Objective To observe effect of phrenic nerve transter to the posterior division ot lower trunk (PDLT) for recovering elbow and finger extension in patients with brachial plexus root avulsion.Methods From June 2005 to December 2008,43 patients with brachial plexus root avulsion were treated with phrenic nerve transfer to PDLT to recover elbow and finger extension.There were 36 males and 7 females,aged from 4 to 44 years (average,23.5±9.9 years).The interval from injury to operation ranged from 1 to 12months (average,3.7±1.9 months).There were 32 cases of total nerve roots avulsion,5 cases of middle and lower trunk avulsion accompanied with upper trunk normal or partial injury,and 6 cases of C6 to T1 nerve root avulsion accompanied with C5 nerve root rupture or partial injury.The normal function of the phrenic nerve in the injured side should be proved preoperatively by radiographic and electromyographic examination.The entire brachial plexus in injured side was exposed through the combined incision.The posterior division of lower trunk was identified and severed as proximal as possible,and the posterior cord and radial nerve were dissociated distally until to the level of midpoint of humerus.Then the branches of the posterior cord except the radial nerve were sectioned.Direct anastomosis of the phrenic nerve and PDLT was performed in 33 patients,and indirect anastomosis through bridge grafting using sural nerve was performed in remaining 10 cases.Results All patients were followed up for 36 to 73 months (average,39.7±7.l months).The percentage of muscle strength ≥grade 3 in elbow,finger and thumb extension was 81.6％,41.9％ and 39.5％,respectively.Conclusion Satisfactory functional recovery of elbow extension had been achieved after the phrenic nerve transfer to the PDLT in patients with brachial nerve root avulsion injury,however,the functional recovery of finger and thumb extension was not as satisfactory as anticipated.

ObjectiveTo observe the functional recovery of shoulder joint and the reduction of posterior dislocated humeral head in children with shoulder joint internal rotation contracture and humeral head posterior dislocation secondary to brachial plexus birth palsy treated by a modified surgical procedure through the anterior combined posterior approach of the shoulder. MethodsNinteen patients,ranging in age from 2.5 to 8.5 years (average 5 years),suffered posterior dislocation of the shoulder joint secondary to internal rotation contracture in brachial plexus birth palsy. The gleno-humeral joint deformity was confirmed by X-ray and CT examination and classified as type Ⅳ in 15 eases and typeⅤin 4 cases according to the modified water's criteria.The surgical procedure was as follows:the contracture soft tissue around the anterior of shoulder joint was released firstly through the anterior approach, and the posterior-inferior capsule of the shoulder was exposed and separated with the pseudoglenoid through the posterior approach,the humeral head was reduced by external rotation the arm,then the posterior-inferior capsule was retighten.A plaster cast was used to fix the shoulder at the neutral position of 0° for 4 weeks. ResultsAfter 12 to 36 months follow up(average of 20 months), the Mallet score of the shoulder was from 11.4 ± 1.7 (range 7-16)preoperative to 15.5 ± 1.8(range 13-19) postoperative,the difference was significantly (P ＜ 0.05).The central relocation of humeral head was achieved in 16 patients, but the humeral head was still dislocated to posterior in 3 cases.ConclusionsThe posterior-inferior capsule was separated with the pseudo-glenoid and retighten through the posterior approach,and reduction of the humeral head by soft tissue releaseing through the anterior approach can recover the concentric relationship of gleno-humeral joint and improve the function of shoulder joint with posterior dislocation secondary to internal rotated contracture deformity in brachial plexus birth palsy.

Objective To expore the effect of nerve repair for patients with traumatic suprascapular nerve combined with axillary nerve injuries.Methods Data of 13 cases with traumatic suprascapular nerve combined axillary nerve injuries treated by surgery from June 2003 to September 2011 were retrospectively analyzed.All the cases were males,and the average age was 28 years old.There were 2 cases of neck of scapula fracture combined with clavicle fracture,3 of floating shoulder injury,1 of humerus neck fracture combined with glenoid cavity fracture,3 of clavicle fracture,1 of acromion fracture,2 of shoulder blade fracture and 1 of atlanto-axial vertebral fractures.All the 13 cases performed isolated lost of the function of shoulder abduction and external rotation completely,and the muscle strength of deltoid,the supraspinatus and infraspinatus was M0.The electrophysiological examination showed complete denervation of axillary nerve and suprascapular nerve.The suprascapular nerve was broken in 10 cases in which 6 cases were repaired by 1 band sural nerve graft and 1 case was repaired by 1 band superficial cervical plexus,and 3 cases were irreparable because of the distal avulsion injury from the target muscle,and 3 cases were performed with neurolysis.The axillary nerve ruptured in 12 cases,in which 10 cases was repaired by 2-3 bands sural nerve graft,and fascicles selected from the median nerve were used to neurotize axillary nerve in 2 cases.The neurolysis of axillary nerve was performed at the quadrilateral space in 1 case.10 of the 13 cases had both the suprascapular nerve and axillary nerve ruptured.Results 13 cases were followed up,the follow up period was 36 to 134 months.In 7 cases,the functional recovery of shoulder abduction were 180° and the average external rotation was 56° and the muscle strength of deltoid attained M4.In 5 cases,the average shoulder abduction was 38°;the range of external rotation was-40°-30°,and the muscle strength of deltoid achieved M4 in 1 case,M3 in 2,M2 in 2.There was no improvement in 1 case.Conclusion The suprascapular nerve associated axillary nerve injury should be suspected in the patients with isolated lost the function of shoulder abduction and extemal rotation completely.Repair of axillary nerve and suprascapular nerve by nerve graft simultaneously could achieve good outcome,and early surgery should be conducted.

Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years (range, 3 months to 56 years). The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%(22/425). The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner's sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route.

Objective To investigate the differences of pre-hospital delay time in acute ST-elevation myocardial infarction (STEMI)between the advanced age group(>75 years old)and control group(≤75 years old).Methods Four hundreds patients with STEMI in the cardiology and emergency departments of the First Affiliated Hospital and Affiliated Luoyang Central Hospital of Zhengzhou University from January 2013 to March 2015 were selected and divided into two groups according to the age,the ad-vanced age group (>75 years old)and control group(≤75 years old).The patients′data were inquired and recorded for conducting the statistical analysis.Results The proportion of pre-hospital delay time < 6 h in the advanced age group was significantly lower than that in the control group and the time for conducting coronary angiography was longer than that in the control group,the differences were statistically significant(P <0.05).The mortality rates of intra-hospital,on 30 d and half a year after discharge in the advanced age group were higher than those in the control group,the differences between the two groups were statistically signif-icant (P <0.05).Conclusion The advanced age patients receiving active therapy are relatively less,which is mainly due to the wor-ry on the age related adverse reactions.

Objective To observe the outcomes of the modified multiple nerve transfer s combined with the late hand function reconstruction to restore the active pick-up function of the paralyzed upper extremity in patients with total brachial plexus avulsion injuries (TBPAI).Methods 33 patients suffered with TBPAI firstly underwent multiple nerve transfers,which including accessory nerve transfers to neurotize the suprascapular nerve to recover the shoulder abduction,contralateral C7 (CC7) nerve transfers via the modified pre-spinal route with direct coaptation to restore lower trunk function and the musculocutaneous nerve was also neurotized by the transferred CC7 nerve via a cutaneous nerve graft to restore the function of elbow flexion,as well as the phrenic nerve transfers to neurotize the posterior division of lower trunk to restore the function of elbow and finger extension.The patients with muscle recovery were selected to perform the hand function reconstruction at the second stage for restoring the active pick-up function.The patients were chosen as followcriterias:the degree of shoulder abduction attained 30°or more,the motor power of elbow,wrist,and finger flexion attained grade M4 or more,elbow and finger extension attained M3 or more.The methods of hand function reconstruction included wrist fusion and flexor carpal ulnaris opponensplasty,in addition to palmar capsulodesis of the metacarpophalangeal joint.Results The mean follow up was 41±7.7 (range,36-73 months) after the first procedure of multiple nerve transfers,the muscle strength of elbow and finger and wrist flexion attained M 4 as well as the elbow and finger extension achieved M3 or more in 10 patients,all of 10 patients achieved 40°-80°shoulder abduction.8 out of 10 patients had performed the second surgical procedure for hand functional reconstruction.6 of them had successfully recovered the active pick-up function.Conclusions The newly designed procedure of multiple nerve transfers could effectively restore the function of shoulder abduction,elbow,wrist,and finger flexion,as well as elbows and finger extension in patients with TBPAI,combined with the hand functional reconstruction,active pick-up function could be successfully reconstructed.

Objective To develop a scale of social adaptation degrees of special service personnel (referred to as scale) applying Traditional Chinese Medicine and psychological theory and to assess its reliability and validity. Methods By literature review, job analysis, inventory survey, topics interview, this scale was determined in dimensions, items and items pool based on theoretical model. Results After specialist important analysis and combining the different results of statistical analysis, including Cronbach's α coefficient, resolution factor, correlation analysis and confirmatory factor analysis, 6 dimensions, 14 factors and 40 items were finally kept in the scale. The dimensions were psychological characteristics, physical condition, intelligence level, interpersonal relationships, environmental factors and moral character. The factors were self-control, self-esteem character bias, self-confidence, physiological function, learning intelligence, creating intelligence, leadership intelligence, gregariousness, cooperative, confidence feeling, natural environment, social environment and moral character. Conclusion This scale was made on the basis of general international principle, it had good reliability and validity meeting measurement standard of traditional Chinese medicine and psychological theory, and it is an effective and practical evaluation tool of social adaptation degrees of special service personnel.

