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 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 detect whether there is neurotropism following end-to-side neurorrhaphy by means of the neuron retrograde tracing technique. Methods Forty female Sprague-Dawley rats were randomly divided into 4 groups: tracing main branch of musculcutaneous nerve(MC) of end-to-side group, tracing MC main branch of normal group, tracing MC motor branch of end-to-side group and tracing MC motor branch of normal group.In two end-to-side groups, the MC was transeeted, then an 1 mm epineukral window was created on the ulnar nerve. Distal end of MC nerve was sutured to the windowed ulnar nerve by means of end-to-side neurorrhaphy.In two normal control groups, MC and ulnar nerves were just exposed. Five months post operation, by means of retrograde Fluoro-Gold neuron tracing technique,the number of C5～ T1 anterior horn motoneurons and dorsal root ganglion sensory neurons of all groups were counted. Results In two tracing MC main branch groups: the motor neuron counts in end-to-side group was 245.2 ± 93.8, the motor neuron counts in normal group was 846.7 ± 264.8, and counts of end-to-side group was 30.0% of the normal control group (P＜ 0.01). The sensory neuron counts in end-to-side was 434.7 ± 160.4, the sensory neuron counts in normal group was 1545.2 ± 287.4, and counts of end-to-side group was 28.1% of the normal control group (P ＜ 0.01). The per-centage of motor neuron in end-to-side group was 0.36 ± 0.09, there was no difference between end-to-side group and normal control group(P＞ 0.05). In two tracing MC motor branch groups: the motor neuron counts in end-to-side group was 72.3 ± 35.3, the motor neuron counts in normal group was 189.7 ± 57.0, and counts of end-to-side group was 38.1% of the normal control group (P ＜ 0.01). The sensory neuron counts in end-to-side was 110.8 ± 52.5, the sensory neuron counts in normal group was 157.9 ± 50.0, and counts of end-to-side group was 70.2% of the normal control group (P ＞ 0.05). The percentage of motor neuron in end-to-side group was 0.40 ± 0.14, the difference between end-to-side group and normal control group was signifieant(P ＜ 0.01 ). Conclusion Neurotropism in collateral spouting after end-to-side neurorrhaphy is not significant.

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 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.

Objective To evaluate the efficacy of the nerve grafting and nerve transfer (neurotization) in the treatment of early obstetrical brachial plexus palsy(OBPP). Methods 48 cases with TassinⅡ-Ⅳ lesion who had no any recovery of elbow flexion, the brachial plexus were explored from 3 to 14 months after birth. The method of nerve repair depended on findings during operation. For the traumatic neuroma, it should be resected and the defect be repaired by nerve grafting with neurotization; the root avulsion was repaired by neurotization; neurolysis was only performed to those plexus that looked nearly normal and had a positive reaction of neurophysiology as tested intra-operatively. The reconstructive procedures included: C5→upper trunk, accessory →supraspinal nerve (2 cases); C5,6→the posterior and the anterior division of the upper trunk respectively, accessory →supraspinal nerve (25 cases); C5,6→the posterior and anterior divisions of the upper trunk respectively, C7→middle trunk, accessory →supraspinal nerve (4 cases); C5→posterior cord, C6→lateral cord, accessory →supraspinal nerve (5 cases); C5→anterior division of the upper trunk, C6→C8, accessory →supraspinal nerve (1 case); C5-7→the posterior, lateral and medial cords respectively, accessory →supraspinal nerve (4 cases); C5→upper trunk, C6→lower trunk (or medial cord), accessory →supraspinal nerve (2 cases); C5,6→the lateral and medial cords respectively, accessory →supraspinal nerve (3 cases); neurolysis (2 cases). Results All the patients were available at follow-up at least for 36 months, who were studied according to both of the Gilberts shoulder and elbow rating system and the Raimondis hand scale system. The score of shoulder, elbow, and hand in 13 cases with Tassin Ⅱ lesion improved from preoperative 0.54, 1.92 and 3.23 to postoperative 3.77, 4.92 and 4.31 respectively; 11 cases with Tassin Ⅲ rose from 0.46, 1.82 and 1.91 to 3.27, 4.18 and 3.64, and 24 cases with Tassin Ⅳ had an elevation from 0.25, 1.25 and 0.33 to 2.92, 3.46 and 2.83. The medial rotation contracture of the shoulder without subluxation and dislocation was found in 7 cases(14.6%) in the process of recovery. Conclusion The resection of the traumatic neuroma combined with nerve grafting and neurotization is really effective in the treatment of early OBPP.

Objective To compare activated and normal Schwann cells in GAP43 gene expression. Methods 10 male SD rats, weighed from 100 g to 120 g. The right median nerve of SD rats was transected at the axillary level and was buried in muscle for predegeneration. 1 week later, the distal segment of the transected right median nerve with 1 cm long was harvested. The untreated left median nerve was harvested as control with same length. The epineurium of nerve was stripped, then the nerve tract was cut to small pieces. Schwann cells were obtained by way of double kinases digestion with 0.25% trypsin and 0.03% collegenase. The right median nerve was activated with additional liquid during digestion so as to obtain the activated Schwann cells. The normal Schwann cells were harvested from left median nerve. rt-PCR was used for GAP43 gene enlargement. mRNA was distilled from activated Schwann cells and untreated Schwann cells respectively. Then the mRNA was reversely transcripted to cDNA with SuperScriptTM, and cDNA worked as template for PCR enlargement. The product of PCR was separated with 1% agarose gel electrophoresis for 40 -50 min and stained with SYBR Green Ⅰnucleic acid gel. Fluorescence intensity of GAP43 PCR products was measured and then compared between the experiment group and control group. Results The Fluorescence intensity of GAP43 PCR product of activated Schwann cells was higher than that of normal Schwann cell. There was significant difference (P=0.003, Paired t test). It indicated that GAP43 mRNA of activated Schwann cells was much more than that of the normal Schwann cells. Conclusion GAP43 gene expression is up regulated in activated Schwann cells in contrast to normal Schwann cells. Activated Schwann cells secreting more GAP43, which may be one of the important mechanisms in promoting 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.