Objective To review researches of treatment of peripheral nerve injury with neuromuscular electrical stimulation (NMES) regarding mechanism, parameters, and cl inical appl ication at home and abroad. Methods The latest original l iterature concerning treatment of peri pheral nerve injury with NMES was extensively reviewed. Results NMES should be used under individual parameters and proper mode of stimulation at early stage of injury. It could promote nerve regeneration and prevent muscle atrophy. Conclusion NMES plays an important role in cl inical appl ication of treating peripheral nerve injury, and implantable stimulation will be the future.
Objective To observe the revascularization process of chemically extracted acellular allogeneous nerve graft in repairing rat sciatic nerve defect. Methods Eighty adult male SD rats were selected. The sciatic nerve trunks from ischial tuberosity to the ramus of tibiofibular nerve of 16 SD rats were obtained and were prepared into acellular nerve stents by chemical reagent. Sixty-four SD rats were used to prepare the models of sciatic nerve defect (1.0 cm) and thereafter were randomized into two groups (n=32): experimental group in which acellular allogeneous nerve grafts were adopted and control group in which orthotopic transplantation of autologous nerve grafts were adopted. Postoperatively, the general conditions of all rats were observed, and the gross and ALP staining observation were conducted at 5, 7, 10, 14, 21, 28 days and 2, 3 months, respectively. Results All the incisions were healed by first intention. Trail ing status and toe’s dysfunction in extension happened to the right hindl imb of rats in two groups and were improved 6 weeks after operation. General observation showed that the grafts of two groups connected well to the nerves, with appearances similar to that of normal nerve. ALP staining demonstrated that the experimental group had no ingrowth of microvessel but the control group had ingrowth of microvessel 5 days after operation; the experimental group had ingrowth of microvessel but both groups had no microvessel 7 days after operation; few longitudinal microvessel throughout the grafts were observed in both groups 10, 14 and 21 days after operation; no obvious difference in capillary network of grafts was observed between two groups 28 days after operation; and the microvascular architecture of grafts in both groups were similar to that of normal nerve 2 and 3 months after operation. Conclusion When the chemically extracted allogeneous nerve graft is adopted to repair the peripheral nerve defect, new blood microvessels can grow into grafts timely and effectively.
ObjectiveTo investigate the effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults.MethodsThe clinical data of 62 cases of unstable distal radius fractures between January 2017 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative exposure, the patients were divided into the observe group (28 cases with the pronator quadratus muscle sparing surgery) and the control group (32 cases with cutting the pronator quadratus muscle in operation and repairing it after volar plate fixation). There was no significant difference in general data such as gender, age, handedness, cause of injury, fracture classification, time from injury to operation, visual analogue scale (VAS) score, and range of motion (ROM) of wrist (flexion, extension, pronation, and supination) before operation between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, and postoperative complications were recorded and compared between the two groups. VAS score and ROM of wrist of two groups before operation and at 3 days and 3 months after operation were calculated and compared. The wrist function was evaluated according to the Krimmer evaluation criteria at 6 months after operation.ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). The postoperative hospital stay and fracture healing time of the observe group were significantly shorter than those of the control group (P<0.05). Patients in both groups were followed up 6-30 months, with an average of 13 months. The VAS score and ROM of wrist of the observe group at 3 days after operation were superior to the control group (P<0.05), but there was no significant difference between the two groups at 3 months after operation (P>0.05). At 6 months after operation, according to Krimmer evaluation criteria, the wrist function of the observe group was excellent in 21 cases and good in 7 cases, with an excellent and good rate of 100%; and the wrist function of the control group was excellent in 22 cases, good in 11 cases, and fair in 1 case, with an excellent and good rate of 97.1%. There was no significant difference in wrist function between the two groups (χ2=1.344, P=0.511). One case of poor incision healing occurred in the observe group, and 7 cases of poor incision healing and 5 cases of tendon pain occurred in the control group after operation. The incidence of postoperative complications was less in the observe group (3.6%) than in the control group (35.3%) (χ2=9.325, P=0.002).ConclusionIt is feasible of the pronator quadratus muscle sparing in the volar plate fixation for unstable distal radius fracture in adults. It is beneficial to recover wrist function early after operation, reduce postoperative complications, shorten the length of hospitalization, protect the soft tissue of fracture site, and promote fracture healing.
