Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of...Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of nerve regeneration and repair. Previous studies have shown that human amniotic membrane can promote the healing of a variety of tissues. In this study, the right common peroneal nerve underwent a 5-mm transection in rats. Epineural nerve repair was performed using 10/0 non-absorbable surgical suture. The repair site was wrapped with a two-layer amniotic membrane with α-cyanoacrylate rapid medical adhesive after suture. Hindlimb motor function was assessed using footprint analysis. Conduction velocity of the common peroneal nerve was calculated by neural electrical stimulation. The retrograde axoplasmic transport of the common peroneal nerve was observed using fast blue BB salt retrograde fluorescent staining. Hematoxylin- eosin staining was used to detect the pathological changes of the common peroneal nerve sputum. The mRNA expression of axon regeneration-related neurotrophic factors and inhibitors was measured using real-time polymerase chain reaction. The results showed that the amniotic membrane significantly improved the function of the injured nerve;the toe spread function rapidly recovered, the nerve conduction velocity was restored, and the number of fast blue BB salt particles were increased in the spinal cord. The amniotic membrane also increased the recovery rate of the tibialis anterior muscle and improved the tissue structure of the muscle. Meanwhile, mRNA expression of nerve growth factor, growth associated protein-43, collapsin response mediator protein-2, and brain-derived neurotrophic factor recovered to near-normal levels, while Lingo-1 mRNA expression decreased significantly in spinal cord tissues. mRNA expression of glial-derived neurotrophic factor did not change significantly. Changes in mRNA levels were more significant in amniotic-membrane-wrapping-treated rats compared with model and nerve sutured rats. These results demonstrate that fresh amniotic membrane wrapping can promote the functional recovery of sutured common peroneal nerve via regulation of expression levels of neurotrophic factors and inhibitors associated with axonal regeneration. The study was approved by the Committee on Animal Research and Ethics at the Affiliate Hospital of Zunyi Medical University, China (approval No. 112) on December 1, 2017.展开更多
Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this i...Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this is caused by differential expression of genes and proteins during Wallerian degeneration remains unclear. The right tibial nerve and the common peroneal nerve of the same rat were exposed and completely cut through and then sutured in the same horizontal plane. On days 1, 7, 14, and 21 after surgery, 1–2 cm of nerve tissue distal to the suture site was dissected out from the tibial and common peroneal nerves. The differences in gene and protein expression during Wallerian degeneration of the injured nerves were then studied by RNA sequencing and proteomic techniques. In the tibial and common peroneal nerves, there were 1718, 1374, 1187, and 2195 differentially expressed genes, and 477, 447, 619, and 495 differentially expressed proteins on days 1, 7, 14, and 21 after surgery, respectively. Forty-seven pathways were activated during Wallerian degeneration. Three genes showing significant differential expression by RNA sequencing (Hoxd4, Lpcat4 and Tbx1) were assayed by real-time quantitative polymerase chain reaction. RNA sequencing and real-time quantitative polymerase chain reaction results were consistent. Our findings showed that expression of genes and proteins in injured tibial and the common peroneal nerves were significantly different during Wallerian degeneration at different time points. This suggests that the biological processes during Wallerian degeneration are different in different peripheral nerves after injury. The procedure was approved by the Animal Experimental Ethics Committee of the Second Military Medical University, China (approval No. CZ20160218) on February 18, 2016.展开更多
BACKGROUND: Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIVE...BACKGROUND: Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIVE: To analyze anatomical causes of sciatic nerve and common peroneal nerve injury by studying the relationship between the sciatic nerve and piriformis. DESIGN, TIME AND SETTING: Observe and measure repeatedly. The experiment was conducted in the Department of Anatomy, Tianjin Medical College between January and June 2005. MATERIALS: Fifty-two adult cadavers 33 males and 19 females, with a total of 104 hemispheres, and fixed with formaldehyde, were provided by Tianjin Medical College and Tianjin Medical University. METHODS: A posterior cut was made from the lumbosacral region to the upper leg, fully exposing the piriformis and path of the sciatic nerve. MAIN OUTCOME MEASURES: (1) Anatomical characteristics of the tibial nerve and common peroneal nerve. (2) According to different areas where the sciatic nerve crosses the piriformis, the study was divided into two types-normal and abnormal. Normal is considered to be when the sciatic nerve passes through the infrapiriform foramen. Remaining pathways are considered to be abnormal. (3) Observe the relationship between the suprapiriform foramen, infrapiriform foramen, as well as the superior and inferior space of piriformis. RESULTS: (1) The nerve tract inside the common peroneal nerve is smaller and thinner, with less connective tissue than the tibial nerve. When pathological changes or variations of the piriformis, or over-abduction of the hip joint, occur, injury to the common peroneal nerve often arises due to blockage and compression. (2) A total of 76 hemispheres (73.08%) were normal, 28 were abnormal (26.92%). The piriformis can be injured, and the sciatic nerve can become compressed, when the hip joint undergoes intorsion, extorsion, or abduction. (3) The structures between the infrapiriform and suprapiriform foramen are where "the first threshold" sciatic nerve projects. The structures between the infrapiriform and suprapiriform gap were "the second threshold". This became the concept of "double threshold". The reduced area caused by pathological changes of "double threshold" may block and compress the sciatic nerve. Because the common peroneal nerve lies on the anterolateral side of the sciatic nerve, injury to the common peroneal nerve is more serious. CONCLUSION: Anatomical characteristics of the common peroneal nerve, as well as variation of the sciatic nerve, piriformis, and the reduced "double threshold", are the main causes of sciatic nerve injury, and are especially common in peroneal nerve injury.展开更多
