| Part 1 Experimental study of the different methods of contralateral C7 transfer to low trunk in total root injury of brachial plexusExperiment 1 Comparative study of contralateral C7 transfer to lower trunk viathe prespinal route and contralateral C7 transfer via the route in superficial layer of the cervical muscleObjective:To evaluate the efficiency of the two different transfer methods to repair lower trunk in total root injury of brachial plexus.Methods:Thirty SD rats were divided into 3 groups randomly. A group (contralateral C7 transfer to lower thunk via the prespinal route):We imitated the total root injury of brachial plexus in the rat models, and then we used contralateral C7 to repair the lower trunk of brachial plexus of the injured side directly via the prespinal route. B group (contralateral C7 transfer via the route superficial layer of the cervical muscle): After imitating of the total root injury of brachial plexus, we repaired the lower trunk of brachial plexus of the injured side by contralateral C7 directly transfer via the route route of in superficial layer of cervical muscle. C group (normal controls):we exposed the brachial plexus of rat models without intervention. Grasping test, electrophysiological examination, muscle tension test, neuromorphology, wet muscle weight and muscle fibers sectional area were performed to evaluate the outcome of each group in the 4th,8th,12th week postoperatively.Results:1. Grasping test. Grasping action were observed in the 8th week in both group A and B. In the 8th and 12th week postoperatively, grasping strength recovery of group A was better than that of group B (P<0.05).2. Electrophysiological examination:In the 4th week postoperatively, there were no statistical differences in the latency and amplitude of median nerve and ulnar nerve between group A and B (P>0.05). There were significant statistical differences between group A and B (P<0.05), in the 8th and 12th week postoperatively.3. Muscle tension test:In the 4th week postoperatively, there were no statistical differences in recovery rate of muscle tension between group A and B (P>0.05). In the 8th and 12th week, recovery rate of muscle tension of group A was significant lower than group B (P<0.05).4. Neuromorphology:There were no statistical differences in the number of regenerated nerve fibers, in the 4th week postoperatively. The number of regenerated nerve fibers of group A was significantly (P<0.05) less than group B, in the 8th and 12th week postoperatively.5. Wet muscle weight and muscle fibers sectional area:In the 4th week postoperatively, there were no significant differences in the wet muscle weight and muscle fibers sectional area between group A and B. In the 8th and 12th week postoperatively, there were significant differences in the wet muscle weight and muscle fibers sectional area between group A and group B, respectively.Conclusion:1. The method that contralateral C7 transfer to lower trunk of injured side directly to repair tool root injury of brachial plexus is feasible.2. The outcome of contralateral C7 transfer via the route in superficial layer of the cervical muscle is better than contralateral C7 transfer to lower trunk via the prespinal route.Experiment 2 Comparative study of contralateral C7 transfer to lower trunk via the prespinal route and contralateral C7 transfer to lower trunk by free nerve graftingObjective:To evaluate the efficiency of contralateral C7 transfer to lower trunk via the prespinal route and contralateral C7 transfer by free nerve grafting to repair lower trunk in total root injury of brachial plexus.Methods:Thirty SD rats were divided into 3 groups randomly. A group (contralateral C7 transfer to lower thunk by free nerve grafting):After imitating of the total root injury of brachial plexus, we repaired the lower trunk of brachial plexus of the injured side by contralateral C7 directly transfer by free sural nerve grafting. B group (contralateral C7 transfer to lower thunk via the prespinal route):We imitated the total root injury of brachial plexus in the rat models, and then we used contralateral C7 to repair the lower trunk of brachial plexus of the injured side directly via the prespinal route.C group (normal controls):we exposed the brachial plexus of rat models without intervention. In the 4th,8th,12th week postoperatively, grasping test, electrophysiological examination, muscle tension test, neuromorphology, wet muscle weight and muscle fibers sectional area were performed to evaluate the outcome of each group.Results:1. Grasping test. Grasping action were observed in the 8th week in both group A and B. In the 8th and 12th week postoperatively, grasping strength recovery of group A was worse than group B (P<0.05).2. Electrophysiological examination:In the 4th week postoperatively, there were no statistical differences in the latency and amplitude of median nerve and ulnar nerve between group A and B (P>0.05). There were significant statistical differences between group A and B (P<0.05), in the 8th and 12th week postoperatively.3. Muscle tension test:In the 4th week postoperatively, there were no statistical differences in recovery rate of muscle tension between group A and B (P>0.05). In the 8th and 12th week, recovery rate of muscle tension of group A was significant lower than group B (P<0.05).4. Neuromorphology:The number of regenerated nerve fibers of group A was significantly less than group B (P<0.05), in each period postoperatively.5. Wet muscle weight and muscle fibers sectional area:In each period postoperatively, the wet muscle weight