ＜ 0.01).There were no statistically significant differences in motor and sensory block score, median nerve block effect and ulnar nerve block effect between the two groups.The musculocutaneous nerve and radial nerve block effects in the experimental group were better than those in the control group ( P ＜ 0.05).After the drug had been used for 30 minutes, VAS score of the experimental group at each point time was significantly lower than that of the oontrol group ( P ＜0.01).The analgesia duration of tourniquet in the experimental group was significantly longer than that of the control group ( P ＜ 0.01 ).Conclusion The modified subclavicular brachial plexus block with localized puncture at the apex of the axilla can provide perfect blockade, satisfactory anesthetic effect and higher safety in upper limb surgery.     

dentification of differentially expressed genes from spinal cord after firearm injury to rabbit sciatic nerves

Objective: Peripheral nerve regeneration depends on gene regulation by central neurons. To search for more effective treatment methods to improve the regeneration of wounded peripheral nerves, gene expression profile of spinal cord after firearm injury to rabbit sciatic nerves are studied with DNA micro-array technique. Methods: A total of 54 rabbits were randomly divided into 4 groups: Groups dl, d3, d7 and normal control group. Lumbar spinal cords were sampled. RNAand mRNA were extracted, labeled by Cy3 and Cy5, and analyzed by mouse_8192S gene chips. Results: A total of 1367, 923, and 61 genes with differential expression were found on day 1, day 3, and day 7 after trauma respectively. Five expressed sequence tag (EST) sequences demonstrated differential expression during 7 days after trauma. Conclusions: There is complex gene profile with differential expression after firearm nerve injury, among which AW701496, U84291, W13926, X04017 andAW822394 EST sequences may be important regulation factors that involved in regeneration of peripheral nerve injury.     

Study on clinical application of selective transfer of ipsilateral C7 nerve root

Objective:To verify the rationality,reliability and practivability of selective transfer of ipsilateral C7 nerve root for treatment of upper trunk avulsion.Methods:Selective transfer of ipsilateral C7 nerve root was carried out in 8 patients (7 with upper trund avulsion,and 1 with left upper trunk avulsion combined with partial injury of the middle trunk)from June 1996 to Februany 1997.selective transfer of the anterior division or the anteriolateral fascicles of the anterior division of ipsilateral C7 to the anterior division of the upper trunk was performed under general anesthesia.Only 5 cases were followed up.Results:Among these 5 cases,effective recovery was observed on 4 cases of the transfer of the anteriolateral fascicles of ipsilateral C7 to the anterior division of the upper trunk.Electromyogyaphic examination showed nerve regeneration could be observed in the 2nd month postoperatively.And detectable elbow flexion by biceps contraction was found in the 4th month postoperatively.The function of the C7 innervating muscles was not jeopardized,and the case with combined partial C7 root injury had a poor result.Conclusions:Selective transfer of ipsilateral C7 nerve root leads to a restoration of reinnervating muscle functions without affecting the function of the muscles innervated by C7.It is therefore a practicable new surgical procedure for treating upper trunk avulsions.     

神经干细胞移植延缓失神经肌萎的作用机制

Objective To study the effect and mechanism of transplanting spinal fetal neural stem cells (NSCs) into the peripheral nerve for delaying muscle denervation atrophy. Methods Spinal. fetal NSCs were separated from spinal cord of enceinte 10 to 12 days SD rats, cultured and purified. After three passages, the formed NSC spheres were blew into single cell suspension ( 106/μl×5 μl) and transplanted into the distal part of the transected tibial nerve. 5 μl of cell culture medium was injected into the distal tibial nerve in the control group. Three and 5 months after the transplantation, the distal part of the tibial nerve and the triceps suraes were harvested and identified with specific markers, by means of indirect immunofluorescent staining to evaluate survival and differentiation of transplanted NSCs in the nerve, and to observe the neuromuscular junctions.Results Compare to the control group, atrophy of the triceps suraes muscle was less severe 3 and 5 months after NSCs transplantation. Postsynaptic membrane was also better preserved in NSCs transplanted group. Five months after NSCs transplantation, new synapses (neuromuscular junction) formed in the denervated muscle.Conclusion NSCs transplantation can delay atrophy denervated muscles. NSCs transplantation can not only maintain the structure of postsynaptic membrane, but also form new synapse with the denervated muscle.     

