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Total brachial plexus injury: contralateral C7 root transfer to the lower trunk versus the median nerve 被引量:6
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作者 Ye Jiang Li Wang +1 位作者 Jie Lao Xin Zhao 《Neural Regeneration Research》 SCIE CAS CSCD 2018年第11期1968-1973,共6页
Contralateral C7(cC7) root transfer to the healthy side is the main method for the treatment of brachial plexus root injury. A relatively new modification of this method involves cC7 root transfer to the lower trunk... Contralateral C7(cC7) root transfer to the healthy side is the main method for the treatment of brachial plexus root injury. A relatively new modification of this method involves cC7 root transfer to the lower trunk via the prespinal route. In the current study, we examined the effectiveness of this method using electrophysiological and histological analyses. To this end, we used a rat model of total brachial plexus injury, and cC7 root transfer was performed to either the lower trunk via the prespinal route or the median nerve via a subcutaneous tunnel to repair the injury. At 4, 8 and 12 weeks, the grasping test was used to measure the changes in grasp strength of the injured forepaw. Electrophysiological changes were examined in the flexor digitorum superficialis muscle. The change in the wet weight of the forearm flexor was also measured. Atrophy of the flexor digitorum superficialis muscle was assessed by hematoxylin-eosin staining. Toluidine blue staining was used to count the number of myelinated nerve fibers in the injured nerves. Compared with the traditional method, cC7 root transfer to the lower trunk via the prespinal route increased grasp strength of the injured forepaw, increased the compound muscle action potential maximum amplitude, shortened latency, substantially restored tetanic contraction of the forearm flexor muscles, increased the wet weight of the muscle, reduced atrophy of the flexor digitorum superficialis muscle, and increased the number of myelinated nerve fibers. These findings demonstrate that for finger flexion functional recovery in rats with total brachial plexus injury, transfer of the cC7 root to the lower trunk via the prespinal route is more effective than transfer to the median nerve via subcutaneous tunnel. 展开更多
关键词 nerve regeneration total brachial plexus injury contralateral c7 root nerve transfer lower trunk median nerve neural regeneration
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Contralateral C7 transfer combined with acellular nerve allografts seeded with differentiated adipose stem cells for repairing upper brachial plexus injury in rats 被引量:3
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作者 Jian-Tao Yang Jin-Tao Fang +3 位作者 Liang Li Gang Chen Ben-Gang Qin Li-Qiang Gu 《Neural Regeneration Research》 SCIE CAS CSCD 2019年第11期1932-1940,共9页