Objective To investigate the effectiveness of free vascularized fibula grafting with unilateral fibula as donor in treatment of bilateral avascular necrosis of femoral head (ANFH). Methods Between June 2007 and January 2008, 14 patients with bilateral ANFH were treated with free vascularized fibula grafting with unilateral fibula as donor. There were 12males and 2 females with an average age of 36.6 years (range, 17-57 years). The necrosis was caused by use of steroids in 3 cases, consumption of alcohol in 4 cases, and idiopathic condition in 7 cases. According to Steinberg system, 16 hips were classified as stage II, 10 hips as stage III, and 2 hips as stage IV. The preoperative Harris hip scores were 77.50 ± 4.19, 69.70 ± 2.76, 59.50 ± 0.50 in patients at stages II, III, and IV, respectively. The duration of operation and the bleeding volume were recorded. The X-ray examination, the Harris hip score, and the compl ications were used to evaluate the effectiveness. Results The duration of the fibula osteotomy was 10-32 minutes (mean, 20 minutes). The duration of the total operation was 100-240 minutes (mean, 140 minutes). The bleeding volume was 200-500 mL (mean, 280 mL). All patients achieved heal ing of incision by first intention. The patients were followed up 12-40 months (mean, 24 months). One case had numbness and hyperthesia of the anterolateral thigh; 1 case had abnormal sensation of the dorsal foot; 1 case had discomfort of the ankle; and they restored to normal at 1 year after operation. According to X-ray films 1 year after operation, the improvement was achieved in 23 hi ps (82.1%) and no deterioration in 5 hips (17.9%). At 1 year after operation, the Harris hip scores were 93.90 ± 4.84, 88.50 ± 8.13, and 78.00 ± 0.00 inpatients at stages II, III, and IV, respectively, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion Unilateral free vascularized fibula grafting has lots of virtues, such as short surgical time, less bleeding volume, l ittle injury, and good results of function recovery. It could be an effective and safe method in treating bilateral ANFH.
Objective To summarize recent progress of microwave ablation combined with endoscopic technique for liver cancer. Method The literatures relevant to treatment of microwave ablation combined with endoscopic technique for liver cancer in recent years were identified by searching PubMed and CNKI, then summarized and reviewed. Results The treatment of endoscopic microwave ablation or it combined with hepatectomy, interventional embolization, neoadjuvant chemotherapy, and two-step hepatectomy could expand the treatment indications for liver cancer, increase the cure rate, and reduce the intraoperative bleeding, postoperative complications and recurrence. Conclusions Microwave ablation combined with endoscopic technique has less invasion and fast recovery for patient with liver cancer. Multi-disciplinary team collaboration and rational use of varied therapeutic methods in treatment of liver cancer could help to improve treatment effect and prolong survival time of patient.
Objective To explore and solve the key technologies of the three dimensional (3D) visual ization reconstruction of functional fascicular groups inside long segmented peri pheral nerve. Methods A 20 cm ulnar nerve from upper arm of fresh adult dead body was embedded by OCT with four pieces of woman’s hair which was used as locating material, then the samples were serially horizontally sl iced into 400 sl ices with 15 μm thickness and 0.5 mm interval. All sl iceswere stained with acetylcholinesterase (AchE) histochemical staining. After that, the 2D panorama images of the same sl ice were obtained with Olympus stereomicroscope and MSHOT MD90 micro figure image device before and after AchE staining. Using the layer processing technique of Photoshop image processing software, the recomposition images including complete 4 location pots were obtained, based on which the algorithm of optimized least square support vector machine (Optimized LS-SVM) and space transformation method was used to fulfill automatic registration. Finally, with artificial assistant outline obtaining, the 3D visual ization reconstruction model of functional fascicular groups of 20 cm ulnar nerve was made using Amira 4.1, and the effects of reverse reduction and the suitabil ity of 3D reconstruction software were evaluated. Results The two-time imaging technique based on the layer process of Photoshop image processing software had the advantages: the image outline had high goodness of fit; the locating pots of merging image was accurate; and the whole procedure was simple and fast. The algorithm of Optimized LS-SVM had high degree of accuracy, and the error rate was only 8.250%. The 3D reconstruction could display the changes of the chiastopic fusion of different nerve functional fascicular groups directly. It could extract alone, merge and combine arbitrarily, and revolve at any angles. Furthermore, the reverse reduction on arbitrarily level dissection of the 3D model was very accurately. Conclusion Based on the two-time imaging technique and computer image layer processing technology, the compute algorithm of auto-registration can be developed and appl ied to 3D visual ization reconstruction of long segmented peripheral nerve. The technological processes is fast, and the reconstruction effect is good.
Objective To investigate the feasibil ity of building the 3D reconstruction of short segment common peroneal nerve functional fascicles based on serial histological sections and computer technology. Methods Five cm of the common peroneal nerve in the popl iteal fossa, donated by an adult, was made into the serial transverse freezing sections(n=200) at an interval of 0.25 mm and 10 μm in thickness per section. Acetylchol inesterase staining was adopted and the nerve fascicles were observed by microscope. 2D panorama images were acquired by high-resolution digital camera under microscope (× 100) and mosaic software. Different functional fascicles were distinguished and marked on each section. The topographic database was matched by image processing software. The 3D microstructure of the fascicular groups of 5 cm common peroneal nerve was reconstructed using Amira 3.1 3D reconstruction software. Results Based on microanatomy and the results of acetylchol inesterase staining, this segmented common peroneal nerve functional fascicles was divided into sensory tract, motor tract, mixed tract and motor-predominating mixed tract. The cross merging was not evident in the nerve fascicles between deep peroneal nerve and superficial peroneal nerve, but existed within the functional fascicles of the deep peroneal nerve and the superficial peroneal nerve. The results of 3D reconstruction reflected the 3D structure of peripheral nerve and its interior functional fascicles factually, which displayed solely or in combination at arbitrary angles. Conclusion Based on serial histological sections and computer technology, the 3D microstructure of short-segment peripheral nerve functional fascicles can be reconstructed satisfactorily, indicating the feasibil ity of building 3D reconstruction of long-segmental peripheral nerve functional fascicles.
