Congenital Pseudarthrosis of Femur and Sciatic Nerve Palsy with Congenital Constriction Band Syndrome: Report of the First Case in Literature

Congenital constriction band syndrome has varied clinical presentations ranging from small, incomplete skin deep constriction band to in utero amputation. Pseudarthrosis of underlying bone most commonly tibia has been reported by many authors. We report the first case of congenital pseudarthrosis of the femur with congenital constriction band syndrome. Nine-day-old female presented with the constriction band in the left thigh with open pseudarthrosis of the femur. The left femur had gross recurvatum deformity and the posterior apex of the pseudarthrosis was exposed via skin ulceration. She had an ipsilateral paralytic clubfoot. She was treated with single-stage excision of constriction band and Z-plasty. Spontaneous union of the femur was achieved at 3 months. Procurvatum deformity of the femur improved gradually over 3 years. This happens to be the first and only reported case of congenital pseudarthrosis of the femur with sciatic nerve palsy due to congenital constriction band.     

移位髋臼骨折合并坐骨神经损伤

报告９例移位髋臼骨折合并坐骨神经损伤的治疗，其中单纯腓侧部损伤５例，联合腓侧部与胫侧部损伤４例。非手术治疗３例，手术治疗６例，平均随访２年，结果为手术治疗５例优良，１例可，非手术治疗２例疗效均不满意，表明手术治疗可有效复位骨折，去除神经外在压迫因素，对性质明确的神经损伤进行必要的松解和修复。本组坐骨神经损伤以腓侧部受累更为常见，腓侧部易受损伤的机理可能与某些局部解剖因素有关     

儿童臀部坐骨神经损伤

目的：探讨儿童臀部坐骨神经损伤的临床特点及处理。方法：回顾性研究分析139例儿童臀部坐骨神经损伤的临床资料。损伤原因中药物注射伤133例,锐器伤4例,钝器伤1例,手术误伤1例。分别进行神经松解术104例,神经吻合术4例,胫后肌转移2例,胫前肌转移1例,非手术治疗10例。结果：139例中除10例保守治疗者外,139例得到0.5-21年（平均8.4)的随访。神经松解术104例中优良者58例,占55.77%;神经吻合术4例良1例,占25%;肌腱转移术优良者16例,占76.19%,结论：和童臀部坐骨神经损伤以注射伤为最常见。诊断明确后应尽早手术进行神经探查松解,年龄愈小,手术越早效果越好,对断裂伤应积极认真进行端端吻合,对上述治疗无效者可通过肌腱转移术,对大龄儿童可采用踝关节融僵术改善踝关节功能。     

髋臼骨折合并坐骨神经损伤的治疗(附20例报告)

目的　探讨髋臼骨折合并坐骨神经损伤的创伤机制及治疗。方法　分析本组髋臼骨折合并坐骨神经损伤共 2 0例 ,均行肌电图检查。 4例采用患肢持续股骨髁上牵引非手术治疗 ;16例采用髋臼骨折切开复位内固定手术治疗 ,术中视坐骨神经损伤程度作神经外膜松解或束间松解。结果　坐骨神经恢复情况 :优 7例 ,良 6例 ,可 4例 ,差 3例。结论　应根据临床检查 ,X线及CT所示骨折移位情况和有无髋关节后脱位 ,作电生理检查 ,结合临床有无造成神经严重损伤的因素而决定是否探查坐骨神经 ;术中肉眼观察坐骨神经损伤程度对指导手术和判断预后有一定意义 ,神经的恢复情况与术中所见损伤程度有关     

