Hand surgery,as a specialty in China,was established and advanced by Wang Shu-huan who unceasingly cre ated innovative skills and trained a lot of talented hand surgeons.Later on,department s of hand surgery were established in Beijng,Tianjin and Shanghai.Hand surgery e xperienced great development after1978when the first classic Hand Surgery was published.Hand Surgery Group of Orthopaedic Associa-tion of China Medical Association wa s established in 1984,and changed its name to Hand Surgery Association of China Me dical Association in 1994.Journal of Hand Surgery was established in 1985,and changed its name to Chinese Journal of Hand Surgery in 1993.The survival rate of replant ed limbs(digits)was raised unceasingly.After replantation of limb,graftin g of phalanges of foot,and flap graft,more achieve-ments were made,such as antebrachia l flap transfer(Yang Guo-fan),reconstruction of hand(Yu Zhong-jia),and contralateral C7root transfer(Gu Yu-dong).2cases of xenoma limbs transplantation were c onducted by Professor Pei in Nanfang Hospital in September 2000.Although the history of hand surgery is not long,much has been achieved.It is well believed that hand surgery will see greater progress in the future. [

86 cases of defect of thumb with defect of metacarpal bone were operated by the second toe transfer to reconstruction of the thumb, of which 82 cases were successful occuping 95. 6% of total cases. The metacarpal-phalangal arthral reconstruction of the thumb was completed by the hemi-arthral and full-arthral transplantation of metatarsal-phalangee joint of second toe. The results of follow-ups after operation revealed that the degree of movement of the joint was 26 in the former, 36% in the latter. The reconstruction of the first web by means of the local flap of the dasalis manual; dasalis pealical flap and groin flap. Fair results were obtainded with 63.2 %; 87. 1% and 100%. respectively. The disadvantages of groinflap method are timeconsuming, and incomfortable in position. The operative methods vary with the degree of the defect of the matacarpal bone and the condition of the web space

Objective To disclose the relationship of the target muscle function and different time interval after nerve grafting reconstructed C5 root resection in young rats.Methods Model of C5 resection was set up in 48 18-day-old SD rats.The rats were randomly divided into C5 resection group,immediate repairing group,3 days delayed repairing group,and 6,9,12,15,18 days delayed repairing groups.Each group experienced nerve grafting bridged the C5 nerve root defection at its time interval.At 6 weeks postoperatively,electrophysiological and histochemical experiment were performed.Results There was no statistical difference among the data of CMAP amplitude and latency and weight of target muscles and number of distal myelinated fiber of immediate repairing group and those of 3,6 days delayed repair group at 6 weeks postoperatively,but compared with C5 resection group,the dates was statistically higher.There was no statistical difference between the data of C5 resection group and that of 15,18 days delayed repairing group.Conclusion Nerve reconstruction for C5 root injury in young rats within 0-6 days (equal to 0-4 months in human beings) has a satisfactory protective effect on target muscles.It suggests that the OBPP children who have the operation indication should undergo surgical management in 4 months after their birth.

Objective To investigate the difference of the glial cell line-derived neurotrophic factor and its receptor content of proximal neurons after nerve grafting was used to reconstruct C5 root in young rats.Methods Model of C5 resection was set up in 12 18-day-old SD rats.Experimental animals were divided in to two groups, one group for C5 resection, another for nerve grafting to reconstruct the C5 defection.At 4 weeks postoperatively, the immunohistochemical staining was performed and the number of GDNF and GFRa1 immunohistochemical positive neurons were calculated respectively.Results The number of GDNF positive neurons in spinal cord and dorsal root ganglion of C5 repairing group was 786.3 ± 176.84 and 2997.0 ±357.99, and that of C5 resection group was 335.0 ± 49.50 and 1632.0 ± 305.55.On the other hand, the number of GFRa1 positive neurons in spinal cord and dorsal root ganglion of C5 repairing group was 787.5 ±178.55 and 3111.0 ± 445.72, that of the other group was 397.3 ± 41.78 and 1588.3 ± 229.00.The statistical analysis result showed GDNF and GFR immunohistochemical positive neurons in spinal cord and dorsal root ganglion of C5 repairing group was statistically more than that of C5 resection group(P < 0.01 ).Conclusion The neuronal protective effect of nerve grafting after reconstructing brachial plexus nerve injury in young rats may be attributed to the increase of GDNF and its receptor GFRa1 content of proximal neuron.

The use of the accessory nerve as a donor is one of the best possibilities for treatment of the brachial plexus in case of paralysis due to root avulsion. In this paper, a brief history of the use of accessory nerve tran sfer for treatment of brachial plexus injury and recent development in the anato my of accessory nerve are introduced. The nerve transfer methods and the effects of the accessory nerve are discussed in particular. The progress in and the dev elopment trend of the accessory nerve transfer methods are also analyzed. It is advisable that the accessory nerve is transferred to restore the suprascapular n erve so as to obtain shoulder abduction. And it is a clinical trend that the dis tal terminal branch of the accessory nerve is used and the function of the upper part of the trapezius muscle is preserved in the transfer. At last, the factors affecting functional outcome in accessory nerve transfer are discussed.

[Objective]To observe the complications after surgical treatment of thoracic outlet syndrome and to analyze causes and prevention of complications.[Methods]A retrospective review was done for 62 cases of thoracic outlet syndrome which had been treated by operation from January 2002 to January 2006.All the complications occrred were collected in the following time.[Results]Follow up time was 14 months to 30 months.According to assessment standard described by Wood,treatment outcome was excellent in 26 cases,good in 16 cases,fair in 11 cases and poor in 9 cases.Nine of all the 62 patients had been found complications,including hematoma in 3 cases,lymphadenectomy in 2 cases,cervical plexus injury in 2 cases,phrenic nerve injury in 1 case,brachial plexus injury in 1 case and pneumothorax in 1 case.All the patients were successfully treated.[Conclusions]The occurrences of complications are related to the skill of operation and individual differences of patients.In order to decrease and finally prevent these complications,operative experiences and preventive measures are needed.

