Jiuzhou Lu

Contralateral C7 transfer via the prespinal and retropharyngeal route to repair brachial plexus root avulsion: a preliminary report.

OBJECTIVEWe sought to investigate a shorter and safer route for contralateral C7 transfer. METHODSEight male patients were treated from December 2005 to November 2006. Their ages ranged from 22 to 43 years (average, 30 yr). Five patients had total brachial plexus avulsion. The operative delay was from 2 to 6 months (mean, 4 mo). The bilateral scalenus anterior muscles were transected before a prespinal and retropharyngeal tunnel was made. The contralateral C7 nerve root was used to repair the upper trunk or the infraclavicular lateral cord and posterior cord of the injured side via this route, with the use of direct neurorrhaphy or nerve grafting. RESULTSThe length of the harvested contralateral C7 nerve root was 4.67 ± 0.52 cm in the first five patients. The nerve graft was 6.25 ± 0.35 cm long for repairing supraclavicular brachial plexus and 8.56 ± 0.45 cm long for repairing infraclavicular brachial plexus. The length of the harvested contralateral C7 nerve root averaged 6.85 cm in the last three patients, two of whom had direct neurorrhaphy to the C5 and six residual nerve roots; in the other patient, a nerve graft 3 cm in length was used. Transient contralateral sensory symptoms were reported in most patients. In all cases, shoulder abduction and elbow flexion recovered by 12 months postoperatively. CONCLUSIONTransection of the bilateral scalenus muscles can reduce the length of the nerve graft and allow the C7 nerve to be transferred more smoothly and safely through the prespinal and retropharyngeal route; this method also favors nerve regeneration and functional recovery.

Hand prehension recovery after brachial plexus avulsion injury by performing a full-length phrenic nerve transfer via endoscopic thoracic surgery

OBJECT The functional recovery of hand prehension after complete brachial plexus avulsion injury (BPAI) remains an unsolved problem. The authors conducted a prospective study to elucidate a new method of resolving this injury. METHODS Three patients with BPAI underwent a new procedure during which the full-length phrenic nerve was transferred to the medial root of the median nerve via endoscopic thoracic surgery support. All 3 patients were followed up for a postoperative period of > 3 years. RESULTS The power of the palmaris longus, flexor pollicis longus, and the flexor digitorum muscles of all 4 fingers reached Grade 3-4/5, and no symptoms of respiratory insufficiency occurred. CONCLUSIONS Neurotization of the phrenic nerve to the medial root of the median nerve via endoscopic thoracic surgery is a feasible means of early hand prehension recovery after complete BPAI.

Combined nerve transfers for repair of the upper brachial plexus injuries through a posterior approach

The upper brachial plexus injury leads to paralysis of muscles innervated by C5 and C6 nerve roots. In this report, we present our experience on the use of the combined nerve transfers for reconstruction of the upper brachial plexus injury. Nine male patients with the upper brachial plexus injury were treated with combined nerve transfers. The time interval between injury and surgery ranged from 3 to 11 months (average, 7 months). The combined nerve transfers include fascicles of the ulnar nerve and/or the median nerve transfer to the biceps and/or the brachialis motor branch, and the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) and triceps branches to the axillary nerve through a posterior approach. At an average of 33 months of follow‐up, all patients recovered the full range of the elbow flexion. Six out of nine patients were able to perform the normal range of shoulder abduction with the strength degraded to M3 or M4. These results showed that the technique of the combined nerve transfers, specifically the SAN to the SSN and triceps branches to the axillary nerve through a posterior approach, may be a valuable alternative in the repair of the upper brachial plexus injury. Further evaluations of this technique are necessary.

Full-length ulnar nerve harvest by means of endoscopy for contralateral C7 nerve root transfer in the treatment of brachial plexus injuries.

Background: To avoid long scar formation after contralateral C7 transfer for treatment of brachial plexus avulsion injuries, endoscopy was used for full-length harvest of the ulnar nerve. The surgical procedure and its clinical effect are reported here. Methods: From July to August of 2001, two patients with total root avulsion were recruited. Three 2- to 3-cm-long incisions were made in the mid upper arm, elbow, and wrist, and the full-length ulnar nerve was harvested using the Endoscope Vessel Harvest System endoscope system. The surgical time was recorded, the vascularity of the dissected ulnar nerves was observed, and the recovery of the injured limb after contralateral C7 nerve root transfer was measured. Results: Compared with the traditional technique, there were no significant differences in surgical time, vascularity of the dissected ulnar nerve, or recovery of the injured limb when the full-length ulnar nerve was harvested with endoscopy (as part of the contralateral C7 nerve root transfer operation), but the degree of scarring after surgery was markedly reduced. Conclusions: Although the same level of curative effect was ensured, the new endoscope-aided method for harvesting the full length of the ulnar nerve for contralateral C7 nerve root transfer was not complicated and caused markedly less scarring.