Motor Nerve Transfers to Restore Extrinsic Median Nerve Function: Case Report

Active pronation is important for many activities of daily living. Loss of median nerve function including pronation is a rare sequela of humerus fracture. Tendon transfers to restore pronation are reserved for the obstetrical brachial plexus palsy patient. Transfer of expendable motor nerves is a treatment modality that can be used to restore active pronation. Nerve transfers are advantageous in that they do not require prolonged immobilization postoperatively, avoid operating within the zone of injury, reinnervate muscles in their native location prior to degeneration of the motor end plates, and result in minimal donor deficit. We report a case of lost median nerve function after a humerus fracture. Pronation was restored with transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres branch of the median nerve. Anterior interosseous nerve function was restored with transfer of the supinator branch to the anterior interosseous nerve. Clinically evident motor function was seen at 4 months postoperatively and continued to improve for the following 18 months. The patient has 4+/5 pronator teres, 4+/5 flexor pollicis longus, and 4−/5 index finger flexor digitorum profundus function. The transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres and supinator branch of the radial nerve to the anterior interosseous nerve is a novel, previously unreported method to restore extrinsic median nerve function.     

Assessment of Functional Recovery of Sciatic Nerve in Rats Submitted to Low-Level Laser Therapy with Different Fluences. An Experimental Study

Peripheral nerve lesions caused sensory and motor deficits along the distribution of the injured nerve. Numerous researches have been carried out to enhance and/or accelerate the recovery of such lesions. The objective of this study was to assess the functional recovery of sciatic nerve in rats subjected to different fluences of low-level laser therapy (LLLT). Thirty-six animals were randomly divided into four groups: one consisting of sham rats and three others irradiated with progressive fluencies of 10 J/cm², 40 J/cm² and 80 J/cm² of laser AsGaAl (830 nm) for 21 consecutive days. They were evaluated by the Sciatic Functional Index (SFI) method. The crush injury was performed by using a portable device with dead weight of 5,000 g whose load was applied for 10 min. A digital camera was used to record the footprints left on the acrylic track, before surgery and after, on the 7th, 14th, and 21st days. The results also showed that on the 7th day, there was a difference between the groups irradiated with 40 J/cm², when compared with the sham group (p < 0.05). On the 14th day the groups irradiated with 40 J/cm² and 80 J/cm² also presented better results when compared with sham, however, on the 21st day, no inter-group difference was found (p > 0.05). It was possible to observe that the LLLT at fluency of 40 J/cm² and 80 J/cm² had a positive influence on the acceleration of the functional nerve recovery.     

Intraneural Perineurioma of the Median Nerve: Case Report and Literature Review

Intraneural perineurioma is a benign peripheral nerve sheath tumor of perineurial cell origin. We present the case of an intraneural perineurioma of the median nerve in a 23-year-old woman which posed a diagnostic challenge. Ultrasonography was found to be a quick, easy, and effective screening tool for identifying the source of the deficit followed by MRI to further elucidate the lesion. We discuss surgical management options for optimizing functional outcomes when addressing such lesions.     

Musculocutaneous Neuropathy: Case Report and Discussion

The musculocutaneous nerve arises from the lateral cord of the brachial plexus and contains fibers from the C5, C6, and C7 spinal nerve roots. It innervates such muscles as the biceps brachii and brachialis as well as supply branches to the skin over the lateral cubital and forearm regions via the lateral antebrachial cutaneous nerve. Musculocutaneous neuropathy can arise from exercise, participating in sports, strenuous activity, cast placement, trauma, and surgery in addition to other less understood causes such as Parsonage Turner syndrome. We present the case of a 55-year-old female who complained of numbness, weakness, and pain throughout the arm starting 1 day following a surgical procedure. Electrodiagnostic testing revealed a musculocutaneous neuropathy with significant axonal injury. Symptoms of musculocutaneous neuropathy may be similar to cervical spinal nerve root impingement or brachial plexus lesions. Therefore, magnetic resonance imaging and electrodiagnostic studies may be useful in differentiating between these conditions. Once the diagnosis of musculocutaneous neuropathy has been made, treatments include relative rest, nonsteroidal anti-inflammatory drugs, splinting, physical therapy, and surgical decompression in cases that do not respond to conservative management.     