Objective To evaluate the value of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury. Methods From November 2006 to February 2008, 10 patients with obstetrical brachial plexus palsy were treated, 8 males and 2 females, aged from 2 months to 3 years (11.4 months on average). There were 7 cases of left side and 3 of right side.According to Tassin classification, 2 cases were type II, 6 type III and 2 type IV. All patients were performed MRI examinations before the operation, whose results were compared with those of exploration during the operation. Results MRI examinations showed 1 patient was normal and 9 patients had post-traumatic spinalmeningolcele. The 6 patients had displacement of spinal cord (4 towards the healthy side and 2 towards the sick side), 6 had deformity of spinal cord, and 2 had avulsed nerve root thickening. MRI detected 19 nerve roots were positive, 16 were true positive and 3 false positive in surgical exploration. MRI detected 6 nerve roots were negative, 4 were true negative and 2 false negative in surgical exploration. The sensitivity, specificity and accuracy of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury were 84.2%, 80.0% and 83.3%, respectively. There were significant differences in the results by preoperative MRI examinations and by exploration during the operation (P lt; 0.05). Conclusion MRI can show pre-gangl ionic injury of brachial plexus of the patients with obstetrical brachial plexus palsy and can supply references for early diagnosis and operation time. MRI can be routinely conducted as a preoperative examination.
Objective To investigate the feasibility of establishing the visualization models of intraneural microvessels of sciatic nerves in Sprague Dawley (SD) rats by systemic infusion of Evan’s blue (EB) or lead oxide and to compare the advantages and disadvantages. Methods Fifteen healthy adult SD rats of either gender, weighing 200-250 g, were randomly divided into traditional group (group A, n=5), fluorescence group (group B, n=5), and radiography group (group C, n=5). Ink, EB, and lead oxide, all mixed with gelatin solution, were injected in groups A, B, and C, respectively. After 2 hours of cryopreservation under 4°C, all sciatic nerves were harvested and observed through stereomicroscope to make sure the filling condition. The two-dimentional (2D) images were then collected via reflexion fluorescent microscope in group B and via micro-CT scan in group C. All images were imported into computer to establish three-dimentional (3D) reconstruction models by Mimics 15.0. Results All groups could show the outline of intraneural microvessels of sciatic nerves under stereomicroscope. Diameters of them were measured under fluorescent microscope, ranging from 10 µm to 30 µm. Both groups B and C could establish 3D reconstruction models from 2D images. These models could clearly reproduce the structure of microvessels. Conclusion Both EB and lead oxide can be used to establish 3D reconstruction models to observe structure of the intraneural vessels. However, EB has some disadvantages, such as predisposition to infiltration, grainy 2D images and time-consuming procedure; it is not suitable for researches of large specimen. Though 2D pictures from lead oxide have lower resolution than EB, it is easier to be manipulated and appropriate for experiments of large specimen.
【Abstract】 Objective To observe the distribution feature of nerve bundles in C7 nerve anterior and posterior division end. Methods The brachial plexus specimen was harvested from 1 fresh adult cadaver. After C7 nerve was confirmed, the distal end of anterior and posterior division was dissected and embedded by OCT. Then the samples were serially horizontally sliced with each 10 μm deep. After acetylcholinesterase (AChE) histochemical staining, the stain characteristics of different nerve fiber bundles were observed and amount of the nerve fiber bundles were counted under optic-microscope. At last, the imaging which were collected were three-dimensional (3-D) reconstructed by using Amira 4.1 software. Results There was no obvious difference in the stain between the anterior and posterior divisions. The running of the nerve fiber bundles were dispersive from proximal end of nerve to distal end of nerve. Nerve fiber bundles of anterior division were mainly sensor nerve fiber bundles, which located in medial side. Nerve fiber bundles of posterior division were mainly moter nerve fiber bundles, having no regularity in the distribution of nerve fiber bundles. The total number of nerve fiber bundles in distal end of anterior division was 7.85 ± 1.04, the number of motor nerve fiber bundles was 2.85 ± 0.36, and the number of sensor nerve fiber bundles was 5.13 ± 1.01. The total number of nerve fiber bundles in distal end of posterior division was 9.79 ± 1.53, the number of motor nerve fiber bundles was 6.00 ± 0.69, and the number of sensor nerve fiber bundles was 3.78 ± 0.94. There were significant differences in the numbers of motor and sensor nerve fiber bundles between anterior and posterior divisions (P lt; 0.05). The microstructure 3-D model was reconstructed based on serial slice through Amira 4.1. The intercross and recombination process of nerves bundles could be observed obviously. The nerve bundle distribution showed cross and combination. Conclusion Nerve fiber bundles of anterior division are mainly sensor nerve fiber bundles and locate in medial side. Nerve fiber bundles of posterior division are mainly motor nerve fiber bundles, which has no regularity in the distribution of nerve fiber bundles. The 3-D reconstruction can display the internal structure feature of the C7 division end.