Nerve grafting has always been necessary when the contralateral C7 nerve root is transferred to treat brachial plexus injury. Acellular nerve allograft is a promising alternative for the treatment of nerve defects, an... Nerve grafting has always been necessary when the contralateral C7 nerve root is transferred to treat brachial plexus injury. Acellular nerve allograft is a promising alternative for the treatment of nerve defects, and results were improved by grafts laden with differentiated adipose stem cells. However, use of these tissue-engineered nerve grafts has not been reported for the treatment of brachial plexus injury. The aim of the present study was to evaluate the outcome of acellular nerve allografts seeded with differentiated adipose stem cells to improve nerve regeneration in a rat model in which the contralateral C7 nerve was transferred to repair an upper brachial plexus injury. Differentiated adipose stem cells were obtained from Sprague-Dawley rats and transdifferentiated into a Schwann cell-like phenotype. Acellular nerve allografts were prepared from 15-mm bilateral sections of rat sciatic nerves. Rats were randomly divided into three groups: acellular nerve allograft, acellular nerve allograft + differentiated adipose stem cells, and autograft. The upper brachial plexus injury model was established by traction applied away from the intervertebral foramen with micro-hemostat forceps. Acellular nerve allografts with or without seeded cells were used to bridge the gap between the contralateral C7 nerve root and C5–6 nerve. Histological staining, electrophysiology, and neurological function tests were used to evaluate the effect of nerve repair 16 weeks after surgery. Results showed that the onset of discernible functional recovery occurred earlier in the autograft group first, followed by the acellular nerve allograft + differentiated adipose stem cells group, and then the acellular nerve allograft group;moreover, there was a significant difference between autograft and acellular nerve allograft groups. Compared with the acellular nerve allograft group, compound muscle action potential, motor conduction velocity, positivity for neurofilament and S100, diameter of regenerating axons, myelin sheath thickness, and density of myelinated fibers were remarkably increased in autograft and acellular nerve allograft + differentiated adipose stem cells groups. These findings confirm that acellular nerve allografts seeded with differentiated adipose stem cells effectively promoted nerve repair after brachial plexus injuries, and the effect was better than that of acellular nerve repair alone. This study was approved by the Animal Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University of China(approval No. 2016-150) in June 2016. 展开更多
关键词 nerve REGENERATION peripheral nerve INJURY brachial plexus INJURY CONTRALATERAL c7 nerve root acellular nerve adipose stem CELLS Schwann CELLS tissue engineering nerve nerve grafting nerve defect neural REGENERATION