NGF对大鼠坐骨神经损伤后腰髓MBP含量及其前角神经元的影响

目的 :探讨NGF对大鼠坐骨神经完全离断后腰髓前角神经元的作用。方法 :30只大鼠分为 3组 ,Ⅰ组为生理盐水对照组 (硅胶管内注入 2 0ul生理盐水 ) ;Ⅱ组为NGF硅胶管给药 ,每只大鼠 10 0ng( 5ng/ul× 2 0ul) ;Ⅲ组为NGF硅胶管内给药后 +每日肌注NGF5 0 0ng/kg。切除单侧坐骨神经 10mm ,并用硅胶管桥接坐骨神经断端。术后 1、2、3、4个月分别进行霍乱毒素亚单位B结合的辣根过氧化酶 (CB -HRP)作为示踪剂 ,同时取标本测定脊髓髓鞘碱性蛋白 (MBP)含量。结果 :CB -HRP示踪Ⅱ和Ⅲ组优于对照组 ,前角运动神经元增多 ,突触连结成网 ;MBP含量Ⅱ组和Ⅲ组明显高于对照组 ,MBP含量减少不明显。结论 :外周神经损伤后 ,损伤局部应用NGF能减少其前角运动神经元死亡及脱髓鞘改变。     

亚甲兰对大鼠坐骨神经阻滞作用及病理损害的初步观察

作者在大鼠中分别应用浓度为１．０、０．７５、０．５和０．２５的亚甲兰作坐骨神经阻滞，发现浓度高于０．５％者阻滞效果明显，持续时间长；０．５％者效果差，０．２５％则无效。阻滞作用于注射４ｈ后出现，２４ｈ－３ｄ达高峰，５ｄ后消退。光镜检查发现，注射亚甲兰后４ｈ坐骨神经本身及相邻的横纹肌纤维出现轻度水肿和淋巴细胞浸润，随时间延长而加重，２４ｈ－５ｄ达高峰，但无神经和肌纤维坏死或细胞膜破裂，２ｗ后水肿减轻     

臀肌挛缩症松解术合并坐骨神经损伤

目的：探讨臀肌挛缩症松解术中坐骨神经损伤的危险因素，预防及处理方法，方法：1983年5月－2001年2月，对960例患者行臀肌挛缩症松解术，导致坐骨神经损伤，采用早期手术探查，显微技术外膜吻合，结果：960例中坐骨神经损伤2例，占0．21％，均经早期手术探查，显微外科技术吻合，效果良好。结论：对中、重度臀肌挛缩症松解时要逐层解剖，暴露清楚，注意坐骨神经变异，一旦损伤，应早期采用显微外科技术修复。     

人工全髋关节置换术中坐骨神经损伤的应用解剖学研究

目的　通过解剖位置的分析探讨全髋置换 (THR)术中坐骨神经 (SN)损伤的因素。方法　本组共 5 6具成年骨盆标本 ,对SN的来源及走行、SN与髋臼的关系进行测量分析 ,并对在THR术中拉钩及螺丝钉固定所致SN损伤 ,进行详尽测量分析。结果　测出SN至髋臼底的距离左侧为 6± 0 85mm ,右侧为 6± 0 71 2 5mm ;SN至髋臼缘的距离左侧为 1 3± 0 75mm ,右侧为 1 4± 0 0 6 2 5mm。SN在髋臼缘处周径左侧为 32± 0 2 75mm ,右侧为 31± 0 6 75mm。髋臼底至坐骨大孔的距离为左侧为 2 9± 0 36 2 5mm ,右侧为 2 9± 0 2 375mm。并确定拉钩及螺丝钉固定在 1～ 3点及 5～ 6点为安全区。结论　在THR术中陈旧髋臼骨折脱位、拉钩的位置不当、螺钉固定髋臼位置不当均可以损伤SN。     

Iatrogenic Sciatic Nerve Palsy Following Hemiarthroplasty of the Hip

Abstract We report a rare complication following insertion of an uncemented hip prosthesis that resulted in posterior perforation of the femoral stem and a sciatic nerve palsy. To our knowledge, sciatic nerve palsy due to the femoral stem perforating the cortex has not been previously described.     

