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Surgical treatment for severe cubital tunnel syndrome with absent sensory nerve conduction

Neural Regeneration Research 2019年第3期14卷 519-524页

作者： Jin-Song Tong Zhen Dong Bin Xu Cheng-Gang Zhang Yu-Dong Gu Department of hand Surgery Huashan Hospital Fudan University Key Laboratory of Hand Reconstruction Ministry of Health Shanghai key laboratory of Peripheral Nerve and Microsurgery

For severe cubital tunnel syndrome, patients with absent sensory nerve action potential tend to have more severe nerve damage than those without. Thus, it is speculated that such patients generally have a poor prognosis. How absent sensory nerve action potential affects surgical outcomes remains uncertain owing to a scarcity of reports and conflicting results. This retrospective study recruited one hundred and fourteen cases(88 patients with absent sensory nerve action potential and 26 patients with present sensory nerve action potential) undergoing either subcutaneous transposition or in situ decompression. The minimum follow-up was set at 2 years. Primary outcome measures of overall hand function included their McGowan grade, modified Bishop score, and Disabilities of the Arm, Shoulder, and hand Questionnaire(DASH) score. For patients with absent sensory nerve action potential, 71 cases(80.7%) achieved at least one McGowan grade improvement, 76 hands(86.4%) got good or excellent results according to the Bishop score, and the average DASH score improved 49.5 points preoperatively to 13.1 points postoperatively. When compared with the present sensory nerve action potential group, they showed higher postoperative McGowan grades and DASH scores, but there was no statistical difference between the modified Bishop scores of the two groups. Following in situ decompression or subcutaneous transposition, great improvement in hand function was achieved for severe cubital tunnel syndrome patients with absent sensory nerve action potential. The functional outcomes after surgery for severe cubital tunnel syndrome are worse in patients with absent sensory nerve action potential than those without. This study was approved by the Ethical Committee of Huashan Hospital, Fudan University, China(approval No. 2017142).

关键词： nerve regeneration absent sensory nerve action potential cubital tunnel syndrome disease severity electrodiagnostic testing in situ decompression subcutaneous transposition surgical outcomes prognostic factors peripheral nerve compression neural regeneration

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Endogenous automatic nerve discharge promotes nerve repair: an optimized animal model

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Neural Regeneration Research 2019年第2期14卷 306-312页

作者： Jing Rui Ying-Jie Zhou Xin Zhao Ji-Feng Li Yu-Dong Gu Jie Lao Department of hand Surgery Huashan Hospital Fudan University Key Laboratory of Hand Reconstruction Ministry of Health Shanghai key laboratory of Peripheral Nerve and Microsurgery

Exogenous electrical nerve stimulation has been reported to promote nerve regeneration. Our previous study has suggested that endogenous automatic nerve discharge of the phrenic nerve and intercostal nerve has a positive effect on nerve regeneration at 1 month postoperatively, but a negative effect at 2 months postoperatively, which may be caused by scar compression. In this study, we designed four different rat models to avoid the negative effect from scar compression. The control group received musculocutaneous nerve cut and repair. The other three groups were subjected to side-to-side transfer of either the phrenic(phrenic nerve group), intercostal(intercostal nerve group) or thoracodorsal nerves(thoracic dorsal nerve group), with sural nerve autograft distal to the anastomosis site. Musculocutaneous nerve regeneration was assessed by electrophysiology of the musculocutaneous nerve, muscle tension, muscle wet weight, maximum cross-sectional area of biceps, and myelinated fiber numbers of the proximal and distal ends of the anastomosis site of the musculocutaneous nerve and the middle of the nerve graft. At 1 month postoperatively, compound muscle action potential amplitude of the biceps in the phrenic nerve group and the intercostal nerve group was statistically higher than that in the control group. The myelinated nerve fiber numbers in the distal end of the musculocutaneous nerve and nerve graft anastomosis in the phrenic nerve and the intercostal nerve groups were statistically higher than those in the control and thoracic dorsal nerve groups. The neural degeneration rate in the middle of the nerve graft in the thoracic dorsal nerve group was statistically higher than that in the phrenic nerve and the intercostal nerve groups. At 2 and 3 months postoperatively, no significant difference was detected between the groups in all the assessments. These findings confirm that the phrenic nerve and intercostal nerve have a positive effect on nerve regeneration at the early stage of recovery. This study established