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Is it necessary to use the entire root as a donor when transferring contralateral C7 nerve to repair median nerve? 被引量:5
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作者 Kai-ming Gao Jie Lao +1 位作者 Wen-jie Guan Jing-jing Hu 《Neural Regeneration Research》 SCIE CAS CSCD 2018年第1期94-99,共6页
If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show goo... If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7 nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7 nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7 root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7 root was transected and transferred to the median nerve. In the entire root + posterior division group, the entire contralateral C7 root was transected but only the posterior division was transferred to the median nerve. After neurectomy,the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root + posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root + posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root + posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7 root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7 nerve. 展开更多
关键词 nerve regeneration peripheral nerve injury brachial plexus injury avulsion injury contralateral c7 transfer nerve root entire root partial root median nerve ulnar nerve animal experiment neural regeneration
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Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: a retrospective study of 73 participants 被引量:4
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作者 Kai-ming Gao Jing-jing Hu +1 位作者 Jie Lao Xin Zhao 《Neural Regeneration Research》 SCIE CAS CSCD 2018年第3期470-476,共7页
Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable.Insufficient number of donors and unreasonable use of donor nerves might ... Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable.Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C7-transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C7 transfer (33 cases) than for those who received partial contralateral C7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at Clinical-Trials.gov (identifier: NCT03166033). 展开更多
关键词 nerve regeneration brachial plexus-avulsion injury nerve transfer phrenic nerve accessary nerve contralateral c7 nerve intercostal nerve shoulder function elbow function median nerve radial nerve 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 被引量:7
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作者 Guang-Hui Hong Jing-Bo Liu +3 位作者 Yu-Zhou Liu Kai-Ming Gao Xin Zhao Jie Lao 《Neural Regeneration Research》 SCIE CAS CSCD 2019年第8期1449-1454,共6页
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 ner... 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 traditional surgery was that the recovery potential of the deep branch of ulnar nerve was preserved. The study was approved by the Ethics Committee of Fudan University (approval number: 2015-064) in July, 2015. 展开更多
