Dendrites play irreplaceable roles in the nerve conduction pathway and are vulnerable to various insults.Peripheral axotomy of motor neurons results in the retraction of dendritic arbors,and the dendritic arbor can be...Dendrites play irreplaceable roles in the nerve conduction pathway and are vulnerable to various insults.Peripheral axotomy of motor neurons results in the retraction of dendritic arbors,and the dendritic arbor can be re-expanded when reinnervation is allowed.RhoA is a target that regulates the cytoskeleton and promotes neuronal survival and axon regeneration.However,the role of RhoA in dendrite degeneration and regeneration is unknown.In this study,we explored the potential role of RhoA in dendrites.A line of motor neuronal conditional knockout mice was developed by crossbreeding HB9~(Cre+)mice with RhoA~(flox/flox)mice.We established two models for assaying dendrite degeneration and regeneration,in which the brachial plexus was transection or crush injured,respectively.We found that at 28 days after brachial plexus transection,the density,complexity,and structural integrity of dendrites in the ventral horn of the spinal cord of RhoA conditional knockout mice were slightly decreased compared with that in Cre mice.Dendrites underwent degeneration at 7 and 14 days after brachial plexus transection and recovered at 28–56 days.The density,complexity,and structural integrity of dendrites in the ventral horn of the spinal cord of RhoA conditional knockout mice recovered compared with results in Cre mice.These findings suggest that RhoA knockout in motor neurons attenuates dendrite degeneration and promotes dendrite regeneration after peripheral nerve injury.展开更多
BACKGROUND Dexmedetomidine(DMED)is frequently used as a sedative in several medical fields.The benefits of DMED include enhanced quality of regional anesthesia,prolonged analgesia,and postoperative opioid-sparing when...BACKGROUND Dexmedetomidine(DMED)is frequently used as a sedative in several medical fields.The benefits of DMED include enhanced quality of regional anesthesia,prolonged analgesia,and postoperative opioid-sparing when administered intravenously or perineurally in combination with regional anesthesia.Severe hemodynamic complications,such as profound bradycardia and hypotension,can occur after DMED administration in critically ill patients or overdosage;however,there are few reports of complications with DMED administration following brachial plexus block(BPB).CASE SUMMARY We present two cases of hemodynamic instability that occurred following the initial loading of DMED under supraclavicular BPB.A healthy 29-year-old man without any medical history showed profound bradycardia after receiving a loading dose of DMED 0.9μg/kg for 9 min.DMED administration was promptly stopped,and after receiving a second dose of atropine,the heart rate recovered.A 62-year-old woman with a history of cardiomyopathy became hypotensive abruptly,requiring the administration of inotrope and vasopressors after receiving a reduced loading dose of 0.5μg/kg for 10 min.Half of the recommended loading dose of DMED was administered due to the underlying heart dysfunction.Decrea-sed blood pressure was maintained despite the intravenous administration of ephedrine.With continuous infusion of dopamine and norepinephrine,the vital signs were maintained within normal ranges.Inotropic and vasopressor support was required for over 6 h after the initial loading dose of DMED.CONCLUSION DMED administration following BPB could trigger hemodynamic instability in patients with decreased cardiac function as well as in healthy individuals.展开更多
Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descripti...Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descriptive retrospective study was based on the medical records of patients who suffered vascular axillary and/or brachial plexus trauma and who underwent surgical repair at the Abidjan Cardiology Institute from January 2008 to June 2022. Epidemiological, anatomo-clinical and surgical data were studied. Results: Thirty-four medical files belonging to 33 men and one woman, aged 32 on average, were collected. The circumstances of occurrence were dominated by the stab wound (n = 22). The combinations of injuries were as follows: associated involvement of the axillary artery and vein (n = 4);isolated involvement of axillary artery (n = 3);isolated involvement of the axillary vein (n = 2);associated involvement of the axillary artery and brachial plexus (n = 17);associated involvement of the axillary artery and vein and brachial plexus (n = 08). Anatomic lesions included acute arterial lesions (n = 29) and arteriovenous fistula (n = 1) and false aneurysms (n = 4). All patients were operated on under general anesthesia;vascular repair included direct suturing (n = 16), arterial and venous bypass using a long saphenous graft (n = 9), prosthetic arterial bypass (n = 5) and prosthetic flattening-graft (n = 4). Brachial plexus surgery consisted of an end-to-end anastomosis of each transected bundle in all cases (n = 25). The medium-term postoperative course was marked by success without functional sequelae in 88.24% of cases (n = 30) and by the persistence of distal paralysis of the thoracic limb after 6 months in 05.88% (n = 2) of all patients, i.e., 8% of patients who presented with brachial plexus injury. Conclusion: The concomitant surgical treatment of these axillary vascular and nerve lesions has given good results. However, if paralysis of the thoracic limb persists after 6 to 12 months, the patient should be referred to a specialist in brachial plexus surgery.展开更多
This study aimed to investigate the reconstruction of the thumb and finger extension function in patients with middle and lower trunk root avulsion injuries of the brachial plexus. From April 2010 to January 2015, we ...This study aimed to investigate the reconstruction of the thumb and finger extension function in patients with middle and lower trunk root avulsion injuries of the brachial plexus. From April 2010 to January 2015, we enrolled in this study 4 patients diagnosed with middle and lower trunk root avulsion injuries of the brachial plexus via imaging tests, electrophysiological examinations, and clinical confirmation. Muscular branches of the radial nerve, which innervate the supinator in the forearm, were transposed to the posterior interosseous nerve to reconstruct the thumb and finger extension function. Electrophysiological findings and muscle strength of the extensor pollicis longus and extensor digitorum communis, as well as the distance between the thumb tip and index finger tip, were monitored. All patients were followed up for 24 to 30 months, with an average of 27.5 months. Motor unit potentials(MUP) of the extensor digitorum communis appeared at an average of 3.8 months, while MUP of the extensor pollicis longus appeared at an average of 7 months. Compound muscle action potential(CMAP) appeared at an average of 9 months in the extensor digitorum communis, and 12 months in the extensor pollicis longus. Furthermore, the muscle strength of the extensor pollicis longus and extensor digitorum communis both reached grade Ⅲ at 21 months. Lastly, the average distance between the thumb tip and index finger tip was 8.8 cm at 21 months. In conclusion, for patients with middle and lower trunk injuries of the brachial plexus, transposition of the muscular branches of the radial nerve innervating the supinator to the posterior interosseous nerve for the reconstruction of thumb and finger extension function is practicable and feasible.展开更多