Modification of the pull-in suture technique for mallet finger.

IntroductionMallet finger injuries are common and involve disruption of the terminal extensor mechanism overlying the distal interphalangeal joint. Many operative techniques have been advocated. The pull-in suture technique is a useful surgical procedure for the treatment of mallet finger. Although this procedure allows accurate realignment of the tendon-bone, it has limitations. PurposeTo eliminate these limitations, we present here a modification of the pull-in suture technique. Material and MethodsFrom January 2008 to October 2009, 10 mallet fingers treated using this modification were included in this prospective study. Of the patients, 6 were men and 4 were women. Their ages at surgery ranged from 19 to 41 years, with a mean of 29.7 years. Of these, 1 involved the thumb; 2, the index finger; 2, the middle finger; 3, the ring finger; and 2, the little finger. The length of time from the injury to surgery ranged from 1 to 20 days (mean, 6.3 days). According to Doyle’s classification, there were 1 type II, 4 type III, and 5 type IVb cases. ResultsAt a mean follow-up of 15.4 (range, 13–22) months, all patients were pain free. The average final active range of motion of the distal interphalangeal joint was 60 degrees (range, 50–70 degrees). Using Crawford’s criteria, 2 patients were graded as excellent, 7 as good, and 1 was graded as fair. Neither pin tract infections nor skin compressive ulcers occurred. ConclusionThe modification eliminated or reduced the incidence of complications when compared with the original method. This technique should be considered when treatment of a mallet deformity using the pull-in suture technique is planned.

Downregulation of miR-223 and miR-19a induces differentiation and promotes recruitment of osteoclast cells in giant-cell tumor of the bone via the Runx2/TWIST-RANK/RANKL pathway

Giant-cell tumor (GCT) of the bone is an invasiveness and high recurrent bone tumor that is considered borderline or potentially malignant. To explore the molecular mechanism leading to bone destruction and identify novel targets for treatment, we conducted silencing of miR-223 and miR-19a in stromal giant cells and identified TWIST and Runx2 as their target genes. We investigated the impact of these microRNAs and their target genes on stromal giant cells that promote the differentiation of monocyte/macrophages into osteoclast cells and recruitment to the bone microenvironment, which in turn enhances the bone destruction capacity of GCT. MiR-223 and miR-19a were found to regulate the expression of TWIST and Runx2, influence the RANKL-RANK pathway and the expression of MCP-1, and finally regulate the pathophysiological process of osteolytic bone destruction. Our results indicate that re-expression of miR-223 and miR-19a induces an inhibitory effect on the bone destruction capacity of GCT, suggesting that re-expression of miR-223 and miR-19a can be a novel strategy for the treatment of GCT.

Morphological Detection and Functional Assessment of Regenerated Nerve after Neural Prosthesis with a PGLA Nerve Conduit

This study aimed to observe the morphological characteristics of a PGLA [poly(glycolide-co-L-lactide)] nerve conduit and regenerated nerve bundle in the human body using high-frequency ultrasound and examine functional recovery of the regenerated nerve using functional magnetic resonance imaging (fMRI) after neural prosthesis with a PGLA nerve conduit. Thirty-nine patients underwent high-frequency ultrasound, and one patient with superficial radial nerve injury (27-mm defect) underwent fMRI at one, three, and six postoperative months. The fMRI examination results were compared with sensory detection and high-frequency ultrasound results during the same follow-up window period. The normal and regenerated nerve bundles had similar ultrasonic imaging features. At one postoperative month, fMRI displayed activeness of the normal cortex in the brain region corresponding to the contralateral superficial radial nerve, while no activeness was observed on the ipsilateral side. From three to six postoperative months, fMRI revealed gradually increasing activeness in the brain region corresponding to the ipsilateral superficial radial nerve, but the activation area on the ipsilateral side was smaller than that on the contralateral side. Combining morphological detection of the regenerated nerve using high-frequency ultrasound and functional detection of the regenerated nerve using fMRI may be a valuable method for evaluating repair of peripheral nerve injury.