神经干细胞移植延缓失神经肌萎的作用机制

Objective To study the effect and mechanism of transplanting spinal fetal neural stem cells (NSCs) into the peripheral nerve for delaying muscle denervation atrophy. Methods Spinal. fetal NSCs were separated from spinal cord of enceinte 10 to 12 days SD rats, cultured and purified. After three passages, the formed NSC spheres were blew into single cell suspension ( 106/μl×5 μl) and transplanted into the distal part of the transected tibial nerve. 5 μl of cell culture medium was injected into the distal tibial nerve in the control group. Three and 5 months after the transplantation, the distal part of the tibial nerve and the triceps suraes were harvested and identified with specific markers, by means of indirect immunofluorescent staining to evaluate survival and differentiation of transplanted NSCs in the nerve, and to observe the neuromuscular junctions.Results Compare to the control group, atrophy of the triceps suraes muscle was less severe 3 and 5 months after NSCs transplantation. Postsynaptic membrane was also better preserved in NSCs transplanted group. Five months after NSCs transplantation, new synapses (neuromuscular junction) formed in the denervated muscle.Conclusion NSCs transplantation can delay atrophy denervated muscles. NSCs transplantation can not only maintain the structure of postsynaptic membrane, but also form new synapse with the denervated muscle.     

神经干细胞移植延缓失神经肌萎的作用机制

Objective To study the effect and mechanism of transplanting spinal fetal neural stem cells (NSCs) into the peripheral nerve for delaying muscle denervation atrophy. Methods Spinal. fetal NSCs were separated from spinal cord of enceinte 10 to 12 days SD rats, cultured and purified. After three passages, the formed NSC spheres were blew into single cell suspension ( 106/μl×5 μl) and transplanted into the distal part of the transected tibial nerve. 5 μl of cell culture medium was injected into the distal tibial nerve in the control group. Three and 5 months after the transplantation, the distal part of the tibial nerve and the triceps suraes were harvested and identified with specific markers, by means of indirect immunofluorescent staining to evaluate survival and differentiation of transplanted NSCs in the nerve, and to observe the neuromuscular junctions.Results Compare to the control group, atrophy of the triceps suraes muscle was less severe 3 and 5 months after NSCs transplantation. Postsynaptic membrane was also better preserved in NSCs transplanted group. Five months after NSCs transplantation, new synapses (neuromuscular junction) formed in the denervated muscle.Conclusion NSCs transplantation can delay atrophy denervated muscles. NSCs transplantation can not only maintain the structure of postsynaptic membrane, but also form new synapse with the denervated muscle.     

同侧颈7神经根移位治疗臂丛上千根性撕脱伤的实验研究

目的 实验性比较同侧C7神经根全根移位与其他3种方法治疗臂丛上千根性撕脱伤的疗效.方法 120只SD大鼠建立上千根性撕脱伤模型后随机等分为4组,每组30只.(1)A组:同侧C7移位至上千+副神经至肩胛上神经;(2)B组:Oberlin手术(尺神经一束移位至肱二头肌支)+副神经至肩胛上神经+桡神经肱三头肌长头支至腋神经前支;(3)C组:膈神经移位至上千前股+副神经至肩胛上神经+颈丛运动支至上千后股;(4)D组:膈神经移位至上千前股+副神经至肩胛上神经,不作腋神经修复.术后3、6和12周每组取10只大鼠作Ochiai评分、Barth足错步试验、Terzis梳头试验及神经再生指标的榆测.结果 术后3周,A组3项行为学检测指标与3个对照组差异无统计学意义(P>0.017),腋神经电生理指标均显著优于3个对照组,其余各项腋神经及三角肌组织学指标均显著优于C组和D组,但与B组比较差异无统计学意义.A组除肌皮神经再生有髓神经纤维通过率显著优于C组外,其余肌皮神经及肱二头肌的电牛理与组织学检测指标与3个对照组比较差异无统计学意义.12周时,A组各项行为学观察、几乎全部腋神经和三角肌的电生理与组织学检测以及部分肌皮神经和肱二头肌的电生理与组织学检测指标均已显著优于3个对照组.结论 同侧C7神经根移位对治疗臂丛上千根性撕脱伤的实验性疗效显著.     

Physiological and clinical advantages of median nerve fascicle transfer to the musculocutaneous nerve following brachial plexus root avulsion injury

OBJECT: Loss of biceps muscle function is a significant disability after brachial plexus root avulsion injuries. Nerve grafting techniques to reestablish anatomical and functional continuity between the spinal cord and the avulsed root have not proven successful. Using nerve transfers for functional restoration of root avulsion injuries appears to be effective and has physiological advantages for reducing regeneration distances. Since the early 1990s, the Oberlin technique of transferring ulnar nerve fascicles to the motor branch of the musculocutaneous nerve has been the preferred operative technique for reinnervation and restoration of biceps muscle function. In the current study the authors examine the efficacy of an alternative technique using median nerve fascicles transferred to the musculocutaneous nerve to reinnervate the biceps muscle. METHODS: Forty consecutive patients with combined C5-6 brachial plexus root avulsions were evaluated pre- and postoperatively according to the British Medical Research Council Motor Grading Scale. Personal interviews concerning quality of life (QOL) after surgery were conducted and scored based on standards set by the World Health Organization. All patients showed some degree of improvement in biceps muscle function. Thirty-six (90%) of the 40 patients regained movement against gravity. The patients had a 77% improvement in overall QOL after the surgery; most notably, 92% of the patients reported their lack of need for medication and 75% a significant lessening of postoperative pain. Redirection of part of the healthy median nerve resulted in no measurable functional deficits, and only 28 patients reported minor sensory disturbances in the first web space for an average of 3 months after surgery. CONCLUSIONS: Median nerve fascicle transfer resulted in a significant improvement in biceps muscle function with an acceptable level of morbidity and should be considered an effective, and in many cases preferable, alternative to ulnar nerve fascicle transfer.     