BACKGROUND Anesthesia plays an essential role in the successful surgical procedures for hand trauma.Compared with general anesthesia,brachial plexus block shows lots of benefits for the upper extremity.Specifically,ul...BACKGROUND Anesthesia plays an essential role in the successful surgical procedures for hand trauma.Compared with general anesthesia,brachial plexus block shows lots of benefits for the upper extremity.Specifically,ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances.The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.AIM To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.METHODS A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected.They were divided into an observation group and a control group with 34 patients in each group.The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block.The analgesic efficacy,intraoperative complications,wound healing time,and length of hospital stay were compared between the two groups under different anesthesia.RESULTS The percentage of cases with analgesia graded as“excellent or very good”was higher in the observation group than in the control group(P<0.05).Moreover,the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group(P<0.05).CONCLUSION Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries.It can reduce the incidence of intraoperative complications,promote wound healing,and shorten the length of hospital stay.展开更多
BACKGROUND:Previous studies of peripheral nerve mechanical properties in animals have utilized one-dimensional drawing methods. OBJECTIVE:To analyze the effects of brachial plexus injury anastomosis simulation on biom...BACKGROUND:Previous studies of peripheral nerve mechanical properties in animals have utilized one-dimensional drawing methods. OBJECTIVE:To analyze the effects of brachial plexus injury anastomosis simulation on biomechanical properties of adult brachial plexus by observing tensile mechanical properties,stress relaxation,and creep deformation of the brachial plexus in normal human cadavers and brachial plexus from simulated brachial plexus injury anastomosis samples. DESIGN,TIME AND SETTING:The in vitro experiment was performed at the Mechanics Experimental Center,Jilin University,China from April to May 2007. MATERIALS:A total of six adult,male cadavers,who had died from acute trauma,and were aged 20-29 years,were supplied by the Research Room of Anatomy,Medical Department,Jilin University,China. AG-10TA Universal Material Testing Machine (Shimadzu,Japan) was used in this study. METHODS:A total of 36 samples of fresh brachial plexus were collected from the cadavers,comprising 12 C5 nerve roots,12 C6 nerve roots at the left and right sides of the superior truck,and 12 C7 nerve roots at the middle truck. The C5 and C6 nerve roots were processed into 50 samples and the C7 nerve roots into 24 samples. A total of 36 C5 and C6 nerve root samples were randomly assigned to a non-surgery control group (n = 18) and brachial plexus injury anastomosis simulation group (n = 18). Brachial plexus injury simulation anastomosis samples underwent an incision in the middle,and then received anastomosis. Samples in both groups underwent a tension test at 5 mm/min on the AG-10TA universal material testing machine. A total of 24 sam-ples from the C6 superior trunk and C7 middle trunk of the brachial plexus were subjected to stress relaxation and creep tests. Test duration was 7 200 seconds. A total of 100 data points were collected and analyzed using a normalization method. MAIN OUTCOME MEASURES:The following parameters were measured:tension maximum displacement,maximum load,maximum stress,maximum strain and stress-strain curve,stress relaxation at 7 200 seconds,creep deformation at 7 200 seconds,stress relaxation,and creep curve in the non-surgery control group and brachial plexus injury simulation anastomosis group. RESULTS:The tension maximum load of brachial plexus was (140.36 ± 30.50) N,maximum stress was (10.67 ± 2.52) MPa,maximum displacement was (7.78 ± 1.48) mm,and maximum strain was (31.64 ± 5.32)% in the non-surgery control group. The tension maximum load of brachial plexus was (93.23 ± 20.65) N,maximum stress was (7.09 ± 1.57) MPa,maximum displacement was (6.13 ± 0.86) mm,and maximum strain was (24.55 ± 3.45)% in the brachial plexus injury simulation anastomosis group. The above-mentioned indices were greater in the non-surgery control group than in the brachial plexus injury simulation anastomosis group (P < 0.01). Stress relaxation at 7 200 seconds was 2.07 MPa and 2.11 MPa,respectively,in the non-surgery control and brachial plexus injury simulation anastomosis groups. Creep deformation at 7 200 seconds was 4.68% and 3.52%,respectively,in the non-surgery control and brachial plexus injury simulation anastomosis groups. CONCLUSION:Decreased tension maximum load,maximum displacement,maximum stress,maximum strain,and creep deformation at 7 200 seconds affected the biomechanical properties of the brachial plexus following brachial plexus injury.展开更多
The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much fa...The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.展开更多
<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
BACKGROUND:Animal models of brachial plexus root avulsion are required for the study of brachial plexus root injuries.The established ventral approach results in slight injuries,and is similar to mechanisms underlying...BACKGROUND:Animal models of brachial plexus root avulsion are required for the study of brachial plexus root injuries.The established ventral approach results in slight injuries,and is similar to mechanisms underlying human brachial plexus root avulsion.OBJECTIVE:To analyze the effects of weight,age,and species on the success rate of brachial plexus root avulsion,and to determine the perfect method for establishing models of brachial plexus root avulsion.DESIGN,TIME AND SETTING:A randomized,block design was performed at the Laboratory of Professor Lihua Zhou,Zhongshan School of Medicine,Sun Yat-sen University,China from June 2008 to June 2009.MATERIALS:Sprague Dawley(SD) rats,golden hamsters,and BALb/C mice were used in the present study.METHODS:All animals were randomly subjected to classical brachial plexus root avulsion and modified brachial plexus root avulsion.MAIN OUTCOME MEASURES:Success rate of brachial plexus root avulsion.RESULTS:The success rate of brachial plexus root avulsion was greater in the modified group than in the classical group(P < 0.01).Moreover,the difference was significant in 15-day-old SD rats,5-week-old SD rats,and 3-month-old BALb/C mice(P < 0.01).The success rate of brachial plexus root avulsion was greater in the same weight,15-day-old juvenile SD rats,than in the 3-month-old BALb/C mice(classical group,P < 0.01;modified group,P < 0.05).The success rate of brachial plexus root avulsion was significantly greater in 3-month-old golden hamsters than in 5-week-old SD rats in the classical group(P < 0.05).The success rate of brachial plexus root avulsion was significantly lower in the 15-day-old SD rats compared with the 5-week-old and 3-month-old SD rats in the classical group(P < 0.01).However,there was no significant difference in the success rate of brachial plexus root avulsion between various ages of SD rats in the modified group(P > 0.05).CONCLUSION:Modified surgery to induce brachial plexus root avulsion significantly increases the success rate of model establishment.Species,age,and weight affect the success rate of brachial plexus root avulsion,and species plays an important role in the success rate.展开更多