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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Comparison between direct repair and humana cellular nerve allografting during contralateral C7 transfer to the upper trunk for restoration of shoulder abduction and elbow flexion 被引量:3
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作者 Liang Li Wen-Ting He +3 位作者 Ben-Gang Qin Xiao-Lin Liu Jian-Tao Yang Li-Qiang Gu 《Neural Regeneration Research》 SCIE CAS CSCD 2019年第12期2132-2140,共9页
Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct re... Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system;meaningful recovery was defined as M3–M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID:[2017] 290) on November 14, 2017. 展开更多
关键词 nerve REGENERATION CONTRALATERAL c7 nerve root transfer nerve graft brachial plexus avulsion injury direct REPAIR human acellular nerve allograft shoulder function elbow function nerve transfer phrenic nerve accessary nerve neural REGENERATION
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Improved C_(3-4) transfer for treatment of root avulsion of the brachial plexus upper trunk Animal experiments and clinical application
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作者 Lin Zou Xuecheng Cao +3 位作者 Jing Li Lifeng Liu Pingshan Wang Jinfang Cai 《Neural Regeneration Research》 SCIE CAS CSCD 2012年第20期1545-1555,共11页
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
关键词 brachial plexus cervical plexus upper trunk root avulsion nerve transfer phrenic nerve translational medicine peripheral nerve injury neural regeneration
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Valproic acid protects neurons and promotes neuronal regeneration after brachial plexus avulsion 被引量:2
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作者 Qiang Li Dianxiu Wu +2 位作者 Rui Li Xiaojuan Zhu Shusen Cui 《Neural Regeneration Research》 SCIE CAS CSCD 2013年第30期2838-2848,共11页
Valproic acid has been shown to exert neuroprotective effects and promote neurite outgrowth in several peripheral nerve injury models. However, whether valproic acid can exert its beneficial effect on neurons after br... Valproic acid has been shown to exert neuroprotective effects and promote neurite outgrowth in several peripheral nerve injury models. However, whether valproic acid can exert its beneficial effect on neurons after brachial plexus avulsion injury is currently unknown. In this study, brachial plexus root avulsion models, established in Wistar rats, were administered daily with valproic acid dis-solved in drinking water (300 mg/kg) or normal water. On days 1, 2, 3, 7, 14 and 28 after avulsion injury, tissues of the C 5-T 1 spinal cord segments of the avulsion injured side were harvested to in-vestigate the expression of Bcl-2, c-Jun and growth associated protein 43 by real-time PCR and western blot assay. Results showed that valproic acid significantly increased the expression of Bcl-2 and growth associated protein 43, and reduced the c-Jun expression after brachial plexus avulsion. Our findings indicate that valproic acid can protect neurons in the spinal cord and enhance neuronal regeneration fol owing brachial plexus root avulsion. 展开更多