and muscle fibers sectional area of group A were significant lower than group B.Conclusion:1. The method that contralateral C7 transfer to lower trunk by free nerve grafting is feasible and effective.2. The outcome of contralateral C7 transfer to lower trunk by free nerve grafting is worse than contralateral C7 transfer via the prespinal route. Part 2 Experimental study To Compare contralateral C7 transfer to lower trunk via the prespinal route and traditional contralateral C7 transferObjective:To evaluate the efficiency of contralateral C7 transfer to lower trunk via the prespinal route and traditional contralateral C7 transfer in total root injury of brachial plexus.Methods:30 SD rats were divided into 3 groups randomly. A group (traditional contralateral C7 transfer):After imitating of the total root injury of brachial plexus, we repaired the lower trunk of brachial plexus of the injured side by two-staged procedures of the contralateral C7 transfer. B group (contralateral C7 transfer to lower trunk via the prespinal route):We imitated the total root injury of brachial plexus in the rat models, and then we used contralateral C7 to repair the lower trunk of brachial plexus of the injured side directly via the prespinal route.C group (normal controls): we exposed the brachial plexus of rat models without intervention. In the 4th,8th,12th week postoperatively, grasping test, electrophysiological examination, muscle tension test, neuromorphology, wet muscle weight and muscle fibers sectional area were performed to evaluate the outcome of each group.Results:1. Grasping test. Grasping action were observed in the 8th week in both group A and B. In the 8th and 12th week postoperatively, there were no statistical differences in grasping strength recovery between group A and group B (P>0.05).2. Electrophysiological examination:There were no statistical differences in the latency and amplitude of median nerve between group A and B (P>0.05), in the 4th,8th and 12th week postoperatively.3. Muscle tension test:In the 4th week postoperatively, there were no statistical differences in recovery rate of muscle tension between group A and B (P>0.05). In the 8th and 12th week, there were statistical differences in recovery rate of muscle tension between group A and group B (P<0.05).4. Neuromorphology:In each period postoperatively. there were no statistical differences in the number of regenerated nerve fibers of median nerve between group A and group B (P>0.05).5. Wet muscle weight and muscle fibers sectional area:In each period postoperatively, there were statistical differences in wet muscle weight between group A and group B (P<0.05) and no statistical differences in muscle fibers sectional area between the two groups (P>0.05).Conclusion:1. The functional restoration outcome of flexor digitorum superficialis is similar in contralateral C7 transfer to lower trunk via the prespinal route and traditional contralateral C7 transfer.Part 3 Experimental study To Compare intercostal nerves transfer to lower trunk and traditional contralateral C7 transfer in tool root injury of brachial plesusObjective:To evaluate the efficiency of intercostal nerves transfer to lower trunk in total root injury of brachial plexus, by comparing the efficiency of intercostal nerves transfer to lower trunk and traditional contralateral C7 transfer.Methods:30 SD rats were divided into 3 groups randomly. A group (traditional contralateral C7 transfer):After imitating of the total root injury of brachial plexus, we repaired the lower trunk of brachial plexus of the injured side by two-staged procedures of the contralateral C7 transfer. B group (intercostal nerves transfer to lower thunk):We imitated the total root injury of brachial plexus in the rat models, and then we used 3rd～6th intercostal nerves transfer to repair the lower trunk of brachial plexus of the injured side directly via the prespinal route.C group (normal controls):we exposed the brachial plexus of rat models without intervention. In the 4th,8th,12th week postoperatively, grasping test, electrophysiological examination, muscle tension test, neuromorphology, wet muscle weight and muscle fibers sectional area were performed to evaluate the outcome of each group.Results:1. Grasping test. Grasping action was observed in the 8th week in group A. whereas in the 12th week in group B. In the 12th week postoperatively, there were significant statistical differences in grasping strength recovery between group A and group B (P<0.05).2. Electrophysiological examination:In the 4th week postoperatively, CMAP was not detected in group B. In the 8th and 12th week, there were significant statistical differences in the latency and amplitude of median nerve between group A and B (P<0.05).3. Muscle tension test:In the 4th week postoperatively, there was no obviously recovery of muscle tension in group B. In the 8th and 12th week, the recovery rate of muscle tension in group B were significantly lower than group A (P<0.05).4. Neuromorphology:In each period postoperatively, the number of regenerated nerve fibers of median nerve in group B were significantly lower than group A (P<0.05).5. Wet muscle weight and muscle fibers sectional area:In each period postoperatively, there were significant differences in wet muscle weight and muscle fibers sectional area between group A and group B (P<0.05).Conclusion:1. The method that interecostal nerves transfer to lower trunk directly was effective for treatment of tool root injury of brachial plexus, but the outcome was worse than traditional contralateral C7 transfer. |