<span style="font-family:Verdana;">A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, ...<span style="font-family:Verdana;">A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than</span><span style="font-family:""> </span><span style="font-family:Verdana;">5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">of this cohort demon</span><span style="font-family:Verdana;">strated a Positive Phoenix Sign (an increase in dorsiflexion strength of the</span><span style="font-family:Verdana;"> Extensor Hallucis Longus muscle (EHL)). One patient had no response to the </span><span style="font-family:Verdana;">peripheral nerve block. Of the 25 patients who demonstrated a positive</span><span style="font-family:Verdana;"> “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decom</span><span style="font-family:Verdana;">pression surgery of the CFN. The one patient in this cohort who did not</span><span style="font-family:Verdana;"> dem</span><span style="font-family:Verdana;">onstrate any improvement in dorsiflexion of the EHL after the nerve block</span><span style="font-family:Verdana;"> did not have any improvement after surgery.展开更多
Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In ...Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Patients received oral vitamin B12 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory function in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months.展开更多
Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of...Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of transplanted nerve attains maximum therapeutic effect remains poorly understood. In this study, a rat model of common peroneal nerve defect was established by resecting a 10-mm long right common peroneal nerve. Rats receiving transplantation of the common peroneal nerve in situ were designated as the in situ graft group. Ipsilateral sural nerves(10–30 mm long) were resected to establish the one sural nerve graft group, two sural nerves cable-style nerve graft group and three sural nerves cable-style nerve graft group. Each bundle of the peroneal nerve was 10 mm long. To reduce the barrier effect due to invasion by surrounding tissue and connective-tissue overgrowth between neural stumps, small gap sleeve suture was used in both proximal and distal terminals to allow repair of the injured common peroneal nerve. At three months postoperatively, recovery of nerve function and morphology was observed using osmium tetroxide staining and functional detection. The results showed that the number of regenerated nerve fibers, common peroneal nerve function index, motor nerve conduction velocity, recovery of myodynamia, and wet weight ratios of tibialis anterior muscle were not significantly different among the one sural nerve graft group, two sural nerves cable-style nerve graft group, and three sural nerves cable-style nerve graft group. These data suggest that the repair effect achieved using one sural nerve graft with a lower number of nerve fibers is the same as that achieved using the two sural nerves cable-style nerve graft and three sural nerves cable-style nerve graft. This indicates that according to the ‘multiple amplification' phenomenon, one small nerve graft can provide a good therapeutic effect for a large peripheral nerve defect.展开更多
基金supported by Guizhou Province Major Special Projects in Science and Technology of China,No.Qin Ke He Zhong Da Zhuan Xiang Zi [2011]6002the Special Co-operation Funds of the Science and Technology Administration in Provinces and Cities of China,No.Sheng Shi He(2014)59(both to LMY)
文摘Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of nerve regeneration and repair. Previous studies have shown that human amniotic membrane can promote the healing of a variety of tissues. In this study, the right common peroneal nerve underwent a 5-mm transection in rats. Epineural nerve repair was performed using 10/0 non-absorbable surgical suture. The repair site was wrapped with a two-layer amniotic membrane with α-cyanoacrylate rapid medical adhesive after suture. Hindlimb motor function was assessed using footprint analysis. Conduction velocity of the common peroneal nerve was calculated by neural electrical stimulation. The retrograde axoplasmic transport of the common peroneal nerve was observed using fast blue BB salt retrograde fluorescent staining. Hematoxylin- eosin staining was used to detect the pathological changes of the common peroneal nerve sputum. The mRNA expression of axon regeneration-related neurotrophic factors and inhibitors was measured using real-time polymerase chain reaction. The results showed that the amniotic membrane significantly improved the function of the injured nerve;the toe spread function rapidly recovered, the nerve conduction velocity was restored, and the number of fast blue BB salt particles were increased in the spinal cord. The amniotic membrane also increased the recovery rate of the tibialis anterior muscle and improved the tissue structure of the muscle. Meanwhile, mRNA expression of nerve growth factor, growth associated protein-43, collapsin response mediator protein-2, and brain-derived neurotrophic factor recovered to near-normal levels, while Lingo-1 mRNA expression decreased significantly in spinal cord tissues. mRNA expression of glial-derived neurotrophic factor did not change significantly. Changes in mRNA levels were more significant in amniotic-membrane-wrapping-treated rats compared with model and nerve sutured rats. These results demonstrate that fresh amniotic membrane wrapping can promote the functional recovery of sutured common peroneal nerve via regulation of expression levels of neurotrophic factors and inhibitors associated with axonal regeneration. The study was approved by the Committee on Animal Research and Ethics at the Affiliate Hospital of Zunyi Medical University, China (approval No. 112) on December 1, 2017.