关键词 neural regeneration peripheral nerve injury brachial plexus root avulsion spinal cord NEURONS valproic acid NEUROPROTECTION neuronal regeneration Bcl-2 c-Jun GAP-43 grants-supported pa-per NEUROREGENERATION
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Functional compensative mechanism of upper limb with root avulsion of C5-C6 of brachial plexus after ipsilateral C7 transfer 被引量:1
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作者 宋捷 陈亮 顾玉东 《Chinese Journal of Traumatology》 CAS 2008年第4期232-238,共7页
Objective: To investigate the compensative mechanism of no further impairment of the upper limb after ipsilateral C7 transfer for treatment of root avulsion of C5-C6 of the brachial plexus. Methods: Sixty Sprague Da... Objective: To investigate the compensative mechanism of no further impairment of the upper limb after ipsilateral C7 transfer for treatment of root avulsion of C5-C6 of the brachial plexus. Methods: Sixty Sprague Dawley (SD) rats were randomly divided into a CT-transection group and a control group, 30 rats each. In the CT-transection group, the left forelimbs of the animals underwent transection of ipsilateral C7 nerve root while C5 and C6 nerve roots were avulsed. In the control group, the left forelimbs only underwent C5 and C6 root avulsion. The representative muscles of C7 (innervated mainly by C7) including latissimus dorsi, triceps, extensor carpi radialis brevis and extensor digitorum communis were evaluated with neurophysiological investigation, muscular histology and motor end plate histomorphometry 3, 6 and 12 weeks after operation. The right forelimbs of all rats were taken as the control sides. Results: Three weeks after operation, the recovery rates of amplitudes of compound muscle action potential (CMAP) and CMAP latency, muscular wet weight and cross-sec- tional area of muscle fibers, and area of postsynaptic membranes of those four representative muscles in the C7- transection group were significantly lower than those of the control group (P 〈0.05 or P 〈0.01). Six weeks postoperatively, the recovery rates of CMAP amplitude and latency of the triceps showed no significant difference between the C7- transection group and the control group (P〉0.05). For theextensor carpi radialis brevis and the extensor digitorum communis, the recovery rates of the cross-sectional area of muscle fibers, the amplitude and latency of CMAP and the area of postsynaptic membranes showed no significant dif- ference between the two groups (P 〉0.05), while the rest parameters were still significantly different between the two group (P 〈0.05 or P 〈0.01). As far as the ultramicrostructure was concerned in the CT-transection group, more motor end plates of four representative muscles were