犬化学去细胞神经同种异体移植的早期观察

目的：以化学去细胞同种异体神经，移植修复犬粗大神经的长段缺损，观察早期功能恢复及神经再生。方法：去细胞神经移植组和自体神经移植组各3犬，分别桥接坐骨神经5.0cm缺损。术后3个月观察其运动功能及神经再生。结果：实验组和对照组在术后功能恢复；移植段内新生神经纤维、新生血管及许旺细胞；吻合口远端有髓神经纤维等方面非常相似。结论：化学去细胞神经作为同种异体神经移植物，在修复粗大和长段神经缺损时不会被宿主排斥和吸收，其早期功能恢复及神经再生与自体神经移植无明显差别。     

髋部骨折脱位合并坐骨神经损伤治疗分析

目的：回顾分析髋部骨折脱位合并坐骨神经损伤的诊断治疗特点。方法：对47例髋部骨折脱位合并坐骨神经损伤的病例进行回顾性分析，随访1～3年。男35例，女12例，年龄18～62岁。髋部骨折脱位分类：单纯髋关节后脱位8例，单纯髋臼骨折4例，髋臼骨折合并髋关节后脱位29例，股骨头、股骨颈骨折合并髋臼骨折各3例。坐骨神经损伤类型：单纯腓总神经损伤34例，腓总神经、胫神经联合损伤13例，非手术治疗15例。手术治疗32例。结果：解剖复位21例，满意复位14例，不满意复位4例。坐骨神经恢复情况：优10例，良18例，差10例，劣9例。结论：对于单纯髋关节后脱位或髋臼骨折移位小于0．5cm者，应用非手术治疗。而对于骨折移位大于0．5cm者，应采取手术治疗，尽早解剖复位并探查坐骨神经，以减低创伤性髋关节炎的发生，并促进坐骨神经功能的恢复。     

髋臼骨折脱位合并坐骨神经损伤的治疗和预后

目的了解髋臼骨折脱位坐骨神经损伤概率、损伤程度,以及手术治疗与非手术治疗的疗效。方法自1999年7月～2007年8月收治208例髋臼骨折脱位合并坐骨神经损伤31例,手术治疗13例,非手术治疗18例。结果手术治疗的13例中8例有胫神经损伤表现,术前胫神经平均分为3.54分(按照LSUHSC评分),3例术后有恢复,4例完全恢复正常,1例未恢复,术后胫神经评分平均为4.77分。13例术前腓总神经平均分为2.23分,术后6例有恢复,2例恢复正常,5例没有恢复,术后腓总神经平均分为2.69分。非手术治疗的18例中14例有胫神经损伤,术前胫神经平均分为3.67分,13例有恢复,12例完全恢复正常,术后胫神经平均分为4.89分。非手术治疗病人都有腓总神经损伤,治疗前腓总神经平均分2.39分,治疗后13例有恢复,3例恢复正常,5例没有恢复,术后腓总神经平均分为3.39分。统计手术治疗与非手术治疗没有明显差异(P=0.206)。胫神经恢复好于腓总神经(P0.01)。结论髋臼骨折引起的坐骨神经损伤,其中腓总神经分支损伤更多见、更严重,无论手术治疗还是非手术治疗恢复都比胫神经差;坐骨神经损伤手术治疗效果并不优于非手术治疗。     