神经束移位治疗臂丛神经根性撕脱伤70例临床报告

目的 观察应用神经束移位治疗臂丛神经根性撕脱伤的效果。方法 对７０例患者,于上臂上中部切取正中神经、心神经、胸背神经及健侧Ｃ７神经束移位给肱二头肌肌支、三角肌肌支等,重建肩、肘关节的功能。结果 供区部分神经切取后对肢体功能无明显影响。正中神经、尺神经部分束文、胸背神经、健侧Ｃ７束支移位比全干移位对肌功能的影响小,且同样有效。结论 肱二头肌肌支、三角肌肌支的神经纤维数量少,用供体神经部分神经束即可提供充足的神经纤维,且能保证移位的神经纤维能良好地长入肱二头肌和三角肌。     

联合尺神经束支和臂丛外神经移位治疗臂丛损伤

目的 观察联合尺神经束支和臂丛外神经移位治疗臂丛损伤的临床效果.方法 臂丛损伤6例,其中单纯上干损伤4例;上中干为主,合并下干部分损伤2例.伤后平均2.8个月接受手术.术式包括尺神经部分束支转位至肌皮神经肱二头肌肌支,膈神经或者副神经斜方肌支转位至肩胛上神经,桡神经肱三头肌长头肌支转位修复腋神经肌支.用肱二头肌、岗上肌和三角肌肌力,肩外展和上举角度,尺神经功能损失等指标对手术方式和效果进行评估.结果 6例中5例得到随访,平均随访时间18个月,肱二头肌均在术后3～4个月开始恢复肌力.随访时间18个月以上的4例屈肘M_4~+～M_5;随访时间4个月的1例屈肘M_3~+.其中3例行外展功能重建,单用膈神经修复的病例上臂可上举至180°,外展肌力M_4~+;联合副神经和肱三头肌长头肌支修复的病例上肢可外展90°,肌力M_4~-;单用副神经修复的病例上肢可外展80°,肌力M_3~+.3例手部握持力与术前相同,2例增强.4例手部尺神经供区功能无明显影响,1例小指掌侧皮肤感觉减退,第一骨间背侧肌萎缩.结论 尺神经部分束支转位修复肱二头肌支可以有效的恢复臂丛损伤后屈肘功能;用膈神经修复肩胛上神经可能取得更好的肩外展和上举效果;本组臂丛下干部分损伤的病例受伤均在3个月内,采用此术式同样恢复了肱二头肌功能,未加重原有的手功能障碍.     

Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion

PURPOSE: To report the results of a surgical technique of nerve transfer to reinnervate the brachialis muscle and the biceps muscle to restore elbow flexion after brachial plexus injury. METHODS: Retrospective review was performed on 6 patients who had direct nerve transfer of a single expendable motor fascicle from both the ulnar and median nerves directly to the biceps and brachialis branches of the musculocutaneous nerve. Assessment included degree of recovery of elbow flexion and ulnar and median nerve function including pinch and grip strengths. RESULTS: Clinical evidence of reinnervation was noted at a mean of 5.5 months (SD, 1 mo; range, 3.5-7 mo) after surgery and the mean follow-up period was 20.5 months (SD, 11.2 mo, range, 13-43 mo). Mean recovery of elbow flexion was Medical Research Council grade 4+. Postoperative pinch and grip strengths were unchanged or better in all patients. No motor or sensory deficits related to the ulnar or median nerves were noted and all patients maintained good hand function. No patients required additional procedures to further improve elbow flexion strength. CONCLUSIONS: Transfer of expendable motor fascicles from the ulnar and median nerves successfully can reinnervate the biceps and brachialis muscles for strong elbow flexion. The reinnervation of the brachialis muscle, the primary elbow flexor, as well as the biceps muscle provides an additional biomechanical advantage that accounts for the excellent elbow flexion strength obtained using this technique. Direct coaptation of the nerve fascicles was performed without the need for nerve grafts and there was no functional or sensory donor morbidity.     

Surgical outcomes following nerve transfers in upper brachial plexus injuries

Background:

Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury.

