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Background Brachial plexus root avulsion (BPRA) can cause motor neuron death, nerve degeneration andupper limb motor dysfunction. The molecular mechanisms of motor neuron death and nerve degeneration arelargely unknown and there are no effective therapies to increase the functional recovery after BRPA.Aim: To detect the early pathway changes in spinal cord tissues after brachial plexus root avulsion.Methods A mouse brachial plexus avulsion and re-implantation model was constructed, and the C5-C7segments of the spinal cords were dissected three days after the surgery. We used RNA-seq to identify theexpression changes of genes and gene networks in spinal cord tissues.Results A total of 2253 differentially expressed genes were found significantly changed with 1852 upregulatedand 401 downregulated at 3 days after BPRA. Gene ontology (GO) enrichment analysis showed thatdifferentially expressed genes were most enriched in immune system process, regulation of immune systemprocess, defense response, plasma membrane part, extracellular region part, cell surface, protein binding,receptor binding, glycosaminoglycan binding. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathwayanalysis showed that the most enriched pathways included osteoclast differentiation, NF-kappa B, cytokinecytokine receptor interaction, TNF, hematopoietic cell lineage, complement and coagulation cascades, PI3KAkt, ECM-receptor interaction, NOD-like receptor, Toll-like receptor signaling pathway.Conclusions This study systematically identified the critical genes and signaling pathways in BPRA pathology.These results expand our understanding of the complex molecular mechanisms involved in BPRA and provide afoundation for future research of spinal cord tissue injury and repair.
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Objective To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014.Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases.The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recov鄄ered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the muscu鄄locutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3.In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively. Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.
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Objective@#To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation.@*Methods@#A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014. Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery.@*Results@#All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recovered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3. In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively.@*Conclusion@#Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.
ABSTRACT
Objective To discuss the characteristic of brachial plexus root avulsion injury of high resolution MR imaging and the value in diagnosing of brachial plexus root avulsion injury early.Methods Fourty-five cases of brachial plexus root avulsion injury patients had being used for investigation to find the characteristic and diagnostic value of MR image of brachial plexus root avulsion injury,which all have pre-operative MR imaging and were diagnosed brachial plexus root avulsion injury by intra-operative exploration and electrophysiology form February 2006 to February 2011.Results Post-traumatic spinalmeningolceles were seen in 42 cases,the frequency was 93.3％; Displacement of spinal cord was seen in 25 cases,the frequency was 55.6％; Absence of anterior and posterior root of spinal nerve was seen in 8 eases,the frequency was 17.8％;Black line sign was seen in 18 cases,the frequency was 40.0％.The sensitivity,specificity,and accuracy of MRI in diagnosing brachial plexus root injury were 95.7％,77.8％ and 94.6％ respectively.Conclusion Posttraumatic spinalmeningolceles are most often seen in MR of brachial plexus root avulsion injury,this sign can play an important role in diagnosing and treatment of brachial plexus root avulsion injury.