犬化学去细胞神经同种异体移植的神经电生理研究

目的　以化学去细胞同种异体坐骨神经 ,移植修复犬坐骨神经的粗大和长段缺损 ,观察其近期神经电生理恢复。方法　12只犬随机分成去细胞神经移植组 (实验组 )和自体神经移植组 (对照组 )各 6只。右侧坐骨神经造成 5 0cm长缺损 ,以两种神经移植物桥接修复。术后 6个月行神经电生理观察 ,包括小腿三头肌运动诱发电位、神经移植段运动传导速度、感觉诱发电位等。结果　 (1)方波 (1 0mA～ 2 0mA ,0 1ms,1 0Hz)刺激移植段近侧神经 ,均在小腿三头肌上记录到运动诱发电位曲线。 (2 )神经移植段运动传导速度 ,实验组平均为 4 7 2m/s、对照组为 6 0 9m/s、正常值为 12 2 0m/s。 (3)方波 (5 0mA～ 10 0mA ,0 2ms,1 9Hz)刺激胫神经远端 ,均在颅顶部记录到感觉诱发电位曲线 ;两组动物的感觉恢复程度相似 ,但均不及正常侧。结论　化学去细胞神经同种异体移植修复犬坐骨神经长段缺损 ,术后 6个月近期感觉及运动传导功能恢复与自体神经移植相似     

化学去细胞同种异体神经移植物储存方法的初步研究

目的探索犬去细胞神经的最佳储存方法.方法采用真空封装辐照灭菌法深低温储存犬去细胞坐骨神经12个月,进行细菌学检查、一般组织学观察、免疫组化染色、透射电镜观察.结果储存过程中不会发生细菌污染,储存去细胞神经的延展性及神经外膜的韧弹性保持良好;其基本结构、神经基底膜及许旺细胞基底板层被保留;仍然保持为没有细胞髓鞘及其碎片的空的神经基质管.结论真空封装辐照灭菌法可有效储存去细胞神经1年.     

Reconstruction of Posterior Interosseous Nerve Injury Following Biceps Tendon Repair: Case Report and Cadaveric Study

Surgical repair of distal biceps tendon rupture is a technically challenging procedure that has the potential for devastating and permanently disabling complications. We report two cases of posterior interosseous nerve (PIN) injury following successful biceps tendon repair utilizing both the single-incision and two-incision approaches. We also describe our technique of posterior interosseous nerve repair using a medial antebrachial cutaneous nerve graft (MABC) and a new approach to the terminal branches of the posterior interosseous nerve that makes this reconstruction possible. Finally, we advocate consideration for identification of the posterior interosseous nerve prior to reattachment of the biceps tendon to the radial tuberosity.     

Surgical Management of Solitary Nerve Sheath Tumors of the Cervical Spine: A Retrospective Case Analysis Based on Tumor Location and Extension

Complete resection of spinal nerve sheath tumors (NSTs) does not always result in significant neurological deficit. The purpose of this retrospective case analysis was to discuss the optimal surgical strategy for spinal NST of the cervical spine. Twenty-four patients who underwent surgery for solitary cervical NST over the past decade were included in this retrospective study. Patients with neurofibromatosis or schwannomatosis were excluded. Seventeen of the 24 cases (70.8%) showed extradural dumbbell extension, most frequently at the C1 or C2 vertebral level. Neurological condition was assessed using the modified McCormick functional schema and sensory pain scale. Total removal of the tumor was achieved in 20 of 24 cases (83.3%). Staged surgery using combined anterior and posterior approaches was applied for 2 of 17 cases with extradural dumbbell extension. Tumor involvement with nerve root fibers critical for upper extremity function (C5–C8) was recognized in 6 of 24 cases (25.0%), with complete resection in all 6 cases. Final assessment of neurological function revealed satisfactory or acceptable recovery in all 6 patients. Spinal NSTs with extradural dumbbell extension are a common condition in the cervical spine. Complete removal of spinal NST of the cervical spine may carry a risk of permanent neurological deficit, but such sequelae appeared to be the exception in the present case analysis. A radical and safe surgical strategy, including staged surgery combining anterior and posterior approaches, should be tailored to the individual case.