Transferring the contralateral C7 nerve root to the median or radial nerve has become an important means of repairing brachial plexus nerve injury.However,outcomes have been disappointing.Electroencephalography(EEG)-b...Transferring the contralateral C7 nerve root to the median or radial nerve has become an important means of repairing brachial plexus nerve injury.However,outcomes have been disappointing.Electroencephalography(EEG)-based human-machine interfaces have achieved promising results in promoting neurological recovery by controlling a distal exoskeleton to perform functional limb exercises early after nerve injury,which maintains target muscle activity and promotes the neurological rehabilitation effect.This review summarizes the progress of research in EEG-based human-machine interface combined with contralateral C7 transfer repair of brachial plexus nerve injury.Nerve transfer may result in loss of nerve function in the donor area,so only nerves with minimal impact on the donor area,such as the C7 nerve,should be selected as the donor.Single tendon transfer does not fully restore optimal joint function,so multiple functions often need to be reestablished simultaneously.Compared with traditional manual rehabilitation,EEG-based human-machine interfaces have the potential to maximize patient initiative and promote nerve regeneration and cortical remodeling,which facilitates neurological recovery.In the early stages of brachial plexus injury treatment,the use of an EEG-based human-machine interface combined with contralateral C7 transfer can facilitate postoperative neurological recovery by making full use of the brain’s computational capabilities and actively controlling functional exercise with the aid of external machinery.It can also prevent disuse atrophy of muscles and target organs and maintain neuromuscular junction effectiveness.Promoting cortical remodeling is also particularly important for neurological recovery after contralateral C7 transfer.Future studies are needed to investigate the mechanism by which early movement delays neuromuscular junction damage and promotes cortical remodeling.Understanding this mechanism should help guide the development of neurological rehabilitation strategies for patients with brachial plexus injury.展开更多
BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,ne...BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,nerve injury may occur.In this report,we present a unique case in which the brachial plexus(division level),suprascapular,and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures.CASE SUMMARY A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure.During the surgery,the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h.Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus(BP)compression and related neuropathy.An electrodiagnostic study confirmed the presence of BP injury involving the wholedivision level,long thoracic,and suprascapular nerve injuries.He was treated with medication,physical therapy,and ultrasound-guided injections.Ultrasoundguided steroid injection at the BP,hydrodissection with 5%dextrose water at the BP and suprascapular nerve,and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed.On postoperative day 194,the pain and arm weakness were resolved,and a follow-up electrodiagnostic study showed marked improvement.CONCLUSION Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture,and treat each specific therapeutic target.展开更多
BACKGROUND The common area of breast cancer metastases are bone,lung and liver.Brachial plexus metastasis from breast cancer is extremely rare.We report a case of subclavian brachial plexus metastasis from breast canc...BACKGROUND The common area of breast cancer metastases are bone,lung and liver.Brachial plexus metastasis from breast cancer is extremely rare.We report a case of subclavian brachial plexus metastasis from breast cancer 6 years postoperative,which were detected by ultrasound,magnetic resonance imaging(MRI)and 18Ffluorodeoxyglucose positron emission tomography and computed tomography(FDG-PET/CT).CASE SUMMARY Our study reports a 64-year-old woman who had right breast cancer and underwent radical mastectomy 6 years before.Ultrasound first revealed a soft lesion measuring 38 mm×37 mm which located on the right side of the clavicle to the armpit subcutaneously.The right subclavian brachial plexus(beam level)was significantly thickened,wrapped around by a hypoechoic lesion,the surrounded axillary artery and vein were pressed.MRI brachial plexus scan showed that the right side of brachial plexus was enlarged compared with the left side and brachial plexus bundle in the distance showed a flake shadow.FDG-PET/CT revealed that the right side of brachial plexus nodular appearance with increased FDG metabolism.These results supported brachial plexus metastasis from breast cancer.Ultrasound exam also found many lesions between pectoralis major,deltoid muscle and inner upper arm.The lesion puncture was performed under ultrasound guidance and the tissue was sent for pathology.Pathology showed large areas of tumor cells in fibroblast tissue.Immunohistochemistry showed the following results:A2-1:GATA3(+),ER(+,strong,90%),PR(+,moderate,10%),HER-2(3+),Ki67(+15%),P120(membrane+),P63(-),E-cadherin(+),CK5/6(-).These results were consistent with the primary right breast cancer characteristics,thus supporting lesion metastasis from breast cancer.CONCLUSION The brachial plexus metastasis from breast cancer is uncommon.Ultrasound has great value in detecting brachial plexus metastasis of breast cancer.It is an easy,non-invasive and affordable method.Close attention should be paid to new grown out lesions in those patients who had a history of breast cancer when doing ultrasound review.展开更多
BACKGROUND Various tumors and tumor-like disorders,originating from the neural sheath,as well as other types,may affect the brachial plexus region.Due to the infrequent presentation,brachial plexus palsy caused by spo...BACKGROUND Various tumors and tumor-like disorders,originating from the neural sheath,as well as other types,may affect the brachial plexus region.Due to the infrequent presentation,brachial plexus palsy caused by spontaneous hematoma in patients with hemophilia might miss the treatment by early surgical decompression and progress to permanent nerve damage.CASE SUMMARY The case reported here was a 30-year-old man with hemophilia,as well as both sensory and motor dysfunction of the left upper extremity.A presumptive diagnosis of brachial plexus tumor was initially made,which was subsequently confirmed to be an organized chronic hematoma rather than a neoplasm.The hemophilia-induced expanding hematoma compressing the brachial plexus was considered to be the main reason for the patient’s complaints.The clinical symptoms were alleviated and the involved nerves partially recovered at a follow-up of 1 year.CONCLUSION Early surgical intervention is crucial and it seems to be an essential precondition for recovery of nerve function in brachial plexus lesions.展开更多
Purpose:To investigate the overall quality of life level and identify influencing factors in patients with traumatic brachial plexus injury.Methods:One hundred three patients with brachial plexus injury were assessed ...Purpose:To investigate the overall quality of life level and identify influencing factors in patients with traumatic brachial plexus injury.Methods:One hundred three patients with brachial plexus injury were assessed using the World Health Organization Quality of Life-BREF(WHOQOL-BREF)and Family Adaptability and Cohesion Evaluation Scale(FACESII-CV)questionnaires.Results:The overall quality of life score from patients with brachial plexus injury was 65.7815.2.The scores for the physical,psychological and environmental factors were significantly lower than the norm(Ps<0.05).Regression analysis showed that age,injury located ipsilateral to the dominant hand,upper limb function score,score of family intimacy and family income were all factors influencing the of quality of life.Conclusions:A brachial plexus injury significantly compromises an individual’s quality of life.Multiple factors influence this quality,which should be targeted to augment the physical and psychological care provided.展开更多
