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Rui J.,Mayo Medical School | Rui J.,Fudan University | Runge M.B.,Mayo Medical School | Spinner R.J.,Mayo Medical School | And 4 more authors.
Annals of Plastic Surgery | Year: 2014

Background: Video-assisted gait kinetics analysis has been a sensitive method to assess rat sciatic nerve function after injury and repair. However, in conduit repair of sciatic nerve defects, previously reported kinematic measurements failed to be a sensitive indicator because of the inferior recovery and inevitable joint contracture.Objective: This study aimed to explore the role of physiotherapy in mitigating joint contracture and to seek motion analysis indices that can sensitively ref lect motor function.Methods: Data were collected from 26 rats that underwent sciatic nerve transection and conduit repair. Regular postoperative physiotherapy was applied. Parameters regarding step length, phase duration, and ankle angle were acquired and analyzed from video recording of gait kinetics preoperatively and at regular postoperative intervals.Results: Stride length ratio (step length of uninjured foot/step length of injured foot), percent swing of the normal paw (percentage of the total stride duration when the uninjured paw is in the air), propulsion angle (toe-off angle subtracted by midstance angle), and clearance angle (ankle angle change from toe off to midswing) decreased postoperatively comparing with baseline values. The gradual recovery of these measurements had a strong correlation with the postYnerve repair time course.Conclusions: Ankle joint contracture persisted despite rigorous physiotherapy. Parameters acquired from a 2-dimensional motion analysis system, that is, stride length ratio, percent swing of the normal paw, propulsion angle, and clearance angle, could sensitively ref lect nerve function impairment and recovery in the rat sciatic nerve conduit repair model despite the existence of joint contractures. Copyright © 2014 Lippincott Williams & Wilkins.

Chu B.,Fudan University | Wang H.,Mayo Medical School | Wang H.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Chen L.,Fudan University | And 2 more authors.
Annals of Plastic Surgery | Year: 2016

The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83 of shoulder abduction and 54.00 of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV.

Zhang C.-G.,Fudan University | Zhang C.-G.,Key Laboratory of Hand Reconstruction | Zhang C.-G.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Gu Y.-D.,Fudan University | And 2 more authors.
Journal of Brachial Plexus and Peripheral Nerve Injury | Year: 2011

Contralateral C7 nerve transfer has been used in treating brachial plexus avulsion injury since 1986. During the past two and half decades, much has been achieved, yet more needs to be explored. In this review article, the indications, technical details, outcome and pitfalls of this technique are summarized. © 2011 Zhang and Gu; licensee BioMed Central Ltd.

Liu Y.,Fudan University | Liu Y.,Key Laboratory of Hand Reconstruction | Liu Y.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Lao J.,Fudan University | And 5 more authors.
Injury | Year: 2013

Background: The treatment of global brachial plexus avulsion is a demanding field of hand and upper extremity surgery. The recent development of functional and quality-of-life (QOL) assessment tools has improved quantifying these functional outcomes after surgery. Objective: We sought to combine Medical Research Council (MRC) grading with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaires and Numerical Rating Scale (NRS) for pain to evaluate the functional outcome of patients who suffered complete brachial plexus avulsion before and after nerve transfers. Methods: The author carried out a retrospective review of 37 patients with global avulsion of the brachial plexus between 2000 and 2007. All of them underwent nerve transfers in Hua Shan Hospital in Shanghai. They were followed up for over 3 years for physical examination and responding to the questionnaires of DASH, NRS, as well as the satisfaction with the surgery. Results: The mean time to surgery was less than 6 months and the mean follow-up period was 4.59 years (range: 3-9 years). The effective motor recovery rate was 54%, 86%, 46% and 43%, respectively, in supraspinatus, biceps, triceps and finger flexor. Patients who underwent nerve transfers scored consistently better on the DASH score and NRS score than those before surgery. There was also a significant correlation between the change in NRS scores and patient satisfaction. Conclusion: This study validated the effect of nerve transfers for global brachial plexus avulsions from objective MRC grading combining with patients' self-assessments. Neurolysis after neurotisations correlated positively with functional outcomes. © 2012 Elsevier Ltd.

Wu J.-X.,Fudan University | Wu J.-X.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | Chen L.,Fudan University | Chen L.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery | And 3 more authors.
Journal of Muscle Research and Cell Motility | Year: 2013

There are no biological marks to indicate if denervated muscle atrophy after nerve injury is irreversible. Clinically in obstetric brachial plexus palsy (OBPP), atrophy of denervated intrinsic musculature of the hand is much faster to irreversible than that of denervated muscles of the arm. 64 pup rats whose C5C6 had been divided and C7C8T1 avulsed, were divided equally into the reconstruction and control groups. The former had subgroups R1, R5, R10, R15 where the ulnar and musculocutaneous nerves were reconstructed one, five, ten and 15 weeks respectively after injury and efficacy was evaluated 12 weeks later. The latter had C1, C5, C10, C15 subgroups where denervated muscles of the two nerves were assessed one, five, ten and 15 weeks after injury. Results of average cross-sectional area of the muscle fiber for intrinsic musculature of the forepaw showed that the R5, R10, R15 subgroups were not statistically superior to the C5, C10, C15 ones, respectively, though R1 was; those for biceps indicated, however, that the R1, R5, R10 subgroups were better than the C1, C5, C10 ones, respectively, though R15 was not. In the reconstruction subgroups regenerative nerve fibers in each nerve were no less than 53 percent of those on the control side, while number of motor end plates was statistically less in subgroups with irreversible muscle atrophy. We conclude that rat model of OBPP is suitable for simulating clinical appearance of atrophy of denervated intrinsic musculature of the hand being faster than that of denervated muscles of the arm. © 2012 Springer Science+Business Media Dordrecht.

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