<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Wheth...<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Whether anesthesia type affects patient outcomes is unclear. </span><span>This study retrospectively compared patient satisfaction between GA and NB after surgery. </span><b><span>Methods: </span></b><span>This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively.</span><span> </span><b><span>Results:</span></b><span> After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p</span><span> </span><span>=</span><span> </span><span>0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: </span><span>-</span><span>1.27 and </span><span>-</span><span>0.77, p</span><span> </span><span>=</span><span> </span><span>0.00074 and p</span><span> </span><span>=</span><span> </span><span>0.0388, respectively), as was surgery duration (effect size: </span><span>-</span><span>0.84, p</span><span> </span><span>=</span><span> </span><span>0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p</span><span> </span><span>=</span><span> </span><span>0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively.</span><span> </span><b><span>Conclusions:</span></b><span> Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.</span>展开更多
Objective: Using single photon emission computed tomography (SPECT) to observe the influence of the up-transmitting of acupuncture signal into the brain in health volunteers whose nerve trunk was blocked by anesthetic...Objective: Using single photon emission computed tomography (SPECT) to observe the influence of the up-transmitting of acupuncture signal into the brain in health volunteers whose nerve trunk was blocked by anesthetics. Methods: Thirty-one healthy volunteers were divided into two groups, the control group of 20 cases, and the brachial plexus blockade (BPB) group of 11 cases, with supraclavicular BPB route adopted. With the control group 2 acupoints were randomly selected (Hegu and Quchi of both sides), while with the BPB group Hegu and Quchi of anesthetic arm side were selected. Siemens ECAM/ ICON SPECT system was used to conduct brain imaging using double imaging assay before acupuncture and 99mTc-ECD imaging agent during acupuncture for cerebral perfusion. The data were quantitatively analyzed by blood functional changing rate (BFCR%) mathematics model. Results: Before acupuncture, the control and BPB groups showed insignificant change by SPECT, but after electro-acupuncture (EA), the control group displayed improved motor and sensory cortex excitability in basal nuclei, contra-lateral thal-amus, parietal and frontal lobe; while BPB group was characterized with reduction of the blood perfusion and cell function of contra-lateral thalamus of anesthetized arm. The difference between the two groups was significant (P<0.01) . Conclusion: (1) After BPB, the up-transmitting of the acupuncture signal via upper limb into the brain, and its strength was impaired or blocked; (2) After BPB, the effect of acupuncture on cerebral perfusion and brain cell function of contra-lateral thalamus was impaired or blocked.展开更多
Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C34 transfer for neurotization of 05-6. Results showed that Terzis grooming test scores were significantly increas...Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C34 transfer for neurotization of 05-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 ＋ phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level IIHV, scapular muscle to level Ill-W, latissimus dorsi and pectoralis major muscles to above level Ⅲ, and the brachial triceps muscle to level 0 Ill. Results showed that the improved 03-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.展开更多
Schwannomas of the head and neck as well as brachial plexus primary tumors are both uncommon entities, and combination of these conditions is quite rare. Schwannomas of the brachial plexus are usually asymptomatic and...Schwannomas of the head and neck as well as brachial plexus primary tumors are both uncommon entities, and combination of these conditions is quite rare. Schwannomas of the brachial plexus are usually asymptomatic and they present as slowly enlarging masses in the supra- or infraclavicular regions. Although imaging plays a routine role in the detection of these neoplasms, identification of the nerve origin is not often feasible until the time of surgery. Definitive diagnosis is based on histopathological features with presence of spindle-shaped Schwann cells. We report a case of a middle aged woman with left lateral mid-neck mass, which based on the clinical findings, was provisionally diagnosed as a painless lymphadenopathy. Ensuing excisional biopsy revealed the brachial plexus as the origin of a tumor, which subsequently was confirmed to be a schwannoma with microscopic evaluation. The course of disease was complicated with upper brachial plexus injury which was recovered by sural nerve graft.展开更多
The brachial plexus (BP), established by the lap twigs of the last four cervical nerves and the first thoracic nerve, assures the driving and sensory innervation of the thoracic member. We bring back a case of rare an...The brachial plexus (BP), established by the lap twigs of the last four cervical nerves and the first thoracic nerve, assures the driving and sensory innervation of the thoracic member. We bring back a case of rare anatomical variation of the brachial plexus. It is a 34-year-old corpse dissected in the laboratory of anatomy of the Faculty of Medicine and Odontostomatology of Bamako in September 2017. The lap twig of the fourth cervical root (C4) participated in the constitution of the brachial plexus. The superior trunk was normally constituted. The average trunk was formed by the cervical roots C7 and C8 instead of only C7. And consequently the inferior trunk was constituted by the thoracic root T1. The posterior beam was only formed by the posterior branches of the superior and more average trunk. The medial beam was formed by all of the inferior trunk which did not give posterior branch for the formation of the posterior beam. The variations of the brachial plexus could entrain failures in the loco regional anesthesia of the brachial plexus.展开更多