关键词： nerve regeneration peripheral nerve regeneration endogenous automatic discharge side-to-side nerve anastomosis phrenic nerve intercostal nerve animal model electrical treatment rats nerve compression neural regeneration

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Modified contralateral C7 nerve transfer: the possibility of permitting ulnar nerve recovery is confirmed by 10 cases of autopsy

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Neural Regeneration Research 2019年第8期14卷 1449-1454页

作者： Guang-Hui Hong Jing-Bo Liu Yu-Zhou Liu Kai-Ming Gao Xin Zhao Jie Lao Department of hand Surgery Huashan Hospital Fudan University Shanghai China Key Laboratory of Hand Reconstruction Ministry of Health Shanghai China Shanghai key laboratory of Peripheral Nerve and Microsurgery Shanghai China

Contralateral C7 nerve transfer surgery is one of the most important surgical techniques for treating total brachial plexus nerve injury. In the traditional contralateral C7 nerve transfer surgery, the whole ulnar nerve on the paralyzed side is harvested for transfer, which completely sacrifices its potential of recovery. In the present, novel study, we report on the anatomical feasibility of a modified contralateral C7 nerve transfer surgery. Ten fresh cadavers (4 males and 6 females) provided by the Department of Anatomy, Histology, and Embryology at the Medical College of Fudan University, China were used in modified contralateral C7 nerve transfer surgery. In this surgical model, only the dorsal and superficial branches of the ulnar nerve and the medial antebrachial cutaneous nerve on the paralyzed side (left) were harvested for grafting the contralateral (right) C7 nerve and the recipient nerves. Both the median nerve and deep branch of the ulnar nerve on the paralyzed (left) side were recipient nerves. To verify the feasibility of this surgery, the distances between each pair of coaptating nerve ends were measured by a vernier caliper. The results validated that starting point of the deep branch of ulnar nerve and the starting point of the medial antebrachial cutaneous nerve at the elbow were close to each other and could be readily anastomosed. We investigated whether the fiber number of donor and recipient nerves matched one another. The axons were counted in sections of nerve segments distal and proximal to the coaptation sites after silver impregnation. Averaged axon number of the ulnar nerve at the upper arm level was approximately equal to the sum of the median nerve and proximal end of medial antebrachial cutaneous nerve (left: 0.94:1;right: 0.93:1). In conclusion, the contralateral C7 nerve could be transferred to the median nerve but also to the deep branch of the ulnar nerve via grafts of the ulnar nerve without deep branch and the medial antebrachial cutaneous nerve. The advantage over traditiona

关键词： nerve regeneration brachial plexus avulsion injury nerve transfer contralateral C7 nerve modified surgery deep branch of ulnar nerve median nerve medial antebrachial cutaneous nerve hand function neural regeneration

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Phrenic and intercostal nerves with rhythmic discharge can promote early nerve regeneration after brachial plexus repair in rats

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Neural Regeneration Research 2018年第5期13卷 862-868页

作者： Jing Rui Ya-Li Xu Xin Zhao Ji-Feng Li Yu-Dong Gu Jie Lao Department of hand Surgery Huashan Hospital Fudan University Shanghai China Key Laboratory of Hand Reconstruction Ministry of Health Shanghai China Shanghai key laboratory of Peripheral Nerve and Microsurgery Shanghai China

Exogenous discharge can positively promote nerve repair. We, therefore, hypothesized that endogenous discharges may have similar effects. The phrenic nerve and intercostal nerve, controlled by the respiratory center, can emit regular nerve impulses; therefore these endogenous automatically discharging nerves might promote nerve regeneration. Action potential discharge patterns were examined in the diaphragm, external intercostal and latissimus dorsi muscles of rats. The phrenic and intercostal nerves showed rhythmic clusters of discharge, which were consistent with breathing frequency. From the first to the third intercostal nerves, spontaneous discharge amplitude was gradually increased. There was no obvious rhythmic discharge in the thoracodorsal nerve. Four animal groups were performed in rats as the musculocutaneous nerve cut and repaired was bland control. The other three groups were followed by a side-to-side anastomosis with the phrenic nerve, intercostal nerve and thoracodorsal nerve. Compound muscle action potentials in the biceps muscle innervated by the musculocutaneous nerve were recorded with electrodes. The tetanic forces of ipsilateral and contralateral biceps muscles were detected by a force displacement transducer. Wet muscle weight recovery rate was measured and pathological changes were observed using hematoxylin-eosin staining. The number of nerve fibers was observed using toluidine blue staining and changes in nerve ultrastructure were observed using transmission electron microscopy. The compound muscle action potential amplitude was significantly higher at 1 month after surgery in phrenic and intercostal nerve groups compared with the thoracodorsal nerve and blank control groups. The recovery rate of tetanic tension and wet weight of the right biceps were significantly lower at 2 months after surgery in the phrenic nerve, intercostal nerve, and thoracodorsal nerve groups compared with the negative control group. The number of myelinated axons distal to the coaptation site of the musculocutan

