Clinical analysis of distal radius core decompression for chronic wrist pain / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.@*METHODS@#A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI.@*RESULTS@#All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up.@*CONCLUSION@#For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.

Brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap / 中华创伤杂志(英文版)

Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter. Common complications recorded in literatures are hematoma and muscle atrophy due to a compartment syndrome. We treated a patient with soft tissue avulsion at forearm using free latissimus dorsi muscle transfer for soft tissue coverage in our hospital. Unfortunately during the transfer the patient's brachial plexus was injured. After timely treatment, he recovered completely.

Long term outcome of contralateral C7 transfer: a report of 32 cases / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To observe long-term functional recovery after contralateral C7 transfer.</p><p><b>METHODS</b>From August 1986 to July 2000, 224 patients with brachial plexus avulsion injuries were treated with contralateral C7 transfer in our department. Thirty-two patients were followed up for over 2 years for evaluation of the following items: 1 influence on healthy limb function; 2 sensory and motor recovery of the recipient nerves in the affected limb; and 3 coordination between the healthy and affected limbs.</p><p><b>RESULTS</b>There was no impairment of healthy limb function. Functional recovery of the recipient area reached > or =M3 in 8 patients (8/10, 80%) after musculocutaneous nerve neurotization, > or =M3 in 4 patients (4/6, 66%) after radial nerve neurotization, > or = M3 in 7 patients (7/14, 50%) and > or = M3 in 12 patients (85.7%) after median nerve neurotization, and > or = M3 in 1 patients (1/2, 50%) after thoracodorsal nerve neurotization. Synchronic contraction of the affected limb with the healthy limb occurred within 2-3 years in 12 patients, within 5 years in 13 patients, and over 5 years in 7 patients.</p><p><b>CONCLUSION</b>Contralateral C7 transfer is an ideal procedure for the treatment of brachial plexus root avulsion injury. Selection of the whole root or the posterior division as neurotizer and a staged operation are the major factors influencing treatment outcome.</p>

Application of nerve grafting and nerve transfer for treatment of early obstetrical brachial plexus palsy / 中华骨科杂志

Objective To evaluate the efficacy of the nerve grafting and nerve transfer (neurotization) in the treatment of early obstetrical brachial plexus palsy(OBPP). Methods 48 cases with TassinⅡ-Ⅳ lesion who had no any recovery of elbow flexion, the brachial plexus were explored from 3 to 14 months after birth. The method of nerve repair depended on findings during operation. For the traumatic neuroma, it should be resected and the defect be repaired by nerve grafting with neurotization; the root avulsion was repaired by neurotization; neurolysis was only performed to those plexus that looked nearly normal and had a positive reaction of neurophysiology as tested intra-operatively. The reconstructive procedures included: C5→upper trunk, accessory →supraspinal nerve (2 cases); C5,6→the posterior and the anterior division of the upper trunk respectively, accessory →supraspinal nerve (25 cases); C5,6→the posterior and anterior divisions of the upper trunk respectively, C7→middle trunk, accessory →supraspinal nerve (4 cases); C5→posterior cord, C6→lateral cord, accessory →supraspinal nerve (5 cases); C5→anterior division of the upper trunk, C6→C8, accessory →supraspinal nerve (1 case); C5-7→the posterior, lateral and medial cords respectively, accessory →supraspinal nerve (4 cases); C5→upper trunk, C6→lower trunk (or medial cord), accessory →supraspinal nerve (2 cases); C5,6→the lateral and medial cords respectively, accessory →supraspinal nerve (3 cases); neurolysis (2 cases). Results All the patients were available at follow-up at least for 36 months, who were studied according to both of the Gilberts shoulder and elbow rating system and the Raimondis hand scale system. The score of shoulder, elbow, and hand in 13 cases with Tassin Ⅱ lesion improved from preoperative 0.54, 1.92 and 3.23 to postoperative 3.77, 4.92 and 4.31 respectively; 11 cases with Tassin Ⅲ rose from 0.46, 1.82 and 1.91 to 3.27, 4.18 and 3.64, and 24 cases with Tassin Ⅳ had an elevation from 0.25, 1.25 and 0.33 to 2.92, 3.46 and 2.83. The medial rotation contracture of the shoulder without subluxation and dislocation was found in 7 cases(14.6%) in the process of recovery. Conclusion The resection of the traumatic neuroma combined with nerve grafting and neurotization is really effective in the treatment of early OBPP.

Experimental study on human Schwann cell culture and proliferation / 中华显微外科杂志

Objective To investigates the possible methodes for adult human Schwann cell culture and proliferation with F-12 medium which could be used on human body. Methods Nineteen human peripheral nerves were used in this study, 12 of them were cultured under F-12 medium and the other 7 nerves under standerd medium. The medium were changed every 2 days, and the nerve tissues were transfered to another plate when there were too many cells, after 6-8 times of transferring, most of the cells were Schwann cells and the nerve tissues were digested using none cell toxic collagenas. The cells were counted and evaluated the survival rate with Live-Dead kit S-100 protein immunostaining was used to assesse the Schwann cell purity. Results The survival rate of the cells were 85.54% and 86.93% , and the Schwann cell purity were 82.64% and 86.37% respectively, there were no difference between the two different medium, but we got more cells from F-12 medium than Standard medium, which was 14.2?10~7 and 5.9?10 respectively. Conclusion The F-12 medium could be used for human Schwann cell culture, meanwhile it had possible function on Schwann cell proliferation.

Study on clinical application of selective transfer of ipsilateral C(7) nerve root / 中华创伤杂志(英文版)

OBJECTIVE: To verify the rationality, reliabilit y and practicability of selective transfer of ipsilateral C(7) nerve root for tr eatment of upper trunk avulsion. METHODS: Selective transfer of ipsilateral C(7) nerve root was ca rried out in 8 patients (7 with upper trunk avulsion, and 1 with left upper trun k avulsion combined with partial injury of the middle trunk) from June 1996 to F ebruary 1997. Selective transfer of the anterior division or the anteriolateral fascicles of the anterior division of ipsilateral C(7) to the anterior division of the upper trunk was performed under general anesthesia. Only 5 cases were fol lowed up. RESULTS: Among these 5 cases, effective recovery was observed o n 4 cases of the transfer of the anteriolateral fascicles of ipsilateral C(7) to the anterior division of the upper trunk. Electromyographic examination showed nerve regeneration could be observed in the 2nd month postoperatively. And detec table elbow flexion by biceps contraction was found in the 4th month postoperati vely. The function of the C(7) innervating muscles was not jeopardized, and the case with combined partial C(7) root injury had a poor result. CONCLUSIONS: Selective transfer of ipsilateral C(7) nerve root leads to a restoration of reinnervating muscle functions without affecting the f unction of the muscles innervated by C(7). It is therefore a practicable new sur gical procedure for treating upper trunk avulsions.