Objective To investigate the latest development in diagnosis and treatment of the injury to the peripheral nerve. Methods The literature at home and abroad was reviewed, and the research findings with clinical experience in diagnosis and treatment for the injury to the peripheral nerve were summarized. Results The treatment for the total brachial plexus avulsion injury was successfully performed by the extra-plexus nerve transfer. The avulsion of the brachial plexus could be directly repaired by the healthy C7 nerve root transfer through the anterior spinal approach. The forearm flexors could bereinforced by the neurovascularized gracilis transplantation. MRI and CTM werethe best methods of early diagnosis for the brachial plexus injury. The pure upper or lower root avulsion of the brachial plexus injuries could be repaired by the intraplexus nerve transfer, which involved a transfer of part of the ulnarnerve in the arm to the motor nerve of the biceps for C5-C6 avulsion of the brachial plexus,and a transfer of selective fascicles of the healthy C7 nerve root or brachial muscle branch to the flexors muscle fascicles of the median nerve or anterior interosseous nerve. The thoracic outlet syndrome always occurred in this position when the neck muscle fatigue occurred in the typists or the gameplayers after their longstanding looking forwards. The C5 and C6 rootswere rolled by the tendenofibrotic tissue at the origin of the scalenus. After a procain block, the symptom subsided. Radiation neuropathy was a series of pathological changes caused by overdoses of the radiation therapy. The pathologic findings consisted of a series of vessel damages and final coagulation necrosis, which induced clusters of abnormally-dilated, thin-walled telangiectasias. Radiation neuropathy could be detected by MRI and could be differentiated from tumor. Once the diagnosis was established, the therapy should be begun early, including the systemic use of steroids, anticoagulation, and hyperbaric oxygen. Conclusion Great progress has been made in diagnosis and treatment of the injury to the peripheral nerve, but a further study should be performed topromote regeneration of the nerves and reconstruction of the related functions.
Abstract This experiment was to study the feasibility from direct observation of muscle contraction of the lower extremity fromelectrical stimulation threshold of nerve fascicle in identifying the Iα intrafusal afferent fibers during selective posterior rhizotomy (SPR) and to investigate the clinical relationship between the muscle spasm and the electrical stimulation of nerve fascicles. The electrical stimulation threshold of all nerve fascicles in 36 cases during SPR were analysed statistically. The results showed that there was a significant difference between the electrical stimulation threshold of the severed nerve fascicles and intact nerve fascicles no matter the nerve root or each posterior nerve rootlet was examined. It was simple and reliable for surgeons to identify correctly the Iα intrafusal afferent fibers intraoperatively from direct observation of the electrical stimulation threshold of nerve fascicle.
OBJECTIVE: To purify and study Schwann cells cytoplasmic neurotrophic protein. METHODS: The dissociated SC taken from 300 newborn rats sciatic nerves were cultured, collected, ultrasonicated and ultraspeed centrifuged. The supernates were ultrafiltrated and concentrated by using ultrafiltration units with PM10, PM30, PM50 ultrafiltration membranes. The ultrafiltrated-concentrated solution with the protein molecular weight 10-30 ku, 30-50 ku and gt; 50 ku were collected respectively. The dissociated spinal cord motoneurons of 14 days embryonic rats were cultured with serum-free conditional medium and the additional SC cytoplasmic proteins were added into the medium. The results showed that the 10-30 ku and gt; 50 ku SC cytoplasmic proteins were able to maintain the survival of motoneurons for 24 hours. Then the 26 ku and 58 ku proteins were further extracted and purified from SC cytoplasm by high pressure liquid chromatography, and their neurobiological activities were studied. RESULTS: The 26 ku and 58 ku Schwann cell’s cytoplasmic proteins were able to maintain the survival of motoneurons cultured in the serum-free medium for 48 hours. The highest biological activity concentration is 20 ng per well. CONCLUSION: Schwann cells cytoplasm contains motoneuron neurotrophic proteins with molecular weight 26 ku and 58 ku.
Schwanns cells were obtained from the distal end of the sciatic nerve following Wallerian degeneration of SD rats. These cells were cultured with the anteriorhorn neuron of spinal cord of 14dayold SD rat fetus. The two kinds of cells were separated by a slice. Through the microscope, the dendrites and the morphology changes at the 24th, 48th, 72th, and 96 th hour after culture were observed. It was demonstrated that the Schwanns cells played the role of maintaining the survival of neuron and promoting the growth of dendrites. It was said that the Schwanns cells could secrete neurotrophic factor which made the body enlarged and caused the dendrites enlonged to several times of the body.