observed and their ultramicrostructure also had a tendency to mature as compared with those of 3 weeks postoperatively. Twelve weeks after operation, all parameters of the CT-transectJon group were not significantly different from those of the control group (P 〉0.05). In the CT-transection group, the motor end plates were densely distributed and their ultramicrostructure in four representative muscles appeared to be mature as compared with those of the control group. Conclusions: After ipsilateral C7 transfer for treatment of root avulsion of C5-C6 of the brachial plexus, the nerve fibers of the lower trunk can compensatively innervate fibers of Crrepresentative muscles by means of motor end plate regeneration, so there is no further impairment on the injured upper limb. 展开更多
关键词 nerve injuries brachial plexus Spinalnerve roots nerve transfer Rats
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胼胝体切断对健侧C7移位术后跨大脑两半球功能重组影响的实验研究 被引量:4
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作者 李占玉 徐建光 +1 位作者 徐文东 顾玉东 《中国矫形外科杂志》 CAS CSCD 北大核心 2008年第9期663-665,共3页
[目的]明确胼胝体在健侧C7移位术后跨大脑两半球功能重组过程中所起的作用。[方法]将45只SD大鼠随机分为正常对照组、健侧C7移位模型术后和胼胝体切断术后3个月、5个月、7个月、10个月共9组。采用运动皮层内微电极电刺激技术,定量评价... [目的]明确胼胝体在健侧C7移位术后跨大脑两半球功能重组过程中所起的作用。[方法]将45只SD大鼠随机分为正常对照组、健侧C7移位模型术后和胼胝体切断术后3个月、5个月、7个月、10个月共9组。采用运动皮层内微电极电刺激技术,定量评价大鼠患肢正中神经代表区在双侧初级运动皮层(MI)内的可塑性变化。[结果]健侧C7移位正中神经术后3个月,患肢正中神经代表区在双侧MI均未出现,术后5个月则仅出现于患肢同侧MI,术后7个月在双侧MI均出现,术后10个月则只出现于对侧MI。而胼胝体切断术后5、7和10个月,患肢正中神经代表区均只出现于患肢同侧MI。[结论]在健侧C7移位大鼠模型上证实术后10个月内运动皮层出现了跨大脑两半球的功能重组,胼胝体在该重组中起关键的通道作用。 展开更多
关键词 臂丛 脊神经根 神经损伤 神经移植 功能重组
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健侧颈7神经根经椎前路转位治疗外伤性臂丛神经损伤患者的护理 被引量:8
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作者 仲艳 周密 +4 位作者 樊丽洁 王长江 邓琳 袁静 刘建英 《解放军护理杂志》 CSCD 2014年第6期48-49,52,共3页
目的:探讨健侧颈7神经根经椎前路转位治疗外伤性臂丛神经损伤患者的护理方法。方法回顾性分析2006年1月至2012年12月在第二炮兵总医院骨科治疗的30例外伤所致臂丛神经损伤的患者的临床资料,所有患者均采用健侧颈7神经根经椎前路转位... 目的:探讨健侧颈7神经根经椎前路转位治疗外伤性臂丛神经损伤患者的护理方法。方法回顾性分析2006年1月至2012年12月在第二炮兵总医院骨科治疗的30例外伤所致臂丛神经损伤的患者的临床资料,所有患者均采用健侧颈7神经根经椎前路转位重建受损的臂丛神经,术前加强心理护理,术后注重肢体及支具护理及健康指导。结果患者术后恢复良好,经过1~2年随访,患者肌力增强。结论健侧颈7神经根经椎前路转位重建受损的臂丛神经效果较好,术后精心护理是患者早日康复的关键。 展开更多
关键词 健侧颈7神经根 外伤性臂丛神经损伤 护理
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同侧颈7神经根选择性移位术治疗臂丛上干根性撕脱伤 被引量:6
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作者 徐建光 胡韶楠 +2 位作者 王欢 沈丽英 顾玉东 《中国创伤骨科杂志》 CSCD 2000年第1期28-30,共3页
目的 针对臂丛上干根性撕脱伤合并膈神经损伤病例,采用新的同侧颈_7神经根选择性束组移位方法,并证实其科学性、可行性与实用性,方法 自96年6月~99年2月,运用同侧颈_7神经根选择性束组移位术12例。其中臂丛上干撕脱伤10例,臂丛上干根... 目的 针对臂丛上干根性撕脱伤合并膈神经损伤病例,采用新的同侧颈_7神经根选择性束组移位方法,并证实其科学性、可行性与实用性,方法 自96年6月~99年2月,运用同侧颈_7神经根选择性束组移位术12例。其中臂丛上干撕脱伤10例,臂丛上干根性撕脱伤合并中干颈_7神经根部分损伤2例。全麻下行同侧选择性颈_7神经根前股前外侧份移位,直接与上干前股显微缝合。术后随访9例,并进行疗效评价。结果 7例颈_7神经根前股外侧份移位至上于前股有明显疗效,术后2月肌电检查证实有移位神经长入;术后4~7月即见肱二头肌恢复屈肘动作,而原颈_7神经根支配肌肉功能均无明显功能障碍。结论 同侧选择性颈_7神经根纤维束组移位不仅不影响颈_7神经根原有支配肌的运动功能,而且提供动力神经源,不失为一种新的切实可行的手术治疗方法。 展开更多
关键词 神经根选择性移位 臂丛上干根性撕脱伤 电生理
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患侧颈_7神经根移位治疗产瘫根性撕脱伤 被引量:4