基金funded by the National Natural Science Foundation of China,No.81572146(to HDL)the Program of Outstanding Medical Talent of Shanghai Municipal Health Bureau,China,No.2017BR034(to HDL)+1 种基金the Shuguang Program of Shanghai Education Development FoundationShanghai Municipal Education Commission,China,No.15SG34(to HDL)
文摘Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this is caused by differential expression of genes and proteins during Wallerian degeneration remains unclear. The right tibial nerve and the common peroneal nerve of the same rat were exposed and completely cut through and then sutured in the same horizontal plane. On days 1, 7, 14, and 21 after surgery, 1–2 cm of nerve tissue distal to the suture site was dissected out from the tibial and common peroneal nerves. The differences in gene and protein expression during Wallerian degeneration of the injured nerves were then studied by RNA sequencing and proteomic techniques. In the tibial and common peroneal nerves, there were 1718, 1374, 1187, and 2195 differentially expressed genes, and 477, 447, 619, and 495 differentially expressed proteins on days 1, 7, 14, and 21 after surgery, respectively. Forty-seven pathways were activated during Wallerian degeneration. Three genes showing significant differential expression by RNA sequencing (Hoxd4, Lpcat4 and Tbx1) were assayed by real-time quantitative polymerase chain reaction. RNA sequencing and real-time quantitative polymerase chain reaction results were consistent. Our findings showed that expression of genes and proteins in injured tibial and the common peroneal nerves were significantly different during Wallerian degeneration at different time points. This suggests that the biological processes during Wallerian degeneration are different in different peripheral nerves after injury. The procedure was approved by the Animal Experimental Ethics Committee of the Second Military Medical University, China (approval No. CZ20160218) on February 18, 2016.
文摘BACKGROUND: Many diseases of the common peroneal nerve are a result of sciatic nerve injury. The present study addresses whether anatomical positioning of the sciatic nerve is responsible for these injuries. OBJECTIVE: To analyze anatomical causes of sciatic nerve and common peroneal nerve injury by studying the relationship between the sciatic nerve and piriformis. DESIGN, TIME AND SETTING: Observe and measure repeatedly. The experiment was conducted in the Department of Anatomy, Tianjin Medical College between January and June 2005. MATERIALS: Fifty-two adult cadavers 33 males and 19 females, with a total of 104 hemispheres, and fixed with formaldehyde, were provided by Tianjin Medical College and Tianjin Medical University. METHODS: A posterior cut was made from the lumbosacral region to the upper leg, fully exposing the piriformis and path of the sciatic nerve. MAIN OUTCOME MEASURES: (1) Anatomical characteristics of the tibial nerve and common peroneal nerve. (2) According to different areas where the sciatic nerve crosses the piriformis, the study was divided into two types-normal and abnormal. Normal is considered to be when the sciatic nerve passes through the infrapiriform foramen. Remaining pathways are considered to be abnormal. (3) Observe the relationship between the suprapiriform foramen, infrapiriform foramen, as well as the superior and inferior space of piriformis. RESULTS: (1) The nerve tract inside the common peroneal nerve is smaller and thinner, with less connective tissue than the tibial nerve. When pathological changes or variations of the piriformis, or over-abduction of the hip joint, occur, injury to the common peroneal nerve often arises due to blockage and compression. (2) A total of 76 hemispheres (73.08%) were normal, 28 were abnormal (26.92%). The piriformis can be injured, and the sciatic nerve can become compressed, when the hip joint undergoes intorsion, extorsion, or abduction. (3) The structures between the infrapiriform and suprapiriform foramen are where "the first threshold" sciatic nerve projects. The structures between the infrapiriform and suprapiriform gap were "the second threshold". This became the concept of "double threshold". The reduced area caused by pathological changes of "double threshold" may block and compress the sciatic nerve. Because the common peroneal nerve lies on the anterolateral side of the sciatic nerve, injury to the common peroneal nerve is more serious. CONCLUSION: Anatomical characteristics of the common peroneal nerve, as well as variation of the sciatic nerve, piriformis, and the reduced "double threshold", are the main causes of sciatic nerve injury, and are especially common in peroneal nerve injury.