BACKGROUND Modified radical mastectomy(MRM)is the most common surgical treatment for breast cancer.General anesthesia poses a challenge in fragile MRM patients,including cardiovascular instability,insufficient postope...BACKGROUND Modified radical mastectomy(MRM)is the most common surgical treatment for breast cancer.General anesthesia poses a challenge in fragile MRM patients,including cardiovascular instability,insufficient postoperative pain control,nausea and vomiting.Thoracic paravertebral block(TPVB)is adequate for simple mastectomy,but its combination with interscalene brachial plexus block(IBPB)has not yet been proved to be an effective anesthesia method for MRM.CASE SUMMARY We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities.An ultrasound-guided TPVB was placed at T2-T3 and T5-T6,and combined with IBPB,with administration of 10,15 and 5 mL of 0.5%ropivacaine,respectively.A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min.Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery.None of the patients required additional narcotics,vasopressors,or conversion to general anesthesia.The maximum pain score was 2 on an 11-point numerical rating scale.Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.CONCLUSION This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM,providing good postoperative analgesia.展开更多
BACKGROUND: Some researches showed that motoneurons in spinal cord anterior horn wound die following brachial plexus injury, but the concrete mechanism of motoneurons death remains unclear. OBJECTIVE: To observe the e...BACKGROUND: Some researches showed that motoneurons in spinal cord anterior horn wound die following brachial plexus injury, but the concrete mechanism of motoneurons death remains unclear. OBJECTIVE: To observe the expression of nitric oxide synthase (NOS) and survival of C7 motoneurons in spinal cord of rats after selective brachial plexus injury. DESIGN: A randomized controlled animal experiment. SETTING:Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University. MATERIALS: Totally 35 adult healthy male Sprague-Dawley rats with the body mass of 200-300 g were provided by Experimental Animal Center, Sun Yet-sen Medical College, Sun Yat-sen University. The rats were divided into control group (n =5) and experimental group(n =30) by random number table method, and the experimental group was divided into three injury subgroups: anterior root avulsion group, dorsal root transection group and spinal cord hemisection group, 10 rats in each group. There were horse anti-neuronal NOS (nNOS) polycolonal antibody (Sigma company) and nicotina mideadeninedinucleotide phosphate (NADPH-d) (Sigma Company). METHODS: The experiment was performed at Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University between September 2004 and April 2005. ①After anesthetizing the rats, the spinous process of second thoracic vertebra as a marker, the vertebra was exposed from C5 to T1 and the lamina of vertebra was unclenched, and spinal dura mater was carved to expose the spinal nerve dorsal roots of C5-T1. The right ventral root of C7 was avulsed, and the residual root was removed in anterior root avulsion group. The right ventral root of C7 was avulsed and the right dorsal roots of brachial plexus (C5-T1) were cut off in dorsal root transection group. In spinal cord hemisection group, the hemisection between the C5 and C6 spinal segment on right side and avulsion of right ventral root of C7 were made. In the control group, the vertebra from C5 to T1 was unclenched and the skin of wound was sutured. ②Three weeks after operation, behavior of rats was observed. The rats were killed after anesthesia. The C7 segment of spinal cord was removed and treated with NADPH-d staining, neutral red counterstaining and NOS immunohistochemistry staining to detect the expression of NOS. MAIN OUTCOME MEASURES: The expression of NOS and survival of C7 motoneurons in spinal cord of rats 3 weeks after operation. RESULTS: Among the 35 included rats, 3 rats died 2 weeks following operation, so totally 32 rats were involved in the result analysis. ①NADPH-d positive neurons of in anterior horn of C7 in the three groups: The NADPH-d positive neurons could be found in anterior horn of C7 in the three groups. The percentage of that in anterior root avulsion group to that of non-injury side of spinal cord was(20.98±2.65)%, (29.43±6.81)% in dorsal root transection group and (31.74±6.80)% in spinal cord hemisection group. There was significant difference among the three injury groups(F =5.135,P =0.016). There was significant difference in anterior root avulsion group with dorsal root transection group and spinal cord hemisection group (t =2.562,3.167,P < 0.05). There was no significant difference between the dorsal root transection group and spinal cord hemisection group (P =0.534). ②survival rate of motoneurons in anterior horn of C7: There were dead motoneurons in the three injury groups, the percentages of surviving motoneurons to that of non-injured side of spinal cord were (69.22±4.04)%,(62.01±3.82)% and (56.74±6.86)%, respectively. There were significant differences among the three groups (F =9.508,P =0.002). The anterior root avulsion group was significantly different from the other two groups(t =2.764,4.587,P < 0.05). There was no significant difference between the dorsal root transection group and spinal cord hemisection group(P =0.073). CONCLUSION: The selective brachial plexus injury can induce the up-regulation of NOS expression in motorneurons of spinal cord anterior horn and block descending pathway of cortex to cause the more significant up-regulation of NOS and low survival rate in motoneurons. It indicates that descending pathway of cortex can inhibit the NOS expression in motorneurons of spinal cord anterior horn, and the high NOS expression might induce the death of motorneurons in spinal cord anterior horn.展开更多
Introduction: Obstetric palsy of the brachial plexus (OPBP) is a paralytic lesion common to obstetric trauma, whose clinical presentation varies according to the severity and extent of the root lesions at birth. Early...Introduction: Obstetric palsy of the brachial plexus (OPBP) is a paralytic lesion common to obstetric trauma, whose clinical presentation varies according to the severity and extent of the root lesions at birth. Early and appropriate rehabilitation is necessary in order to improve the functional prognosis of the injured limb. Under special conditions, parents could carry out this physiotherapy themselves. Objective: The aim of this work was to assess limb functional recovery in newborns and infants with OPBP after rehabilitation by their parents. Patients and Methods: We conducted a prospective study at the NCRDP in Yaoundé over a period of 18 months. We included all patients aged 0 to 2 years with OPBP, isolated or associated with other lesions and followed at least two (02) years at the NCRDP. Results: We recruited 69 cases. The hospital frequency of OPBP was estimated at 1.02%. The age at first consultation was [0 - 28 d] in 50.8% of cases. The sex ratio was 0.68. The right side was reached in 54.4% of cases. The Erb’s palsy predominated in 79.7% of cases. The risk factors for OPBP were vaginal delivery, cephalic presentation, shoulder dystocia and macrosomia. Physiotherapy was performed as prescribed in 94.9% of cases allowing excellent and good functional recovery in 76.81% of cases. Conclusion: In the care of their children’s OPBP rehabilitation by sensitized, actively involved and supervised parents would be a good alternative to professional physiotherapy in all situations where the latter would not be possible.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
Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients w...Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at Sao Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from?1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95° flexion, 50° abduction, 45° external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-month-old lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.展开更多