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作者 张咸中 金春 《实用手外科杂志》 2003年第4期195-196,共2页
目的报道患侧C7神经根移位治疗根性撕脱伤性产瘫的临床效果。方法将患侧C7在中干前后股处切断并移位与上干或下干远端缝合,治疗单纯上干或下干根性撕脱伤的产瘫患儿11例,其中上干损伤9例,下干损伤2例。结果单纯上干损伤者优5例,良3例,中... 目的报道患侧C7神经根移位治疗根性撕脱伤性产瘫的临床效果。方法将患侧C7在中干前后股处切断并移位与上干或下干远端缝合,治疗单纯上干或下干根性撕脱伤的产瘫患儿11例,其中上干损伤9例,下干损伤2例。结果单纯上干损伤者优5例,良3例,中2例,差1例。单纯下干损伤者差2例。结论患侧C7神经根移位是治疗单纯上干根性撕脱伤产瘫的较好方法,值得应用推广,但对单纯下干损伤的产瘫效果较差。 展开更多
关键词 颈7神经根移位 手术治疗 产瘫根性撕脱伤 手术方法
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早期神经移位治疗臂丛颈5-7根性损伤的长期疗效观察
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作者 徐房添 徐芳 +3 位作者 赖光松 高辉 姬广林 杨千绮 《江西医药》 CAS 2015年第12期1339-1341,共3页
目的分析早期移位桡神经三头肌肌支及副神经治疗臂丛颈5-7根性损伤中重建肩外展功能的长期疗效。方法臂丛颈5-7根性损伤11例,确诊后早期即施行神经移位术:桡神经肱三头肌长头支移位至腋神经的三角肌支、副神经移位至肩胛上神经,施行双... 目的分析早期移位桡神经三头肌肌支及副神经治疗臂丛颈5-7根性损伤中重建肩外展功能的长期疗效。方法臂丛颈5-7根性损伤11例,确诊后早期即施行神经移位术:桡神经肱三头肌长头支移位至腋神经的三角肌支、副神经移位至肩胛上神经,施行双重移位,同时重建冈上下肌与三角肌的功能。术中运用电生理技术,增加手术的准确性和合理性。并进行了平均67.8个月的长期随访,按结果分析疗效。结果优9例,良2例,肩外展功能恢复满意。6例在术后约3个月冈上下肌、三角肌电生理检查即可检出再生电位。结论臂丛颈5-7根性损伤确诊后,早期行副神经及肱三头肌肌支双重移位是重建肩外展功能安全有效的方法,提高了肩外展的修复效率。 展开更多
关键词 臂丛 颈5-7根性损伤 肩外展功能重建 神经移位
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正中及尺神经部分束早期移位治疗臂丛C5-7根性损伤的长期疗效观察
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作者 徐房添 高辉 +6 位作者 赖光松 姬广林 刘午阳 徐芳 杨千绮 陈睿云 艾芳 《赣南医学院学报》 2015年第6期910-912,923,共4页
目的:分析正中及尺神经部分束早期移位治疗臂丛C5、C6、C7根性损伤中重建屈肘功能的长期疗效。方法:对11例臂丛C5-7根性损伤,确诊后早期施行神经移位术:正中神经部分束移位至肌皮神经的肱二头肌支、尺神经部分束移位至肱肌肌支,双重移位... 目的:分析正中及尺神经部分束早期移位治疗臂丛C5、C6、C7根性损伤中重建屈肘功能的长期疗效。方法:对11例臂丛C5-7根性损伤,确诊后早期施行神经移位术:正中神经部分束移位至肌皮神经的肱二头肌支、尺神经部分束移位至肱肌肌支,双重移位,重建屈肘功能。术中运用电生理技术,增加手术的合理性和准确性。并进行平均67.8个月的长期随访,按结果分析疗效。结果:优9例,良2例,屈肘功能恢复满意。6例于术后3个月肱二头肌、肱肌肌电图即能检出再生电位。一例术后6个月肱二头肌才检出再生电位,该病人于伤后8个月才施行手术。结论:臂丛C5-7根性损伤确诊后,早期正中及尺神经部分束双重移位是重建屈肘功能安全有效的方法,较之单一的尺神经束移位(Oberlin术式)提高了屈肘功能的修复效率,具有效果好、恢复快、操作简单的优点。 展开更多
关键词 臂丛 C5-7根性损伤 屈肘功能重建 神经移位
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健侧C_7神经根移位经椎体前通路的应用解剖及临床研究 被引量:44
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作者 王树锋 胡琪 +3 位作者 王海华 苏彦农 赵俊会 常万绅 《中华手外科杂志》 CSCD 2003年第2期69-71,共3页
目的 通过尸体解剖及临床手术 ,找到健侧C7神经移位修复臂丛损伤的最佳桥接神经通路。方法 对 8具成人颈段尸体标本 ,显露双侧臂丛神经 ,将右侧C7神经在干股交界处切断并游离至椎孔处 ,经前斜角肌的深面翻转至椎体前 ,测量C7神经根至... 目的 通过尸体解剖及临床手术 ,找到健侧C7神经移位修复臂丛损伤的最佳桥接神经通路。方法 对 8具成人颈段尸体标本 ,显露双侧臂丛神经 ,将右侧C7神经在干股交界处切断并游离至椎孔处 ,经前斜角肌的深面翻转至椎体前 ,测量C7神经根至对侧臂丛上干前后股的距离。临床选择 13例臂丛神经撕脱伤患者 ,术中测量健侧C7神经根经椎体前及颈前皮下通路修复患侧臂丛上干或前后股的距离 ,并对其手术入路进行观测。结果 尸体标本测量C7神经根经椎体前通路至对侧臂丛上干前后股的距离平均为 ( 7.9± 2 .6)cm , x±s,下同。临床测量健侧C7神经根经椎体前通路及颈前皮下通路至对侧臂丛上干或前后股的距离分别为 ( 9.4± 1.2 )cm及 ( 18.2± 3 .2 )cm。两组相比差异有显著意义 (P<0 .0 1)。临床应用 13例全部取得成功 ,无并发症出现。结论 经椎体前通路是健侧C7神经移位修复臂丛损伤的最佳桥接神经通路之一。 展开更多
关键词 健侧c7神经根移位 椎体前通路 解剖学 臂丛神经损伤
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同侧颈_7神经根移位术的临床应用 被引量:21
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作者 蔡佩琴 顾玉东 +2 位作者 薛锋 彭峰 陈琳 《中华手外科杂志》 CSCD 2002年第2期73-74,共2页
目的 探讨同侧颈7神经根移位术治疗臂丛上干撕脱伤的有效性与安全性。方法  1998年2月至 2 0 0 0年 9月 ,对 4例颈5、6神经根节前损伤患者 ,采用同侧颈7神经根移位修复上干 ,其中 2例同时将副神经移位至肩胛上神经。结果 术后随访 1... 目的 探讨同侧颈7神经根移位术治疗臂丛上干撕脱伤的有效性与安全性。方法  1998年2月至 2 0 0 0年 9月 ,对 4例颈5、6神经根节前损伤患者 ,采用同侧颈7神经根移位修复上干 ,其中 2例同时将副神经移位至肩胛上神经。结果 术后随访 1~ 2年半 ,4例肱二肌肌力均恢复至M4。肩外展 :1例外展15° ,1例 45° ,2例 >90°。供区神经的支配肌 ,除短期内肌力下降 1级外 ,均无明显功能障碍。结论 臂丛上干损伤采用同侧颈7神经根移位是有效的、安全的手术方法。如系下干不全损伤时 。 展开更多
