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[Objective]To discuss the result of using latissimus dorsi musculocutaneous flap which function was recovered by repairing the thoracodorsal nerve with nerve transfering for reconstruction of flexor of elbow or digits in brachial plexus injury patients.[Method]From march 2000 to June 2003,eight patients with brachial plexus total roots avulsion were treated by mlutiple donor nerves transfer.The function of latissimus dorsi muscle recorved well but not the biceps muscle in five patients.The function of flex digits did not recover while the latissimus dorsi muscule recorverd well in three patients.All of them had the aid of latissimus dorsi musculocutaneous flap to reconstruct the flexor of elbow or digits.[Result]The patients were followed up for one year to half past three years,all of musculocutaneous flap were survived,the muscle strenght graded 3 to 4 and the active motion of the elbow was over 100 degrees in flexion and 10 degrees to 25 degrees in extension.All the digits can grasp,the fist closure was about 2 cm and the muscle strenght was grade 3 of the involved digits.[Conclusion]It is a good method to reconstruct the flexor of elbow or digits by the recovered latissimus dorsi musculocutaneous flap in brachial plexus total roots avulsion patients.When treating brachial plexus total roots avulsion patients,it is necessary to repair the thoracodorsal nerve.
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[Objective]To investigate the morphological characteristic of the scalenus minimus. [Methods]Totally 32(64 sides) embalmed adult cadavers were dissected and studied,the morphology of scalenus minimus and its relationship to brachial plexus was observed.Ten scalenus minimus were stained by HE to study membrane of the muscles.Twenty-seven(54 sides) embalmed adult cadavers were dissected carefully to investigate its nerve and blood supply.[Results]Scalenus minimus was found in 84.4% of cadavers(54/64).Its insertion was mainly composed of tendinous tissue,which was spaned by the lower trunk of brachial plexus.Scalenus minimus supply nerve branches was from ventral rami of the cervical seven root,and vascular supply was from:(1) branches of deep cervical artery,(2) branches of subclavia artery.[Conclusion]Scalenus minimus muscle,an independent but inconstant muscle,is existed in most people and sometimes responsible for compression of brachial plexus.It is suggested that scalenus minimus muscle should be resected carefully as well as scalenus anticus and medius during surgical treatment of thoracic outlet syndrome.
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<p><b>OBJECTIVES</b>To investigate anatomical mechanism of the ulnar wrist pain caused by the compression of the dorsal branch of the ulnar nerve, and discuss the diagnosis and treatment of the compression.</p><p><b>METHODS</b>40 sides of the upper extremities of adult cadavers were studied anatomically. The dorsal branch of the ulnar nerve and its relationship to the surroundings was dissected and observed grossly and microscopically. 13 cases of the compression of the dorsal branch of the ulnar nerve were treated and followed up.</p><p><b>RESULTS</b>The dorsal branch of the ulnar nerve was penetrated from the deep of the flexor carpi ulnaris muscle 5.6 approximately 6.8 cm proximally from the styloid process of the ulna, then ran along the ulna and divided into 2 approximately 3 big branches at the medial side of the head of the ulna. The transverse branch was apt to injury during wrist movement as it crossed or rounded the head of the ulna where it was close to the peristeam. Seven of 13 cases of the compression of the dorsal branch of the ulnar nerve were treated by local block, and 6 by surgical neurolysis. Nine cases of this group got showed good effect without recurrence after 4 months to 1 year follow-up.</p><p><b>CONCLUSION</b>The anatomical basis of the compression of the dorsal branch of the ulnar nerve is repetitive traction to this nerve during wrist movement, and the compression of the transverse branch is the main cause of ulnar wrist pain. The compression of the dorsal branch of the ulnar nerve should be considered to the patients with ulnar wrist pain and abnormal sensation along the dorsal ulnar side of hand.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Ulnar Nerve , Ulnar Nerve Compression Syndromes , Diagnosis , Therapeutics , WristABSTRACT
Purpose To explore the effects of cervical sympathetic nerve on the axoplasmic transport of the trigeminal nerve. Methods 48 Wistar rats were used with the right side as experimental side and the left side as control side.5 μl of 30% horseradish peroxidare(HRP) solution was injected into the symmetrical areas on both sides of the infraorbital regions.Then 0.4 ml of suspension made up of 0.2 ml 0.5% bupivacaine and 0.2 ml hydroprednisone-A was injected into C5 transverse process on the right side,and 0.4 ml of 0.9% normal saline on the control side.The animals survived for 4,6,8,10,12,14h,and were killed after perfusing through the ascending aorta.The superior cervical sympathetic ganglia and the trigeminal ganglia on both sides frozen sectioned,and treated with TMB method.The HRP labeled cells in the sections were observed under light microscope.The positive labeled cells were classified and counted.The sum of mean area and the mean optical density of HRP labeled cells in superior cervical sympathetic ganglia and the trigeminal ganglia on both sides were analysed by image pattern analysis system. Results The labeled cells were found in the trigeminal ganglia of the experimental sides after 6 h,the control side,8 h.The velocity of HRP axoplasmic transport of the experimental side was (5.50±0.95)mm/h,the control side (3.99±0.81)mm/h(P<0.01).The sum of mean area and the product of the sum of mean area and the mean optical density of HRP labeled cells in the trigeminal ganglia of the experimental side were larger than those of the control side (P<0.01).The labeled cells were found in the superior cervical sympathetic ganglia on both sides after 8 h.The sum of mean area and the mean optical density of HRP labeled cells in the superior cervical sympathetic ganglia on the control sides were larger than those of the experimental sides (P<0.01). Conclusions Cervical sympathetic nerve can affect the velocity of the axoplasmic transport of the trigeminal nerve.The cervical local block slows accelerates the axoplasmic transport of the cervical sympathetic nerve and the axoplasmic transport of the trigeminal nerve.
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Purpose To study the relationship between sympathetic nerve and the branches of primary sensory neurons in dominating cervical zygapophyseal joints with the HRP retrograde tracing methods.To explore the mechanism of the external intervertebral foramen's cryical nerve compression syndrome with neck-shoulder pain and the symptom of head and face regions. Methods 8 Wistar rats were used with the right side as experimental side and the left side as control side.5 μl of 30% HRP solution was injected into the C5/C6 cervical zygapophyseal joint capsule of the right side by microinjection syringe and 5 μl of 0.9% normal saline was injected into the left side as control.The animals survived for 48 hours and were killed by perfusing through ascending aorta.The C1-T1 DRG,cervical sympathetic ganglia and trigeminal ganglia on both sides were sectioned by frozen section method,and treated with TMB method.The HRP labeled cells in sections were observed under optical microscope.The classification and count of HRP labeled cells in DRG and cervical sympathetic ganglia on experimental sides were analysed by image pattern analysis system. Results There were HRP labeled cells in middle cervical ganglia,inferior cervical ganglia (stellate ganglia) and C5-C7 DRG on experimental sides after HRP injection.Most of the labeled cells were small or middle size.The sum of mean area and the mean optical density of HRP labeled cells were larger in the middle cervical ganglia and C6 DRG than that in inferior cervical ganglia(stellate ganglia) and C5 or C7 DRG separately (P<0.01).There wasn't any HRP labeled cell in C1-T1 DRG of control side and in trigeminal ganglia. Conclusions The cervical zygapophyseal joint mainly dominated by the sensory branches of the three cervical nerves next to it and by the branches of the sympathetic nerves.It may be related to the causing of neck-shoulder pain and the symptoms of head and face regions of patients with the external intervertebral foramen's cervical nerve compression