Materials and Methods:

We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years) in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations), surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients), and phrenic nerve to suprascapular nerve (1 patient). In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients), intercostal nerves (2 patients), and phrenic nerve with nerve graft (2 patients). Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients), both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients), spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient), intercostal nerves (3rd, 4th and 5th) to musculocutaneous nerve (4 patients) and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient).

Results:

Motor and sensory recovery was assessed according to Medical Research Council (MRC) Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170 degrees). Eight patients scored M4 power in elbow flexion and assessed as excellent results. Good results (M3+) were obtained in seven patients. Five patients had fair results (M2+ to M3).     

Oberlin's ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results

We present 7 children with obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve. Three were male, and 4 were female. The left-side brachial plexus was affected in 4 patients, and the right side in 3 patients. All children had vaginal delivery; two of them presented with shoulder dystocia. The average birth weight was 4300 g (range, 3620-5500 g). Average age at time of operation was 16 months (range, 11-24 months). The indication for the operation was absent active elbow flexion with active shoulder abduction against gravity in 4 cases, and no biceps function and bad shoulder function in 3 cases. Oberlin's ulnar nerve transfer was done in 4 cases without brachial plexus exploration in those children with good shoulder function, and exploration of the brachial plexus was performed in the other 3 cases with bad shoulder function. The average follow-up was 19 months (range, 13-30 months). Five children had biceps muscle >or=M(3) with active elbow flexion against gravity, and 2 children had biceps muscle 相似文献   

Use of quantitative intra-operative electrodiagnosis during partial ulnar nerve transfer to restore elbow flexion: the treatment of eight patients following a brachial plexus injury

The transfer of part of the ulnar nerve to the musculocutaneous nerve, first described by Oberlin, can restore flexion of the elbow following brachial plexus injury. In this study we evaluated the additional benefits and effectiveness of quantitative electrodiagnosis to select a donor fascicle. Eight patients who had undergone transfer of a simple fascicle of the ulnar nerve to the motor branch of the musculocutaneous nerve were evaluated. In two early patients electrodiagnosis had not been used. In the remaining six patients, however, all fascicles of the ulnar nerve were separated and electrodiagnosis was performed after stimulation with a commercially available electromyographic system. In these procedures, recording electrodes were placed in flexor carpi ulnaris and the first dorsal interosseous. A single fascicle in the flexor carpi ulnaris in which a high amplitude had been recorded was selected as a donor and transferred to the musculocutaneous nerve. In the two patients who had not undergone electrodiagnosis, the recovery of biceps proved insufficient for normal use. Conversely, in the six patients in whom quantitative electrodiagnosis was used, elbow flexion recovered to an M4 level. Quantitative intra-operative electrodiagnosis is an effective method of selecting a favourable donor fascicle during the Oberlin procedure. Moreover, fascicles showing a high-amplitude in reading flexor carpi ulnaris are donor nerves that can restore normal elbow flexion without intrinsic loss.     

Comparative experimental study on treatment outcome of nerve transfer, using selective C7 nerve root vs. phrenic nerve

The treatment outcome of nerve transfer using the C7 nerve root or phrenic nerve was compared in a rat experiment. One hundred and twenty SD rats were divided into two groups, one undergoing phrenic nerve transfer to the musculocutaneous nerve, and the other partial ipsilateral C7 (anteriolateral fascicles of the anterior division) to the musculocutaneous nerve. Neurotization outcomes of the two groups were evaluated by comparing the electrophysiologic, histologic, and myophysiologic changes of the biceps muscle. No significant differences were found between parameters from the phrenic nerve transfer group and those from the ipsilateral C7 nerve transfer group. This indicates that the treatment outcome of selective ipsilateral C7 transfer is comparable to that of phrenic nerve transfer. It is the surgery of choice in treating brachial plexus upper-trunk avulsion accompanied by phrenic nerve injury.     

Transfer of pectoral nerves to the musculocutaneous nerve in obstetric upper brachial plexus palsy

OBJECTIVE: To investigate the results of transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric brachial palsy. METHODS: In 25 cases of obstetric brachial palsy (20 after breech deliveries), branches of the pectoral nerve plexus were transferred directly to the musculocutaneous nerve. For all patients, the nerve transfer was part of an extended brachial plexus reconstruction. Results were tested both clinically and with the Mallet scale, at a mean follow-up time of 70 months (standard deviation, 34.3 mo). RESULTS: There were two complete failures, which were attributable to disconnection of the transferred nerve endings. The results after transfer were excellent in 17 cases and fair in 5 cases. Steindler flexorplasty improved elbow flexion for three patients. CONCLUSION: Transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric upper brachial palsy may be effective, if the specific anatomic features of the pectoral nerve plexus are sufficiently appreciated.