Objective To evaluate clinical effects of using axonal repair technique (cell surgery) for the treatment of peripheral nerve injuries. Methods 12 patients with 13 injured peripheral nerves were treated with axonal repair technique of soaking the stumps of the nerve in a modified Collins fluid, freezing the stumps with liquid nitrogen, trimming the solidified stumps with a sharp blade, coapting the nerve with glue and two stitches of epineurium, so that the injured peripheral nerves were repaired at the axonal level. The postoperative evaluation was performed at an average of 9.7 months. Results In four of 12 cases operated upon with contralateral C 7 nerve root transfer(C 7 to ulnar nerve), regenerating axons had reached to the ipsilateral sternoclavicular joint or axilla at postoperative 4-7 months, so that the second stage of contralateral C7 nerve root transfer procedure could be performed. In five cases of which the accessory nerves were transferred to suprascapular nerves, the strength of supra-and infraspinatus of 3 patients had recovered to MRC 3-4 at postoperative 16 months, and that of the other two, to MRC 1-2 at 12 months. In one case undergoing the second stage procedure of contralateral C 7 nerve root transfer (ulnar nerve to median nerve), the flexor carpi radialis showed some nerve regeneration shown in EMG at postoperative 4 months. In one case of which phrenic nerve was transferred to the musculocutaneous nerve (the nerve graft 8 cm), the biceps showed some nerves regeneration shown in the EMG 15 months postoperatively. In one patient for whom two digital nerves were repaired, the protective sensation had recovered 3 months postoperatively. Conclusion Axonal repair technique is an effective and practical way for the treatment of peripheral nerve injury.

Objective To study the effect of extract of leave ginkgo biloba (EGb) for protection of the motor and sensory neurons axotomy-induced in rats. Methods Thirty male Sprague-Dawley rats weighing 180－ 220 g (8－ 9 weeks of age), were randomly divided into control group and EGb24/6 group. Models of sciatic nerve injury were established by transection of left sciatic nerve at 0.5 cm away from the points of muscular innervation. The proximal stump of sciatic nerve was double ligated to inhibit nerve regeneration. The distal end of the nerve was implanted into the biceps femoris. Then 2 ml of normal saline was given to control group, and 2 ml of EGb24/6 to the EGb24/6 groups daily. The rats were sacrificed in 7,14,28 days after surgery respectively, and then 4％ paraformaladehyde was perfused transcardially. The L4－ 6 spinal cord and L5 dorsal root ganglion (DRG) were harvested. HE staining and CV technique were used for detection of the motor neurons and compared with contra-lateral side. TUNEL technique was used for detection of apoptotic motor and sensory neurons. Eletron microscopic technique was used for observation of change of L5 DRG neurons. Result The number of motor neurons was significantly higher in EGb24/6 group in each postoperative period than that in control group (P

Objective To establish a experimental method for evaluating nerve regeneration after operation by means of tracing the retrograde axonal plasm flow by 125 I HRP Methods Eighteen SD rats were used The right sciatic nerve of mouse was transected at the site 0 8cm distal to sciatic notch and then anastomosed immediately Four weeks later,500?l of 125 I HRP solution was injected into the right musculi triceps surae The right sciatic nerve segment proximal to the anastomosis site was cut for checking up the intensity of radioactivity in each tissue at 24 hours after injection The fiber number of nerve distal to the site of anastomosis were calculated The relationship between the intensity of radioactivity and the fiber number was analysed Results The relationship between the intensity of radioactivity of sciatic nerve segment proximal to the site of anastomosis and the fiber number of distal sciatic nerve segment was correlation and there was statistic significance. Conclusion The status of nerve regeneration distal to the site of anastomosis can be evaluated by means of intensity of 125 Iodine in the nerve segment proximal to the site of anastomosis

Objective To analyse the alterative characteristics of electrophysiology by detecting somatosensory evoked potential(SEP) during cerebral remodeling after transfer of healthy C7 nerve root both in patients and normal individuals. Methods From 2002 to 2003, 12 cases of the left total brachial plexus nerve root avulsion were surgically treated by transferring healthy C7 nerve root to impaired median nerve through bridged ulnar nerve. The waveform of SEP of bilateral cortical expressions were recorded after stimulating median nerve of impaired upper extremity at the wrist and elbow. Meanwhile, latent period and amplitude of wave of SEP, and nerve conduction velocity from the level of wrist to elbow were exhibited and compared. Results There were differences of the latency and amplitude of SEP in normal individuals between two sides of cerebrum to some extent. In the healthy sides (first group), difference of latency of SEP on two sides of cerebral cortex had no statistical significance but in the reverse for the amplitude of SEP. For the diseased sides(second group), difference of amplitude of SEP for both sides of cerebral cortex between the patients and the nonmal individuals were of statistical significance, but on the contrary for the change of latency of SEP. Conclusion Cerebral cortex dominating affected extremity is able to bring up functional remodeling electrophysiologically after nerve transfer of healthy C7 nerve root. Shortened latency and augmented amplitude discrepancy of SEP recorded on both sides of cerebral cortex were preliminary electrophysiological criterions. After contralateral C7 nerve root transfer, the examination of SEP can offer data of corresponding cortex "reinnervation", which provides objective evidence for further treatment to promote functional recovery and cortical plasticity.