文摘<span style="font-family:Verdana;">A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than</span><span style="font-family:""> </span><span style="font-family:Verdana;">5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">of this cohort demon</span><span style="font-family:Verdana;">strated a Positive Phoenix Sign (an increase in dorsiflexion strength of the</span><span style="font-family:Verdana;"> Extensor Hallucis Longus muscle (EHL)). One patient had no response to the </span><span style="font-family:Verdana;">peripheral nerve block. Of the 25 patients who demonstrated a positive</span><span style="font-family:Verdana;"> “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decom</span><span style="font-family:Verdana;">pression surgery of the CFN. The one patient in this cohort who did not</span><span style="font-family:Verdana;"> dem</span><span style="font-family:Verdana;">onstrate any improvement in dorsiflexion of the EHL after the nerve block</span><span style="font-family:Verdana;"> did not have any improvement after surgery.
文摘Cutaneous nerve injury is the most common complication following foot and ankle surgery. However, clinical studies including long-term follow-up data after cutaneous nerve injury of the foot and ankle are lacking. In the current retrospective study, we analyzed the clinical data of 279 patients who underwent foot and ankle surgery. Subjects who suffered from apparent paresthesia in the cutaneous sensory nerve area after surgery were included in the study. Patients received oral vitamin B12 and methylcobalamin. We examined final follow-up data of 17 patients, including seven with sural nerve injury, five with superficial peroneal nerve injury, and five with plantar medial cutaneous nerve injury. We assessed nerve sensory function using the Medical Research Council Scale. Follow-up immediately, at 6 weeks, 3, 6 and 9 months, and 1 year after surgery demonstrated that sensory function was gradually restored in most patients within 6 months. However, recovery was slow at 9 months. There was no significant difference in sensory function between 9 months and 1 year after surgery. Painful neuromas occurred in four patients at 9 months to 1 year. The results demonstrated that the recovery of sensory function in patients with various cutaneous nerve injuries after foot and ankle surgery required at least 6 months.
基金supported by the National Basic Research Program of China(973 Program),No.2014CB542200a grant from the Ministry of Education Innovation Team,No.IRT1201+2 种基金the National Natural Science Foundation of China,No.31271284,31171150,81171146,30971526,31100860,31040043,31640045,31671246a grant from the Educational Ministry New Century Excellent Talents Support Project in China,No.BMU20110270a grant from the National Key Research and Development Program in China,No.2016YFC1101604
文摘Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of transplanted nerve attains maximum therapeutic effect remains poorly understood. In this study, a rat model of common peroneal nerve defect was established by resecting a 10-mm long right common peroneal nerve. Rats receiving transplantation of the common peroneal nerve in situ were designated as the in situ graft group. Ipsilateral sural nerves(10–30 mm long) were resected to establish the one sural nerve graft group, two sural nerves cable-style nerve graft group and three sural nerves cable-style nerve graft group. Each bundle of the peroneal nerve was 10 mm long. To reduce the barrier effect due to invasion by surrounding tissue and connective-tissue overgrowth between neural stumps, small gap sleeve suture was used in both proximal and distal terminals to allow repair of the injured common peroneal nerve. At three months postoperatively, recovery of nerve function and morphology was observed using osmium tetroxide staining and functional detection. The results showed that the number of regenerated nerve fibers, common peroneal nerve function index, motor nerve conduction velocity, recovery of myodynamia, and wet weight ratios of tibialis anterior muscle were not significantly different among the one sural nerve graft group, two sural nerves cable-style nerve graft group, and three sural nerves cable-style nerve graft group. These data suggest that the repair effect achieved using one sural nerve graft with a lower number of nerve fibers is the same as that achieved using the two sural nerves cable-style nerve graft and three sural nerves cable-style nerve graft. This indicates that according to the ‘multiple amplification' phenomenon, one small nerve graft can provide a good therapeutic effect for a large peripheral nerve defect.