OBJECTIVE: To compare the clinical effect of brachial plexus block with "One Injection Two Points" guided under ultrasound and the conventional method guiding by ultrasound. METHODS: 70 patients were randomi...OBJECTIVE: To compare the clinical effect of brachial plexus block with "One Injection Two Points" guided under ultrasound and the conventional method guiding by ultrasound. METHODS: 70 patients were randomized evenly into 2 groups, with 35 patients in each group, while the Experiment Group(Group B) received One Injection Two Points" method, the Control Group(Group A) received the conventional method.The nerve block every 5 s, the success rate of anesthesia, the dosage of local anesthetics, second remedial anesthesia, adverse reactions, etc.were recorded. RESULTS: Group B was superior to group A in the success rate of anesthesia; There were 6 patients in group A who required constant pump injection of Remifentanil to remedy, while no patients in Group B needed remedy treatment. There were no serious adverse reactions in both groups.CONCLUSIONS: The clinical effect of brachial plexus block with "One Injection Two Points" method guided under ultrasoundguiding by ultrasound was superior to that of the conventional method.展开更多
基金the Ministry of Science and Technology China Brain Initiative Grant,No.2022ZD0204701the National Natural Science Foundation of China,Nos.82071386&81870982(all to JG)。
文摘Dendrites play irreplaceable roles in the nerve conduction pathway and are vulnerable to various insults.Peripheral axotomy of motor neurons results in the retraction of dendritic arbors,and the dendritic arbor can be re-expanded when reinnervation is allowed.RhoA is a target that regulates the cytoskeleton and promotes neuronal survival and axon regeneration.However,the role of RhoA in dendrite degeneration and regeneration is unknown.In this study,we explored the potential role of RhoA in dendrites.A line of motor neuronal conditional knockout mice was developed by crossbreeding HB9~(Cre+)mice with RhoA~(flox/flox)mice.We established two models for assaying dendrite degeneration and regeneration,in which the brachial plexus was transection or crush injured,respectively.We found that at 28 days after brachial plexus transection,the density,complexity,and structural integrity of dendrites in the ventral horn of the spinal cord of RhoA conditional knockout mice were slightly decreased compared with that in Cre mice.Dendrites underwent degeneration at 7 and 14 days after brachial plexus transection and recovered at 28–56 days.The density,complexity,and structural integrity of dendrites in the ventral horn of the spinal cord of RhoA conditional knockout mice recovered compared with results in Cre mice.These findings suggest that RhoA knockout in motor neurons attenuates dendrite degeneration and promotes dendrite regeneration after peripheral nerve injury.
基金Supported by the Fund of Biomedical Research Institute,Jeonbuk National University Hospital,Jeonju,Republic of Korea.
文摘BACKGROUND Dexmedetomidine(DMED)is frequently used as a sedative in several medical fields.The benefits of DMED include enhanced quality of regional anesthesia,prolonged analgesia,and postoperative opioid-sparing when administered intravenously or perineurally in combination with regional anesthesia.Severe hemodynamic complications,such as profound bradycardia and hypotension,can occur after DMED administration in critically ill patients or overdosage;however,there are few reports of complications with DMED administration following brachial plexus block(BPB).CASE SUMMARY We present two cases of hemodynamic instability that occurred following the initial loading of DMED under supraclavicular BPB.A healthy 29-year-old man without any medical history showed profound bradycardia after receiving a loading dose of DMED 0.9μg/kg for 9 min.DMED administration was promptly stopped,and after receiving a second dose of atropine,the heart rate recovered.A 62-year-old woman with a history of cardiomyopathy became hypotensive abruptly,requiring the administration of inotrope and vasopressors after receiving a reduced loading dose of 0.5μg/kg for 10 min.Half of the recommended loading dose of DMED was administered due to the underlying heart dysfunction.Decrea-sed blood pressure was maintained despite the intravenous administration of ephedrine.With continuous infusion of dopamine and norepinephrine,the vital signs were maintained within normal ranges.Inotropic and vasopressor support was required for over 6 h after the initial loading dose of DMED.CONCLUSION DMED administration following BPB could trigger hemodynamic instability in patients with decreased cardiac function as well as in healthy individuals.
文摘Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descriptive retrospective study was based on the medical records of patients who suffered vascular axillary and/or brachial plexus trauma and who underwent surgical repair at the Abidjan Cardiology Institute from January 2008 to June 2022. Epidemiological, anatomo-clinical and surgical data were studied. Results: Thirty-four medical files belonging to 33 men and one woman, aged 32 on average, were collected. The circumstances of occurrence were dominated by the stab wound (n = 22). The combinations of injuries were as follows: associated involvement of the axillary artery and vein (n = 4);isolated involvement of axillary artery (n = 3);isolated involvement of the axillary vein (n = 2);associated involvement of the axillary artery and brachial plexus (n = 17);associated involvement of the axillary artery and vein and brachial plexus (n = 08). Anatomic lesions included acute arterial lesions (n = 29) and arteriovenous fistula (n = 1) and false aneurysms (n = 4). All patients were operated on under general anesthesia;vascular repair included direct suturing (n = 16), arterial and venous bypass using a long saphenous graft (n = 9), prosthetic arterial bypass (n = 5) and prosthetic flattening-graft (n = 4). Brachial plexus surgery consisted of an end-to-end anastomosis of each transected bundle in all cases (n = 25). The medium-term postoperative course was marked by success without functional sequelae in 88.24% of cases (n = 30) and by the persistence of distal paralysis of the thoracic limb after 6 months in 05.88% (n = 2) of all patients, i.e., 8% of patients who presented with brachial plexus injury. Conclusion: The concomitant surgical treatment of these axillary vascular and nerve lesions has given good results. However, if paralysis of the thoracic limb persists after 6 to 12 months, the patient should be referred to a specialist in brachial plexus surgery.
文摘This study aimed to investigate the reconstruction of the thumb and finger extension function in patients with middle and lower trunk root avulsion injuries of the brachial plexus. From April 2010 to January 2015, we enrolled in this study 4 patients diagnosed with middle and lower trunk root avulsion injuries of the brachial plexus via imaging tests, electrophysiological examinations, and clinical confirmation. Muscular branches of the radial nerve, which innervate the supinator in the forearm, were transposed to the posterior interosseous nerve to reconstruct the thumb and finger extension function. Electrophysiological findings and muscle strength of the extensor pollicis longus and extensor digitorum communis, as well as the distance between the thumb tip and index finger tip, were monitored. All patients were followed up for 24 to 30 months, with an average of 27.5 months. Motor unit potentials(MUP) of the extensor digitorum communis appeared at an average of 3.8 months, while MUP of the extensor pollicis longus appeared at an average of 7 months. Compound muscle action potential(CMAP) appeared at an average of 9 months in the extensor digitorum communis, and 12 months in the extensor pollicis longus. Furthermore, the muscle strength of the extensor pollicis longus and extensor digitorum communis both reached grade Ⅲ at 21 months. Lastly, the average distance between the thumb tip and index finger tip was 8.8 cm at 21 months. In conclusion, for patients with middle and lower trunk injuries of the brachial plexus, transposition of the muscular branches of the radial nerve innervating the supinator to the posterior interosseous nerve for the reconstruction of thumb and finger extension function is practicable and feasible.