关键词 临床应用 神经损伤 臂丛 神经根 神经移位
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健侧C_7神经移位修复臂丛神经根干部损伤的改良术式 被引量:19
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作者 彭峰 蔡佩琴 +2 位作者 陈德松 陈琳 顾玉东 《中华手外科杂志》 CSCD 2003年第2期66-68,共3页
目的 证实移植神经经胸锁乳突肌下方通道的改良术式修复臂丛神经根干部损伤的可行性和优点。方法  2 0 0 1年 2月至 2 0 0 2年 12月 ,对 10例臂丛神经根干部损伤患者行健侧C7神经移位于患侧臂丛上干或下干。术中发现两神经断端间距为 ... 目的 证实移植神经经胸锁乳突肌下方通道的改良术式修复臂丛神经根干部损伤的可行性和优点。方法  2 0 0 1年 2月至 2 0 0 2年 12月 ,对 10例臂丛神经根干部损伤患者行健侧C7神经移位于患侧臂丛上干或下干。术中发现两神经断端间距为 5 .5cm~ 10cm ,平均 7.8cm。采用桡浅神经、腓肠神经、前臂外侧皮神经及前臂内侧皮神经等为移植神经 ,桥接健侧C7神经和患侧受神经。将移植神经经胸锁乳突肌下方通道为该术式的改良处。结果  3例患者术后随访时间较短未统计在内。 7例患者术后随访 6~ 15个月 ,6例修复上干者 ,其中 2例的屈肘肌力为M3 、肩外展肌力M2 ,2例屈肘、肩外展肌力M1~ 2 ,2例腋神经、肌皮神经肌电图有运动动作电位出现。 1例修复下干者 ,刺痛觉恢复至腕部 ,正中、尺神经肌电图示有运动动作电位出现。结论 健侧C7神经移位术中移植神经经胸锁乳突肌下方通道是可行的。其优点是缩短移植神经的长度和充分利用健侧C7的神经动力源。 展开更多
关键词 健侧c7神经移位 修复 臂丛神经根干部损伤 术式改良 神经移植
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同侧颈_7神经根移位治疗臂丛上干根性撕脱伤患肢功能变化的实验研究 被引量:5
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作者 宋捷 陈亮 顾玉东 《中华手外科杂志》 CSCD 北大核心 2007年第6期367-372,共6页
目的研究臂丛上干根性撕脱伤再切取同侧颈,后不造成肢体功能进一步损害的代偿机制。方法60只SD大鼠随机等分为二组,上干根性撕脱+同侧颈_7神经根切断为实验组,单纯上干根性撕脱为对照组。术后3、6和12周每组取10只大鼠对颈_7神经根代表... 目的研究臂丛上干根性撕脱伤再切取同侧颈,后不造成肢体功能进一步损害的代偿机制。方法60只SD大鼠随机等分为二组,上干根性撕脱+同侧颈_7神经根切断为实验组,单纯上干根性撕脱为对照组。术后3、6和12周每组取10只大鼠对颈_7神经根代表肌(背阔肌、肱三头肌、桡侧腕短伸肌和指总伸肌)作肌肉组织学、神经电生理与运动终板组织形态学的检测。结果术后3周实验组与对照组相比,四块颈_7代表肌的湿重显著减轻且肌细胞截面积缩小,复合肌肉动作电位(CMAP)的潜伏期显著延长并波幅明显下降,运动终板突触后膜面积明显减小,上述指标的二组差异均有统计学意义(P<0.05或P<0.01)。荧光显微镜观察显示实验组颈,代表肌的运动终板分布稀疏,电镜下可见形态不成熟的再生运动终板。伤后6周,实验组肱三头肌CMAP潜伏期及波幅的恢复率以及桡侧腕短伸肌与指总伸肌肌细胞截面积、CMAP潜伏期及波幅和突触后膜面积的恢复率与对照组相比,差异无统计学意义(P均>0.05)。实验组颈_7代表肌的运动终板数量已较3周时明显增多,超微形态亦趋于成熟。到12周,实验组各项检测指标的恢复率均已接近对照组(P均>0.05),其颈_7代表肌的运动终板分布密集且数量较多,超微结构接近成熟,形态与对照组基本一致。结论臂丛上干根性撕脱伤切取同侧颈,神经根后,下干神经纤维能通过末梢运动终板的再生对中干代表肌进行代偿性支配,故不会导致肢体功能的进一步损害。 展开更多
关键词 臂丛 脊神经根 神经移位 神经损伤 大鼠 Sprague-Dawley
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改良健侧颈_(7)神经根移位术治疗全臂丛神经根性撕脱伤 被引量:1
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作者 王立 段文旭 +4 位作者 王丰羽 张晓然 马学林 邵新中 张哲敏 《中华手外科杂志》 CSCD 北大核心 2022年第5期368-370,共3页
目的探讨采用改良健侧颈_(7)移位术治疗伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤的临床疗效。方法自2017年10月至2019年10月,我院对16例伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤患者,行改良健侧颈7移位术。手术分两期进行:... 目的探讨采用改良健侧颈_(7)移位术治疗伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤的临床疗效。方法自2017年10月至2019年10月,我院对16例伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤患者,行改良健侧颈7移位术。手术分两期进行:Ⅰ期,将健侧颈_(7)前股外侧束经游离桡神经浅支移植修复患侧上干前股;将健侧颈_(7)后股的一束纤维,经尺神经手背支游离移植修复患侧肩胛上神经;健侧颈_(7)后股大部与带血供的患侧尺神经远端缝合。Ⅱ期:患侧尺神经远端移位正中神经远端。结果 16例患者随访20~45个月,平均32个月。依据顾玉东臂丛神经损伤修复后功能评定标准:冈上、下肌肌力恢复达M3及以上8例,M_(2) 6例,M_(0)~M_(2) 2例。肱二头肌肌力M_(3)及以上11例,M_(2) 5例。屈腕、屈指肌力M3及以上9例,M2~M1 7例。正中神经支配区皮肤感觉恢复达S3 6例,S2~S1 10例。结论对伴有膈神经、副神经损伤的全臂丛根性撕脱伤患者行改良健侧颈7移位术,可以充分发挥健侧颈_(7)的动力储备,取得满意的临床疗效。 展开更多
关键词 臂丛 神经移位 健侧颈_(7)神经根 膈神经 副神经
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