ObjectiveTo classify the type of lumbosacral plexus nerve root injury.MethodsFrom November 2004 to August 2011,36 patients suffered with lumbarsacral plexus nerve root injury underwent surgical exploration in our department.There were 24 males and 12 females,aged from 7 to 49 years(average,29.5 years).By inductively analyzing the location and amount of nerve root injury,preoperative clinical manifestations and results of physical examination,the clinical typing of lumbarsacral plexus nerve root injury was made.ResultsLumbosacral plexus nerve root injury was classified into 6 types:total lumbosacral plexus nerve root injury (4 cases),lumbar plexus and upper sacral plexus nerve root injury (6 cases),sacral plexus nerve root injury (9 cases),upper sacral plexus nerve root injury (11 cases),lower sacral plexus nerve root injury(4 cases) and lumbar plexus injury(2 cases).There were 19 patients with total lumbosacral plexus nerve root injury,lumbar plexus and upper sacral plexus nerve root injury or sacral plexus nerve root injury,among which 73.7％(14/19) nerve root injury located in the spinal canal and all of them were nerve root avulsion or rupture.There were 17 patients with upper sacral plexus nerve root injury,lower sacral plexus nerve root injury or lumbar plexus nerve root injury,among which 64.7％ (11/17) nerve root injury located in intro-pelvic or pelvic sacral foramina,and all of them were distraction injury.ConclusionThis clinical typing is useful for the accurate diagnosis of lumbosacral plexus nerve root injury.In addition,it is also beneficial for judging the location and characteristics of nerve root injury.

Objective: To observe the possibility of posterior approach via sacrectomy for reaching intrapelvic sacral plexus and expose the deep intrapelvic origin of sciatic nerve from sacral plexus in order to perform nerve graft. Methods: Five adult cadaver specimens were used in the study with prone position in May 2012. Cut off the gluteus maximus along the origins and lift to the lateral side, the piriformis was lay beneath. The sciatic nerve and the inferior gluteal nerve pierced from the infrapiriformis foramen in the operative field. Excise the origin of the piriformis via sacrectomy with osteotome and the length and width of the insertion on sacrum were measured. The piriformis was resected and then the sacral nerve roots beneath were exposed. The S2-S4 sacral nerve roots and the deep intrapelvic origin of sciatic nerve from sacral plexus were revealed after carefully dissecting. From July 2012 to June 2016, nine patients with lumbosacral plexus injury were performed surgery through the posterior approach in Department of Hand Surgery, Beijing Jishuitan Hospital.There were 6 male and 3 female patients, with a mean age of 29 years. All patients were diagnosed as upper and lower sacral plexus injury, in one of them combing with contralateral lower sacral plexus injury. The average time from injury to operation was 8.3 months. Results: The length and width of the piriformis insertion on sacrum were (3.44±0.15) cm and (2.42±0.11) cm, respectively. The deep intrapelvic origin of sciatic nerve from sacral plexus in all nine patients can be revealed clearly and there was enough operative space that nerve transfer or graft can be performed through the posterior approach via sacrectomy. The total blood loss during operation was (1 822±1 523) ml. Conclusion The piriformis and part of sacrum it attached can be resected safely through the posterior approach and the deep intrapelvic sacral plexus and the origin of sciatic nerve can be well exposed.

Objective To explore the feasibility of transferring of the obturator nerve onto the vesical branch of pelvic nerve with direct anastomosis,in order to restore the automatic micturition function of patients with bilateral lower sacral plexus injury (S2-S4).Methods Data of five patients (4 males and 1 female) with bilateral lower sacral plexus injury who had surgery from May to July 2018 were retrospectively analyzed.The average age was 26 years old (range,23-30 years old) and the average delay from injury to operation was 10.2 months (range,7-14 months).Three patients suffered with fell off injury and two patients had car accident injury.All patients presented with continence and the urodynamics revealed flaccid neuropathic bladder with neurogenic adynamia of detrusor muscle.The vesical branch of pelvic nerve was dissected between the bladder and the ureter where it entered the bladder neck from backward to forward almost vertically.The obturator nerve was dissected along the pelvic sidewall,and the comparable bundle branch of obturator nerve was transferred onto the vesical branch of pelvic nerve with direct anastomosis.The diameter and freed length of pelvic nerve and the fascicles of the obturator nerve were measured intraoperatively,and the cutaneous sensation of medial thigh and the muscle strength of hip adduction were evaluated postoperatively.Results The surgery was performed through the traditional abdominal paramedian approach in 3 patients and through the pararectus approach in 2 patients.The vesical branch of pelvic nerve in all five patients could be revealed clearly and there was enough operative space for nerve transferring.The surgery was successful in all five patients without any complication.The donor nerves were anterior branch of obturator nerve in 2 patients,posterior branch of obturator nerve in 1 patient,2/3 fascicles of anterior branch of obturator nerve in 1 patient and 2/3 fascicles of posterior branch of obturator nerve in 1 patient.The average length and diameter of freed fascicles of obturator nerve were 2.28 cm (range,1.9-2.6 cm) and 1.36 mm (range,1.2-1.5 mm).The average length and diameter of pelvic nerve were 2.46 cm (range,2.2-2.7 cm) and 1.2 mm (range,1.1-1.3 mm).The vesical branch of pelvic nerve and the bundle branch of the obturator never were comparable and anastomosed free of tension.The sensation of medial aspect of thigh was almost normal and the muscle strength of hip adduction was M4 postoperatively.Conclusion The vesical branch of pelvic nerve can be well exposed via pararectus approach.Transferring of the fascicles of obturator nerve onto the vesical branch of pelvic nerve is feasible and safe.