文摘BACKGROUND Anesthesia plays an essential role in the successful surgical procedures for hand trauma.Compared with general anesthesia,brachial plexus block shows lots of benefits for the upper extremity.Specifically,ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances.The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.AIM To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.METHODS A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected.They were divided into an observation group and a control group with 34 patients in each group.The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block.The analgesic efficacy,intraoperative complications,wound healing time,and length of hospital stay were compared between the two groups under different anesthesia.RESULTS The percentage of cases with analgesia graded as“excellent or very good”was higher in the observation group than in the control group(P<0.05).Moreover,the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group(P<0.05).CONCLUSION Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries.It can reduce the incidence of intraoperative complications,promote wound healing,and shorten the length of hospital stay.
文摘BACKGROUND:Previous studies of peripheral nerve mechanical properties in animals have utilized one-dimensional drawing methods. OBJECTIVE:To analyze the effects of brachial plexus injury anastomosis simulation on biomechanical properties of adult brachial plexus by observing tensile mechanical properties,stress relaxation,and creep deformation of the brachial plexus in normal human cadavers and brachial plexus from simulated brachial plexus injury anastomosis samples. DESIGN,TIME AND SETTING:The in vitro experiment was performed at the Mechanics Experimental Center,Jilin University,China from April to May 2007. MATERIALS:A total of six adult,male cadavers,who had died from acute trauma,and were aged 20-29 years,were supplied by the Research Room of Anatomy,Medical Department,Jilin University,China. AG-10TA Universal Material Testing Machine (Shimadzu,Japan) was used in this study. METHODS:A total of 36 samples of fresh brachial plexus were collected from the cadavers,comprising 12 C5 nerve roots,12 C6 nerve roots at the left and right sides of the superior truck,and 12 C7 nerve roots at the middle truck. The C5 and C6 nerve roots were processed into 50 samples and the C7 nerve roots into 24 samples. A total of 36 C5 and C6 nerve root samples were randomly assigned to a non-surgery control group (n = 18) and brachial plexus injury anastomosis simulation group (n = 18). Brachial plexus injury simulation anastomosis samples underwent an incision in the middle,and then received anastomosis. Samples in both groups underwent a tension test at 5 mm/min on the AG-10TA universal material testing machine. A total of 24 sam-ples from the C6 superior trunk and C7 middle trunk of the brachial plexus were subjected to stress relaxation and creep tests. Test duration was 7 200 seconds. A total of 100 data points were collected and analyzed using a normalization method. MAIN OUTCOME MEASURES:The following parameters were measured:tension maximum displacement,maximum load,maximum stress,maximum strain and stress-strain curve,stress relaxation at 7 200 seconds,creep deformation at 7 200 seconds,stress relaxation,and creep curve in the non-surgery control group and brachial plexus injury simulation anastomosis group. RESULTS:The tension maximum load of brachial plexus was (140.36 ± 30.50) N,maximum stress was (10.67 ± 2.52) MPa,maximum displacement was (7.78 ± 1.48) mm,and maximum strain was (31.64 ± 5.32)% in the non-surgery control group. The tension maximum load of brachial plexus was (93.23 ± 20.65) N,maximum stress was (7.09 ± 1.57) MPa,maximum displacement was (6.13 ± 0.86) mm,and maximum strain was (24.55 ± 3.45)% in the brachial plexus injury simulation anastomosis group. The above-mentioned indices were greater in the non-surgery control group than in the brachial plexus injury simulation anastomosis group (P < 0.01). Stress relaxation at 7 200 seconds was 2.07 MPa and 2.11 MPa,respectively,in the non-surgery control and brachial plexus injury simulation anastomosis groups. Creep deformation at 7 200 seconds was 4.68% and 3.52%,respectively,in the non-surgery control and brachial plexus injury simulation anastomosis groups. CONCLUSION:Decreased tension maximum load,maximum displacement,maximum stress,maximum strain,and creep deformation at 7 200 seconds affected the biomechanical properties of the brachial plexus following brachial plexus injury.
基金supported by the National Natural Science Foundation of China,No.81672240(to LC)
文摘The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.
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a Grant from Health Department of Guangdong Province in China,No. A2007169
文摘BACKGROUND:Animal models of brachial plexus root avulsion are required for the study of brachial plexus root injuries.The established ventral approach results in slight injuries,and is similar to mechanisms underlying human brachial plexus root avulsion.OBJECTIVE:To analyze the effects of weight,age,and species on the success rate of brachial plexus root avulsion,and to determine the perfect method for establishing models of brachial plexus root avulsion.DESIGN,TIME AND SETTING:A randomized,block design was performed at the Laboratory of Professor Lihua Zhou,Zhongshan School of Medicine,Sun Yat-sen University,China from June 2008 to June 2009.MATERIALS:Sprague Dawley(SD) rats,golden hamsters,and BALb/C mice were used in the present study.METHODS:All animals were randomly subjected to classical brachial plexus root avulsion and modified brachial plexus root avulsion.MAIN OUTCOME MEASURES:Success rate of brachial plexus root avulsion.RESULTS:The success rate of brachial plexus root avulsion was greater in the modified group than in the classical group(P < 0.01).Moreover,the difference was significant in 15-day-old SD rats,5-week-old SD rats,and 3-month-old BALb/C mice(P < 0.01).The success rate of brachial plexus root avulsion was greater in the same weight,15-day-old juvenile SD rats,than in the 3-month-old BALb/C mice(classical group,P < 0.01;modified group,P < 0.05).The success rate of brachial plexus root avulsion was significantly greater in 3-month-old golden hamsters than in 5-week-old SD rats in the classical group(P < 0.05).The success rate of brachial plexus root avulsion was significantly lower in the 15-day-old SD rats compared with the 5-week-old and 3-month-old SD rats in the classical group(P < 0.01).However,there was no significant difference in the success rate of brachial plexus root avulsion between various ages of SD rats in the modified group(P > 0.05).CONCLUSION:Modified surgery to induce brachial plexus root avulsion significantly increases the success rate of model establishment.Species,age,and weight affect the success rate of brachial plexus root avulsion,and species plays an important role in the success rate.
