Objective To investigate the effect of different function of sympathetic nerve on the pain of peripheral nerve chronic compression. Methods Forty-eight male Sprague-Dawley rats were made into lower trunk chronic compression models and divided into 6 groups (A1,B1,C1,A2,B2,C2) with 8 rats per group. The C8T1 dorsal root ganglions of the compressed sides of group A1 (control group), B1 (sympathetic block group)and C1 (de-sympathetic group) were harvested 3 months after compression surgery. The compressed lower trunks of group A2 (control group), B2(sympathetic block group)and C2(de-sympathetic group)were decompressed 3 months after compression surgery and bred for another month and then the C8T1 dorsal root ganglions of the compressed sides were harvested. The levels of substance P mRNA in the C8T1 dorsal root ganglions were tested with RT-PCR technique. Results the mean relative levels of substance P mRNA of group A1, B1 and C1 were (3.620 ± 0.830) × 10-2, (2.945 ± 0.724) × 10-2, (2.239 ± 0.734) × 10-2, respectively, with a significant difference (P = 0.006) and those of group A2, B2 and C2 were (3.163 ± 1.026) × 10-2, (2.355 ± 0.680) × 10-2,(1.487 ± 0.802) × 10-2, the difference among which was statistically significant (P = 0.003). Conclusion The pain of peripheral nerve chronic compression is affected by sympathetic function. The more lower the sympathetic function is, the more light the pain is. Sympathetic blockage or resection helps to relieve the pain of peripheral nerve compression disease after being decompressed.

Five cases of carcinoma located in the middle portion of the esophagus were resected with end-to-end anastomosis in the left neck. The lower portion (about 2.5-4.0cm in length) of the esophaguswas reserved to preserve the physiological function of the lower esophageal sphincter. The operationwas satisfactory, especially in the prevention of regurgitant esophagitis. No tension was observed at the site "of the anastomosis, and blood supply to the esophagus was not disturbed. Adequate mobilization of the lesser curvature of the stomach was the most important step. Such complications as leakage of the esophageal anastomosis and stricture were not seen in these five cases. Regurgitation was not observed in short-term follow-up. A normal esophageal peristalsis and cardiac opening were observed by barium meal radiography after the operation.

[Objective]To discuss the result of using latissimus dorsi musculocutaneous flap which function was recovered by repairing the thoracodorsal nerve with nerve transfering for reconstruction of flexor of elbow or digits in brachial plexus injury patients.[Method]From march 2000 to June 2003,eight patients with brachial plexus total roots avulsion were treated by mlutiple donor nerves transfer.The function of latissimus dorsi muscle recorved well but not the biceps muscle in five patients.The function of flex digits did not recover while the latissimus dorsi muscule recorverd well in three patients.All of them had the aid of latissimus dorsi musculocutaneous flap to reconstruct the flexor of elbow or digits.[Result]The patients were followed up for one year to half past three years,all of musculocutaneous flap were survived,the muscle strenght graded 3 to 4 and the active motion of the elbow was over 100 degrees in flexion and 10 degrees to 25 degrees in extension.All the digits can grasp,the fist closure was about 2 cm and the muscle strenght was grade 3 of the involved digits.[Conclusion]It is a good method to reconstruct the flexor of elbow or digits by the recovered latissimus dorsi musculocutaneous flap in brachial plexus total roots avulsion patients.When treating brachial plexus total roots avulsion patients,it is necessary to repair the thoracodorsal nerve.

[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 investigate the morphological characteristic of the scalenus minimus. [Methods]Totally 32(64 sides) embalmed adult cadavers were dissected and studied,the morphology of scalenus minimus and its relationship to brachial plexus was observed.Ten scalenus minimus were stained by HE to study membrane of the muscles.Twenty-seven(54 sides) embalmed adult cadavers were dissected carefully to investigate its nerve and blood supply.[Results]Scalenus minimus was found in 84.4% of cadavers(54/64).Its insertion was mainly composed of tendinous tissue,which was spaned by the lower trunk of brachial plexus.Scalenus minimus supply nerve branches was from ventral rami of the cervical seven root,and vascular supply was from:(1) branches of deep cervical artery,(2) branches of subclavia artery.[Conclusion]Scalenus minimus muscle,an independent but inconstant muscle,is existed in most people and sometimes responsible for compression of brachial plexus.It is suggested that scalenus minimus muscle should be resected carefully as well as scalenus anticus and medius during surgical treatment of thoracic outlet syndrome.