关键词： nerve regeneration endogenous automatic discharge side-to-side nerve anastomosis peripheral nerve regeneration phrenic nerve intercostal nerve peripheral nerve injury neural regeneration

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Proteomic analysis of trans-hemispheric motor cortex reorganization following contralateral C7 nerve transfer

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Neural Regeneration Research 2018年第2期13卷 331-339页

作者： Yin Yuan Xiu-yue Xu Jie Lao Xin Zhao Department of hand Surgery Huashan HospitalFudan UniversityShanghaiChina Key Laboratory of Hand Reconstruction Ministry of HealthShanghaiChina Shanghai key laboratory of Peripheral Nerve&Microsurgery ShanghaiChina

Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Pre- vious studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth asso- ciated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function （including neuron differentiation and development, axonogenesis, and guidance）, microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light （NFL） and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteom- ic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C7 nerve transfer.

关键词： nerve regeneration brachial plexus brain plasticity contralateral C,q cortex reorganization isobaric tags for relative and absolute quantitation proteomics nerve transfer neurofilament light Thy-1 neural regeneration

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Clinical research of postoperative comprehensive rehabilitation in treating brachial plexus injuries

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Chinese Medical Journal 2014年第9期127卷 1782-1784页

作者： Xu Xiaojun Zhou Junming Gu Yudong Department of hand Surgery Huashan Hospital Fudan University Key Laboratory of Hand Reconstruction Ministry of Health Shanghai Key Laboratory of Peripheral Nerve and Microsurgery Shanghai 200040 China

Brachial plexus injury is regarded as one of the most difficult international medical problem. Microsurgery is an advanced technology and has progressed further on the operation, especially on the nerve repair.

关键词： brachial plexus neuropathies physical therapy modalities exercise therapy, nerve regeneration

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Electroacupuncture attenuates neuropathic pain after brachial plexus injury

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Neural Regeneration Research 2014年第14期9卷 1365-1370页

作者： Shenyu Zhang Hailiang Tang Junming Zhou Yudong Gu Department of hand Surgery Huashan HospitalFudan University Key Laboratory of Hand Reconstruction Ministry of Health Shanghai key laboratory of Peripheral Nerve and Microsurgery Department of Neurosurgery Huashan HospitalFudan University

Electroacupuncture has traditionally been used to treat pain, but its effect on pain following brachial plexus injury is still unknown. In this study, rat models of an avulsion injury to the left brachial plexus root （associated with upper-limb chronic neuropathic pain） were given electroacupuncture stimulation at bilateral Quchi （LIll）, Hegu （LI04）, Zusanli （ST36） and Yanglingquan （GB34）. After electroacupuncture therapy, chronic neuropathic pain in the rats＇ upper limbs was significantly attenuated. Immunofluorescence staining showed that the expression of β-endorphins in the arcuate nucleus was significantly increased after therapy. Thus, experimental findings indi- cate that electroacupuncture can attenuate neuropathic pain after brachial plexus injury through upregulating β-endorphin expression.

关键词： nerve regeneration peripheral nerve injury brachial plexus injury neuropathic pain electroacupuncture ^-endorphin chronic neuropathic pain brachial plexus avulsion neuralregeneration

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Clinical research of comprehensive rehabilitation in treating brachial plexus injury patients

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Chinese Medical Journal 2012年第14期125卷 2516-2520页

作者： ZHOU Jun-ming GU Yu-dong XU Xiao-jun ZHANG Shen-yu ZHAO Xin Department of hand Surgery Huashan Hospital Fudan UniversityKey Laboratory of Hand Reconstruction Ministry of HealthShanghai Key Laboratory of Peripheral Nerve and MicrosurgeryShanghai 200040 China