基金supported by the National Natural Science Foundation of China, No.31771322(to PXZ)the Natural Science Foundation of Beijing, No.7212121(to PXZ)+2 种基金Shenzhen Science and Technology Plan Project, No.JCYJ20190806162205278(to PXZ)Funds for Severe Trauma Standardized Treatment, No.SZSM202011001(to PXZ)a grant from National Center for Trauma Medicine, Beijing, China, No.BMU2020 XY005-01(to PXZ)
文摘Transferring the contralateral C7 nerve root to the median or radial nerve has become an important means of repairing brachial plexus nerve injury.However,outcomes have been disappointing.Electroencephalography(EEG)-based human-machine interfaces have achieved promising results in promoting neurological recovery by controlling a distal exoskeleton to perform functional limb exercises early after nerve injury,which maintains target muscle activity and promotes the neurological rehabilitation effect.This review summarizes the progress of research in EEG-based human-machine interface combined with contralateral C7 transfer repair of brachial plexus nerve injury.Nerve transfer may result in loss of nerve function in the donor area,so only nerves with minimal impact on the donor area,such as the C7 nerve,should be selected as the donor.Single tendon transfer does not fully restore optimal joint function,so multiple functions often need to be reestablished simultaneously.Compared with traditional manual rehabilitation,EEG-based human-machine interfaces have the potential to maximize patient initiative and promote nerve regeneration and cortical remodeling,which facilitates neurological recovery.In the early stages of brachial plexus injury treatment,the use of an EEG-based human-machine interface combined with contralateral C7 transfer can facilitate postoperative neurological recovery by making full use of the brain’s computational capabilities and actively controlling functional exercise with the aid of external machinery.It can also prevent disuse atrophy of muscles and target organs and maintain neuromuscular junction effectiveness.Promoting cortical remodeling is also particularly important for neurological recovery after contralateral C7 transfer.Future studies are needed to investigate the mechanism by which early movement delays neuromuscular junction damage and promotes cortical remodeling.Understanding this mechanism should help guide the development of neurological rehabilitation strategies for patients with brachial plexus injury.
文摘BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,nerve injury may occur.In this report,we present a unique case in which the brachial plexus(division level),suprascapular,and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures.CASE SUMMARY A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure.During the surgery,the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h.Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus(BP)compression and related neuropathy.An electrodiagnostic study confirmed the presence of BP injury involving the wholedivision level,long thoracic,and suprascapular nerve injuries.He was treated with medication,physical therapy,and ultrasound-guided injections.Ultrasoundguided steroid injection at the BP,hydrodissection with 5%dextrose water at the BP and suprascapular nerve,and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed.On postoperative day 194,the pain and arm weakness were resolved,and a follow-up electrodiagnostic study showed marked improvement.CONCLUSION Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture,and treat each specific therapeutic target.
文摘BACKGROUND The common area of breast cancer metastases are bone,lung and liver.Brachial plexus metastasis from breast cancer is extremely rare.We report a case of subclavian brachial plexus metastasis from breast cancer 6 years postoperative,which were detected by ultrasound,magnetic resonance imaging(MRI)and 18Ffluorodeoxyglucose positron emission tomography and computed tomography(FDG-PET/CT).CASE SUMMARY Our study reports a 64-year-old woman who had right breast cancer and underwent radical mastectomy 6 years before.Ultrasound first revealed a soft lesion measuring 38 mm×37 mm which located on the right side of the clavicle to the armpit subcutaneously.The right subclavian brachial plexus(beam level)was significantly thickened,wrapped around by a hypoechoic lesion,the surrounded axillary artery and vein were pressed.MRI brachial plexus scan showed that the right side of brachial plexus was enlarged compared with the left side and brachial plexus bundle in the distance showed a flake shadow.FDG-PET/CT revealed that the right side of brachial plexus nodular appearance with increased FDG metabolism.These results supported brachial plexus metastasis from breast cancer.Ultrasound exam also found many lesions between pectoralis major,deltoid muscle and inner upper arm.The lesion puncture was performed under ultrasound guidance and the tissue was sent for pathology.Pathology showed large areas of tumor cells in fibroblast tissue.Immunohistochemistry showed the following results:A2-1:GATA3(+),ER(+,strong,90%),PR(+,moderate,10%),HER-2(3+),Ki67(+15%),P120(membrane+),P63(-),E-cadherin(+),CK5/6(-).These results were consistent with the primary right breast cancer characteristics,thus supporting lesion metastasis from breast cancer.CONCLUSION The brachial plexus metastasis from breast cancer is uncommon.Ultrasound has great value in detecting brachial plexus metastasis of breast cancer.It is an easy,non-invasive and affordable method.Close attention should be paid to new grown out lesions in those patients who had a history of breast cancer when doing ultrasound review.
基金Supported by the Foundation of Science and Technology Department of Zhejiang Province,No.LGF19H060010the Foundation of Health and Family Planning Commission of Zhejiang Province,No.2021KY445.
文摘BACKGROUND Various tumors and tumor-like disorders,originating from the neural sheath,as well as other types,may affect the brachial plexus region.Due to the infrequent presentation,brachial plexus palsy caused by spontaneous hematoma in patients with hemophilia might miss the treatment by early surgical decompression and progress to permanent nerve damage.CASE SUMMARY The case reported here was a 30-year-old man with hemophilia,as well as both sensory and motor dysfunction of the left upper extremity.A presumptive diagnosis of brachial plexus tumor was initially made,which was subsequently confirmed to be an organized chronic hematoma rather than a neoplasm.The hemophilia-induced expanding hematoma compressing the brachial plexus was considered to be the main reason for the patient’s complaints.The clinical symptoms were alleviated and the involved nerves partially recovered at a follow-up of 1 year.CONCLUSION Early surgical intervention is crucial and it seems to be an essential precondition for recovery of nerve function in brachial plexus lesions.
文摘Purpose:To investigate the overall quality of life level and identify influencing factors in patients with traumatic brachial plexus injury.Methods:One hundred three patients with brachial plexus injury were assessed using the World Health Organization Quality of Life-BREF(WHOQOL-BREF)and Family Adaptability and Cohesion Evaluation Scale(FACESII-CV)questionnaires.Results:The overall quality of life score from patients with brachial plexus injury was 65.7815.2.The scores for the physical,psychological and environmental factors were significantly lower than the norm(Ps<0.05).Regression analysis showed that age,injury located ipsilateral to the dominant hand,upper limb function score,score of family intimacy and family income were all factors influencing the of quality of life.Conclusions:A brachial plexus injury significantly compromises an individual’s quality of life.Multiple factors influence this quality,which should be targeted to augment the physical and psychological care provided.
