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

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. [

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.

Peripheral nerve injury of a limb usually causes functional reorganization of the contralateral somatosensory cortex.However, the patients with an operation of the contralateral seventh cervical nerve (C7) transfer to an injured arm with brachial plexus root avulsions usually have the sole tactile sensibility of the healthy hand when the injured hand is touched at the early stage after the operation. Then, at later stage they gradually get normal sense from the injured and the normal hands independently. Mimicked the process in a rat model based on the above operation, representations of the injured forepaw and the healthy forepaw in the somatosensory cortex were studied by means of somatosensory evoked potential (SEP) recording. Somatosensory function shown in SEP response amplitude and peak latency of the injured forepaw gradually recovered with time after the operation due to the contralateral C7 regeneration toward the injured limb, accompanied with the recovery process of limb movement. The somatosensory representation of the injured forepaw was observed exclusively in the ipsilateral somatosensory cortex since the 5th month after the operation. Accordingly, the overlapped representation of the injured and healthy forepaws emerged in the ipsilateral somatosensory cortex of 13 rats studied except one with separated representation though the SEP latency and response amplitude were different in responding to stimuli on the two forepaws. It is concluded that the contralateral peripheral nerve transfer to the injured arm can cause dynamically functional reorganization in the ipsilateral somatosensory cortex suggesting a remarkable plasticity of the brain function induced by an alteration of sensory input between two sides of the body in adult rats.

Objective To detected the motor cortex reorganization and compared the influence on reorganization process as regard to different transfer modes of contralateral seventh cervical nerve root (C7)in young rats model of total brachial plexus root avulsion. Methods The young Sprague-Dawley rats model of total brachial plexus root avulsion was established. The left radix dorsalis and radix ventralis from the fifth cervical nerve root (C5) to the first thoracic nerve root (T1)were exposed and the roots from C5 to T1 were avulsed from the spinal cord. Then, the contralateral C7 transfer operation was performed. Three different operative modes were applied randomly which included contralateral C7 transference to anterior division of the upper trunk (group A, n=30), to both musculocutaneous and median nerves (group B, n=30), or to median nerve (group C, n=30). The movement evocation of motor cortex was measured by intracortical microstimula-tion in both hemispheres, and functional reorganization was assessed dynamically in 1.5, 3, 6, 9 and 12 months after operation. Results After contralateral C7 transference, the ipsilateral motor cortex initially acti- vated the injured limb at 1.5 month, and subsequently the motor cortex of both hemispheres activated the in-jured limb at the 3rd and 6th month. The injured limb was activated mainly by the contralateral motor cortex in group A at the 9th month. The contralateral motor cortex exclusively controlled the injured limb in all three groups at the 12th month after the operation. Meanwhile, the extent of functional reorganization was better in group B than that of group C. Conclusion After contralateral C7 transfer operation, motor cortex in charging injured limb developed a transhemispheric functional reorganization in young rats with total brachial plexus root avulsion. Different operative modes contributed to the functional reorganization of motor cortex. Transferring contralateral C7 to anterior division of the upper trunk or to both musculocutaneous and median nerves provided better functional reorganization than to median nerve.

Objective To compare the differences of chemotaxis at the tissue specific level and topographic specificity level during peripheral nerve regeneration after the severance injury of the sciatic nerve in rats of different ages. Methods 40 specific pathogen free Sprague Dawley 18 day old rats (called as young group) were chosen to correspond as nearly as possible to humans of about 1 year of age. 40 adult rats (called as adult group) were chosen to correspond as adult humans. The tissue and topographic specificity models were set up respectively after the severance of the sciatic nerve at the right side. Electromyography and morphological evaluations were conducted for determination of the nerve regeneration on 3 and 6 weeks postoperatively. Results On 3 and 6 weeks after operation, the recovery rate of nerve conduction velocity, the exact rate of nerve regeneration, the ratio of nerve conduction velocity between tibial and peroneal nerve, the ratio of amplitude of CMAP between tibial and peroneal nerve, the ratio of the number of myelinated axon between the tibial and peroneal nerve at the distal part in the young group were lower than those in the adult group respectively. There were statistically significant differences between the 2 groups. The recovery rate of amplitude in compound muscle action potential (CMAP) was lower in the young group than in the adult group, but the difference was not significant enough. Conclusion Since the tissue and topographic specificities in the young rats are both inferior to those in the adult rats, co contraction between agonists and antagonists may result from cross innervation during the peripheral nerve regeneration.

Objective To investigate the effect of nerve grafting to enzyme histochemical changes on neurons after brachinal plexus nerve in jury in young rats. Methods Model of C5 resection was set up in 24 18-day-old SD rats. Experimental animals were divided in to two groups, one group for C5 resection, another for nerve grafting in repairing the C5 defection. At 4 weeks postoperatively, cholinesterase (CHE) and acidphosphatase (ACP) histochemical stain of neurons in C5 anterior horn and dorsal root ganglia (DRG) were detected. Results Compared with C5 resection group, bio-activity of CHE of C5 repairing group was statistically higher, and that of ACP was statistically lower. Conclusion Nerve grafting has protective effect on survival of neurons after brachial plexus nerve injury in young rats.

[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