Background Brachial plexus injury is one of the difficult medical problems in the world. The aim of this study was to observe the clinical therapeutic effect of comprehensive rehabilitation in treating dysfunction after brachial plexus injury. Methods Forty-three cases of dysfunction after brachial plexus injury were divided into two groups randomly. The treatment group, which totaled 21 patients （including 14 cases of total brachial plexus injury and seven cases of branch brachial plexus injury）, was treated with comprehensive rehabilitation including transcutaneous electrical nerve stimulation, mid-frequency electrotherapy, Tuina therapy, and occupational therapy. The control group, which totaled 22 patients （including 16 cases of total brachial plexus injury and six cases of branch brachial plexus injury）, was treated with home-based electrical nerve stimulation and occupational therapy. Each course was of 30 days duration and the patients received four courses totally. After four courses, the rehabilitation effect was evaluated according to the brachial plexus function evaluation standard and electromyogram （EMG） assessment. Results In the treatment group, there was significant difference in the scores of brachial plexus function pre- and post-treatment （P 〈0.01） in both ＂total＂ and ＂branch＂ injury. The scores of two ＂total injury＂ groups had statistical differences （P 〈0.01）, while the scores of two ＂branch injury＂ groups had statistical differences （P 〈0.05） after four courses. EMG suggested that the appearance of regeneration potentials of the recipient nerves in the treatment group was earlier than the control group and had significant differences （P 〈0.05）. Conclusion Comprehensive rehabilitation was more effective in treating dysfunction after brachial plexus injury than nonintegrated rehabilitation.

关键词： brachial plexus injury comprehensive rehabilitation therapeutic effects

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Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

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Neural Regeneration Research 2015年第7期10卷 1172-1176页

作者： Li Zhang Aierken Rehemutula Feng Peng Cong Yu Tian-bin Wang Lin Chen Department of hand Surgery Huashan Hospital Fudan University Key Laboratory of Hand Reconstruction Ministry of Health Shanghai key laboratory of Peripheral Nerve and Microsurgery Department of Orthopedics Beijing University People’s Hospital

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

关键词： nerve regeneration peripheral nerve injury ultrasonography carpal tunnel syndrome diagnosis cross-sectional area classification clinical laboratory technique electrodiagnosis median nerve 973 Program neural regeneration

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End-to-side neurorrhaphy repairs peripheral nerve injury：sensory nerve induces motor nerve regeneration

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Neural Regeneration Research 2017年第10期12卷 1703-1707页

作者： Qing Yu She-hong Zhang Tao Wang Feng Peng Dong Han Yu-dong Gu Department of hand Surgery Huashan Hospital of Fudan UniversityKey Laboratory of Hand Reconstructionthe Ministry of HealthKey Laboratory of Peripheral Nerve and MicrosurgeryShanghaiChina Department of Rehabilitation Medicine Huashan Hospital of Fudan UniversityShanghaiChina

End-to-side neurorrhaphy is an option in the treatment of the long segment defects of a nerve.It involves suturing the distal stump of the disconnected nerve（recipient nerve） to the side of the intimate adjacent nerve（donor nerve）.However,the motor-sensory specificity after end-to-side neurorrhaphy remains unclear.This study sought to evaluate whether cutaneous sensory nerve regeneration induces motor nerves after end-to-side neurorrhaphy.Thirty rats were randomized into three groups：（1） end-to-side neurorrhaphy using the ulnar nerve（mixed sensory and motor） as the donor nerve and the cutaneous antebrachii medialis nerve as the recipient nerve;（2） the sham group：ulnar nerve and cutaneous antebrachii medialis nerve were just exposed;and（3） the transected nerve group：cutaneous antebrachii medialis nerve was transected and the stumps were turned over and tied.At 5 months,acetylcholinesterase staining results showed that 34% ± 16% of the myelinated axons were stained in the end-to-side group,and none of the myelinated axons were stained in either the sham or transected nerve groups.Retrograde fluorescent tracing of spinal motor neurons and dorsal root ganglion showed the proportion of motor neurons from the cutaneous antebrachii medialis nerve of the end-to-side group was 21% ± 5%.In contrast,no motor neurons from the cutaneous antebrachii medialis nerve of the sham group and transected nerve group were found in the spinal cord segment.These results confirmed that motor neuron regeneration occurred after cutaneous nerve end-to-side neurorrhaphy.

关键词： nerve regeneration peripheral nerve injury end-to-side neurorrhaphy motor-sensory specificity rat dorsal root ganglion motor neuron axon cutaneous antebrachii medialis nerve ulnar nerve acetylcholinesterase staining retrograde neuron tracing neural regeneration

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