文摘BACKGROUND Modified radical mastectomy(MRM)is the most common surgical treatment for breast cancer.General anesthesia poses a challenge in fragile MRM patients,including cardiovascular instability,insufficient postoperative pain control,nausea and vomiting.Thoracic paravertebral block(TPVB)is adequate for simple mastectomy,but its combination with interscalene brachial plexus block(IBPB)has not yet been proved to be an effective anesthesia method for MRM.CASE SUMMARY We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities.An ultrasound-guided TPVB was placed at T2-T3 and T5-T6,and combined with IBPB,with administration of 10,15 and 5 mL of 0.5%ropivacaine,respectively.A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min.Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery.None of the patients required additional narcotics,vasopressors,or conversion to general anesthesia.The maximum pain score was 2 on an 11-point numerical rating scale.Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.CONCLUSION This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM,providing good postoperative analgesia.
文摘BACKGROUND: Some researches showed that motoneurons in spinal cord anterior horn wound die following brachial plexus injury, but the concrete mechanism of motoneurons death remains unclear. OBJECTIVE: To observe the expression of nitric oxide synthase (NOS) and survival of C7 motoneurons in spinal cord of rats after selective brachial plexus injury. DESIGN: A randomized controlled animal experiment. SETTING:Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University. MATERIALS: Totally 35 adult healthy male Sprague-Dawley rats with the body mass of 200-300 g were provided by Experimental Animal Center, Sun Yet-sen Medical College, Sun Yat-sen University. The rats were divided into control group (n =5) and experimental group(n =30) by random number table method, and the experimental group was divided into three injury subgroups: anterior root avulsion group, dorsal root transection group and spinal cord hemisection group, 10 rats in each group. There were horse anti-neuronal NOS (nNOS) polycolonal antibody (Sigma company) and nicotina mideadeninedinucleotide phosphate (NADPH-d) (Sigma Company). METHODS: The experiment was performed at Department of Anatomy, Sun Yet-sen Medical College, Sun Yet-sen University between September 2004 and April 2005. ①After anesthetizing the rats, the spinous process of second thoracic vertebra as a marker, the vertebra was exposed from C5 to T1 and the lamina of vertebra was unclenched, and spinal dura mater was carved to expose the spinal nerve dorsal roots of C5-T1. The right ventral root of C7 was avulsed, and the residual root was removed in anterior root avulsion group. The right ventral root of C7 was avulsed and the right dorsal roots of brachial plexus (C5-T1) were cut off in dorsal root transection group. In spinal cord hemisection group, the hemisection between the C5 and C6 spinal segment on right side and avulsion of right ventral root of C7 were made. In the control group, the vertebra from C5 to T1 was unclenched and the skin of wound was sutured. ②Three weeks after operation, behavior of rats was observed. The rats were killed after anesthesia. The C7 segment of spinal cord was removed and treated with NADPH-d staining, neutral red counterstaining and NOS immunohistochemistry staining to detect the expression of NOS. MAIN OUTCOME MEASURES: The expression of NOS and survival of C7 motoneurons in spinal cord of rats 3 weeks after operation. RESULTS: Among the 35 included rats, 3 rats died 2 weeks following operation, so totally 32 rats were involved in the result analysis. ①NADPH-d positive neurons of in anterior horn of C7 in the three groups: The NADPH-d positive neurons could be found in anterior horn of C7 in the three groups. The percentage of that in anterior root avulsion group to that of non-injury side of spinal cord was(20.98±2.65)%, (29.43±6.81)% in dorsal root transection group and (31.74±6.80)% in spinal cord hemisection group. There was significant difference among the three injury groups(F =5.135,P =0.016). There was significant difference in anterior root avulsion group with dorsal root transection group and spinal cord hemisection group (t =2.562,3.167,P < 0.05). There was no significant difference between the dorsal root transection group and spinal cord hemisection group (P =0.534). ②survival rate of motoneurons in anterior horn of C7: There were dead motoneurons in the three injury groups, the percentages of surviving motoneurons to that of non-injured side of spinal cord were (69.22±4.04)%,(62.01±3.82)% and (56.74±6.86)%, respectively. There were significant differences among the three groups (F =9.508,P =0.002). The anterior root avulsion group was significantly different from the other two groups(t =2.764,4.587,P < 0.05). There was no significant difference between the dorsal root transection group and spinal cord hemisection group(P =0.073). CONCLUSION: The selective brachial plexus injury can induce the up-regulation of NOS expression in motorneurons of spinal cord anterior horn and block descending pathway of cortex to cause the more significant up-regulation of NOS and low survival rate in motoneurons. It indicates that descending pathway of cortex can inhibit the NOS expression in motorneurons of spinal cord anterior horn, and the high NOS expression might induce the death of motorneurons in spinal cord anterior horn.
文摘Introduction: Obstetric palsy of the brachial plexus (OPBP) is a paralytic lesion common to obstetric trauma, whose clinical presentation varies according to the severity and extent of the root lesions at birth. Early and appropriate rehabilitation is necessary in order to improve the functional prognosis of the injured limb. Under special conditions, parents could carry out this physiotherapy themselves. Objective: The aim of this work was to assess limb functional recovery in newborns and infants with OPBP after rehabilitation by their parents. Patients and Methods: We conducted a prospective study at the NCRDP in Yaoundé over a period of 18 months. We included all patients aged 0 to 2 years with OPBP, isolated or associated with other lesions and followed at least two (02) years at the NCRDP. Results: We recruited 69 cases. The hospital frequency of OPBP was estimated at 1.02%. The age at first consultation was [0 - 28 d] in 50.8% of cases. The sex ratio was 0.68. The right side was reached in 54.4% of cases. The Erb’s palsy predominated in 79.7% of cases. The risk factors for OPBP were vaginal delivery, cephalic presentation, shoulder dystocia and macrosomia. Physiotherapy was performed as prescribed in 94.9% of cases allowing excellent and good functional recovery in 76.81% of cases. Conclusion: In the care of their children’s OPBP rehabilitation by sensitized, actively involved and supervised parents would be a good alternative to professional physiotherapy in all situations where the latter would not be possible.
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.
文摘Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at Sao Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from?1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95° flexion, 50° abduction, 45° external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-month-old lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.
文摘OBJECTIVE: To compare the clinical effect of brachial plexus block with "One Injection Two Points" guided under ultrasound and the conventional method guiding by ultrasound. METHODS: 70 patients were randomized evenly into 2 groups, with 35 patients in each group, while the Experiment Group(Group B) received One Injection Two Points" method, the Control Group(Group A) received the conventional method.The nerve block every 5 s, the success rate of anesthesia, the dosage of local anesthetics, second remedial anesthesia, adverse reactions, etc.were recorded. RESULTS: Group B was superior to group A in the success rate of anesthesia; There were 6 patients in group A who required constant pump injection of Remifentanil to remedy, while no patients in Group B needed remedy treatment. There were no serious adverse reactions in both groups.CONCLUSIONS: The clinical effect of brachial plexus block with "One Injection Two Points" method guided under ultrasoundguiding by ultrasound was superior to that of the conventional method.