文摘<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Whether anesthesia type affects patient outcomes is unclear. </span><span>This study retrospectively compared patient satisfaction between GA and NB after surgery. </span><b><span>Methods: </span></b><span>This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively.</span><span> </span><b><span>Results:</span></b><span> After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p</span><span> </span><span>=</span><span> </span><span>0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: </span><span>-</span><span>1.27 and </span><span>-</span><span>0.77, p</span><span> </span><span>=</span><span> </span><span>0.00074 and p</span><span> </span><span>=</span><span> </span><span>0.0388, respectively), as was surgery duration (effect size: </span><span>-</span><span>0.84, p</span><span> </span><span>=</span><span> </span><span>0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p</span><span> </span><span>=</span><span> </span><span>0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively.</span><span> </span><b><span>Conclusions:</span></b><span> Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.</span>
基金This program was supported by Natural Science Foundation of Guangdong Province (No. 990962)
文摘Objective: Using single photon emission computed tomography (SPECT) to observe the influence of the up-transmitting of acupuncture signal into the brain in health volunteers whose nerve trunk was blocked by anesthetics. Methods: Thirty-one healthy volunteers were divided into two groups, the control group of 20 cases, and the brachial plexus blockade (BPB) group of 11 cases, with supraclavicular BPB route adopted. With the control group 2 acupoints were randomly selected (Hegu and Quchi of both sides), while with the BPB group Hegu and Quchi of anesthetic arm side were selected. Siemens ECAM/ ICON SPECT system was used to conduct brain imaging using double imaging assay before acupuncture and 99mTc-ECD imaging agent during acupuncture for cerebral perfusion. The data were quantitatively analyzed by blood functional changing rate (BFCR%) mathematics model. Results: Before acupuncture, the control and BPB groups showed insignificant change by SPECT, but after electro-acupuncture (EA), the control group displayed improved motor and sensory cortex excitability in basal nuclei, contra-lateral thal-amus, parietal and frontal lobe; while BPB group was characterized with reduction of the blood perfusion and cell function of contra-lateral thalamus of anesthetized arm. The difference between the two groups was significant (P<0.01) . Conclusion: (1) After BPB, the up-transmitting of the acupuncture signal via upper limb into the brain, and its strength was impaired or blocked; (2) After BPB, the effect of acupuncture on cerebral perfusion and brain cell function of contra-lateral thalamus was impaired or blocked.
基金supported by the Military Medicine and Health Research Foundation of China,No.06M098, CWS11J240
文摘Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C34 transfer for neurotization of 05-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 ＋ phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level IIHV, scapular muscle to level Ill-W, latissimus dorsi and pectoralis major muscles to above level Ⅲ, and the brachial triceps muscle to level 0 Ill. Results showed that the improved 03-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.
文摘Schwannomas of the head and neck as well as brachial plexus primary tumors are both uncommon entities, and combination of these conditions is quite rare. Schwannomas of the brachial plexus are usually asymptomatic and they present as slowly enlarging masses in the supra- or infraclavicular regions. Although imaging plays a routine role in the detection of these neoplasms, identification of the nerve origin is not often feasible until the time of surgery. Definitive diagnosis is based on histopathological features with presence of spindle-shaped Schwann cells. We report a case of a middle aged woman with left lateral mid-neck mass, which based on the clinical findings, was provisionally diagnosed as a painless lymphadenopathy. Ensuing excisional biopsy revealed the brachial plexus as the origin of a tumor, which subsequently was confirmed to be a schwannoma with microscopic evaluation. The course of disease was complicated with upper brachial plexus injury which was recovered by sural nerve graft.
文摘The brachial plexus (BP), established by the lap twigs of the last four cervical nerves and the first thoracic nerve, assures the driving and sensory innervation of the thoracic member. We bring back a case of rare anatomical variation of the brachial plexus. It is a 34-year-old corpse dissected in the laboratory of anatomy of the Faculty of Medicine and Odontostomatology of Bamako in September 2017. The lap twig of the fourth cervical root (C4) participated in the constitution of the brachial plexus. The superior trunk was normally constituted. The average trunk was formed by the cervical roots C7 and C8 instead of only C7. And consequently the inferior trunk was constituted by the thoracic root T1. The posterior beam was only formed by the posterior branches of the superior and more average trunk. The medial beam was formed by all of the inferior trunk which did not give posterior branch for the formation of the posterior beam. The variations of the brachial plexus could entrain failures in the loco regional anesthesia of the brachial plexus.