OBJECTIVE: To study the effects of Schwann cell cytoplasmic derived neurotrophic proteins (SDNF) on the regeneration of peripheral nerve in vivo. METHODS: Ninety adult SD rats were chosen as the experimental model of degenerated muscle graft with vascular implantation bridging the 10 mm length of right sciatic nerve. They were divided randomly into three groups, 30 SD rats in each groups. 25 microliters of 26 ku SDNF (50 micrograms/ml, group A), 58 ku SDNF (50 micrograms/ml, group B) and normal saline(group C) were injected respectively into the proximal, middle and distal part of the degenerated muscle grafts at operation, 7 and 14 days postoperatively. The motorial function recovery assessment was carried out every 15 days with the sciatic nerve function index(SFI) after 15 days to 6 months of operation. Histological and electrophysiological examination of regenerating nerve were made at 1, 3 and 6 months postoperatively. RESULTS: There were significant statistic differences between the both of experimental groups(group A and B) and control group(group C) in the respects of the histological, electrophysiological examination and SFI(P lt; 0.01). CONCLUSION: The 26 ku SDNF and 58 ku SNDF can improve the regeneration of the injured peripheral nerve in vivo.
OBJECTIVE: To review the advance in materials of nerve conduit and Schwann cell transplantation for preparation of artificial nerve with tissue engineering technique. METHODS: Recent literatures about artificial nerve, nerve conduit and Schwann cell transplantation were extensively reviewed. RESULTS: Many biomaterials such as silicon, dacron, expanded polytetrafluoroethylene(ePTFE), polyester and chitin could be used as nerve conduits to repair nerve defect, the degradable biomaterials were better. The nerve conduit with intrinsic filaments could be used to bridge an extended gap in peripheral nerve. Purified and cultured Schwann cells were still bioactive. Axonal regeneration could be enhanced after implantation of Schwann cells into nerve conduit. CONCLUSION: The ideal artificial nerve is composed of three dimensional biodegradable nerve conduit and bioactive Schwann cells, Schwann cells can be distributed in nerve conduit just like Bünger’s band.
OBJECTIVE To study the protective effects of Schwann cell derived neurotrophic factor (SDNF) on motoneurons of spinal anterior horn from spinal root avulsion induced cell death. METHODS Twenty SD rats were made the animal model of C6.7 spinal root avulsion induced motoneuron degeneration, and SDNF was applied at the lesion site of spinal cord once a week. After three weeks, the C6.7 spinal region was dissected out for motoneuron count, morphological analysis and nitric oxide synthase (NOS) enzyme histochemistry. RESULTS 68.6% motoneurons of spinal anterior horn death were occurred after 3 weeks following surgery, the size of survivors was significantly atrophy and NOS positive neurons increased. However, in animals which received SDNF treatment, the death of motoneurons was significantly decreased, the atrophy of surviving motoneurons was prevented, and expression of NOS was inhibited. CONCLUSION SDNF can prevent the death of motoneurons following spinal root avulsion. Nitric oxide may play a role in these injury induced motoneuron death.
Objective To know the possibility of nerveregeneration after artery sleeve anastomosis and end-to-side suture Methods Seventy-five SD rats were divided into 5 groups. First, the distal end ofsevered peroneal nerve was sutured end-to -side with artery sleeve anastomosis withnormal nerve tibial trunk in groups A, B, C and D. Second, the tibial epineurium at the suture site was not removed in group A; the epineurium at the suturesite was removed(windowing) in group B; the distal end of pre-injured peroneal nerve was sutured after 14 days and windowing was done in group C; and the neural growth factor was injected into artery sleeve and windowing was done in group D. While the distal end of severed peroneal nerve was sutured end to side directly with normal nerve tibial trunk and windowing was done in group E. The histological observation was made and the number of nerve fibers was recorded after 4, 8 and 12 weeks of operation.Results After 4 weeks, there existed the regeneration of axons and myeline sheaths in groups C, D, E, and no nerve fiber regeneration was seen in group A. After 8 weeks, the regenerating nerve fibers were significantly more in groups C, D and E than in group B and ingroup E than groups C and D(Plt;0.05). After 12 weeks, the regenerating nervefibers were significantly more in groups C，D and E than in group B(Plt;0.05).Conclusion End-to-side coaptation with artery sleeve anastomosis is a new valuable method in repair of peripheral nerve injuries.