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 study the effects of skeleton musclular relaxation on nerve conduction and regeneration. Methods Musclocontaneous nerve injury model was established in 96 mice and the animals were divided into skeleton muscle relaxation, skeleton muscle relaxation and neurotrophic drugs, neurotrophic drugs and control group. Nerve conduction and regeneration were evaluated by electromyography; muscle weight and counting of distal regenerated myelinated nerve fibers. Results The velocity of nerve conduction and regeneration in skeletal muscle group was the same as that in skeleton muscle relaxation and neurotrophic group, and higher than that in control group. Conclusion Skeleton muscle can enhance nerve conduction and regeneration.

Objective To report carpal tunnel release using Universal Subcutaneous Endoscope System from anatomical and clinical point of view for the purpose of avoiding operative complication and improving clinical efficacy. Methods Operation approach and adjacent structures were observed and measured on 18 fresh upper limb specimens and 26 formaldehyde solution fixed upper limb specimens. Nineteen patients with 21 carpal tunnel syndrome (CTS) were treated with this method under local anaesthesia without tourniquet. The incision is made in the wrist just 2-3 cm superior to palmar crease of the wrist at the medial border of the palmaris longus. The operation plane is just under the deeper layer of deep fascia. The instrument points to the third web. The median nerve and its branches, flexor retinaculum and superficial palmar arch were carefully observed. Results The results were satisfactory in all patients. Conclusion Single wrist portal arthroscopic procedure is a safe, simple and efficient approach if the anatomic structures of the wrist are perfectly clear to the opeator.

Objective To investigate the feasibility of endoscopy in diagnosis and treatment of compressed peripheral nerves. Methods An 1.5 cm transverse incision posterior to the margin of pectoralis major along the second rib was made in 2 old and 9 fresh cadaver specimens. The distance from the incision to the insertions of anterior and middle scalene muscle on the first rib was measured at various angles. The structures surrounding the approach was observed and measured to find a safer approach for endoscopic treatment of brachial plexus compression syndrome. Results With the upper limb hyperabducted at 120 degrees, anteriorly tilting at 30 degrees, through an 1.5 cm transverse incision made posteriorly to the margin of pectoralis major and along the second rib, the apparatus was inserted toward the point 6.5 cm laterally apart from the sternoclavicular articulation and 7.8 cm in depth, reaching the insertions of the anterior and middle scalene muscle on the first rib without injury to the nerves and vessels. Conclusion The approach is safe for endoscopic apparatus reaching the insertions of the anterior and middle scalene muscles on the first rib. It also provides a basis for further investigation of cutting anterior and middle scalene muscles through endoscope.

Purpose　To study the relationship between sympathetic nerve and the branches of primary sensory neurons in dominating cervical zygapophyseal joints with the HRP retrograde tracing methods.To explore the mechanism of the external intervertebral foramen's cryical nerve compression syndrome with neck-shoulder pain and the symptom of head and face regions.　Methods　8 Wistar rats were used with the right side as experimental side and the left side as control side.5 μl of 30% HRP solution was injected into the C5/C6 cervical zygapophyseal joint capsule of the right side by microinjection syringe and 5 μl of 0.9% normal saline was injected into the left side as control.The animals survived for 48 hours and were killed by perfusing through ascending aorta.The C1-T1 DRG,cervical sympathetic ganglia and trigeminal ganglia on both sides were sectioned by frozen section method,and treated with TMB method.The HRP labeled cells in sections were observed under optical microscope.The classification and count of HRP labeled cells in DRG and cervical sympathetic ganglia on experimental sides were analysed by image pattern analysis system.　Results　There were HRP labeled cells in middle cervical ganglia,inferior cervical ganglia (stellate ganglia) and C5-C7 DRG on experimental sides after HRP injection.Most of the labeled cells were small or middle size.The sum of mean area and the mean optical density of HRP labeled cells were larger in the middle cervical ganglia and C6 DRG than that in inferior cervical ganglia(stellate ganglia) and C5 or C7 DRG separately (P<0.01).There wasn't any HRP labeled cell in C1-T1 DRG of control side and in trigeminal ganglia.　Conclusions　The cervical zygapophyseal joint mainly dominated by the sensory branches of the three cervical nerves next to it and by the branches of the sympathetic nerves.It may be related to the causing of neck-shoulder pain and the symptoms of head and face regions of patients with the external intervertebral foramen's cervical nerve compression