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《Chinese Journal of Reparative and Reconstructive Surgery》 2006-04
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RECENT PROGRESS IN DIAGNOSIS AND TREATMENT OF THE INJURY TO THE PERIPHERAL NERVE

ZHU Jiakai. Department of Orthopedic and Microsurgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, P.R.China  
Objective To investigate the latest development in diagnosis and treatment of the injury to the peripheral nerve. Methods The literature at home and abroad was reviewed, and the research findings with clinical experience in diagnosis and treatment for the injury to the peripheral nerve were summarized. Results The treatment for the total brachial plexus avulsion injury was successfully performed by the extra-plexus nerve transfer. The avulsion of the brachial plexus could be directly repaired by the healthy C_7 nerve root transfer through the anterior spinal approach. The forearm flexors could be reinforced by the neurovascularized gracilis transplantation. MRI and CTM were the best methods of early diagnosis for the brachial plexus injury. The pure upper or lower root avulsion of the brachial plexus injuries could be repaired by the intra-plexus nerve transfer, which involved a transfer of part of the ulnar nerve in the arm to the motor nerve of the biceps for C_5-C_6 avulsion of the brachial plexus,and a transfer of selective fascicles of the healthy C_7 nerve root or brachial muscle branch to the flexors muscle fascicles of the median nerve or anterior interosseous nerve. The thoracic outlet syndrome always occurred in this position when the neck muscle fatigue occurred in the typists or the game-players after their longstanding looking forwards. The C_5 and C_6 roots were rolled by the tendenofibrotic tissue at the origin of the scalenus. After a procain block, the symptom subsided. Radiation neuropathy was a series of pathological changes caused by overdoses of the radiation therapy. The pathologic findings consisted of a series of vessel damages and final coagulation necrosis, which induced clusters of abnormally-dilated, thin-walled telangiectasias. Radiation neuropathy could be detected by MRI and could be differentiated from tumor. Once the diagnosis was established, the therapy should be begun early, including the systemic use of steroids, anticoagulation, and hyperbaric oxygen. Conclusion Great progress has been made in diagnosis and treatment of the injury to the peripheral nerve, but a further study should be performed to promote regeneration of the nerves and reconstruction of the related functions.
【CateGory Index】: R651.3
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