to Peripheral Nerve Rerouting Article
of Anastomosed Vessels
Shaocheng, Dang Ruishan, .Zhao Jie, et al,
Department of Orthopedics, Changhai Hospital, Shanghai, 200433
Objective: To reconstruct partial
peripheral nerve function in complete paraplegia patients with
transverse injury of thoracic spinal cord.
Methods: One side of the Inar nerve was
cut off in the carpal level, of which the deep branch of the distal
end was anastomosed with the pronator quadraturs muscle branch of
anterior interosseous nerve, and the superficial branch of the distal
ulnar nerve was anastomosed with the superficial branch of radial
nerve. The proximal ulnar nerve was dissected from the subcutaneous
tunnel to its origin in the axilla. The separated avascularized ulnar
nerve was conducted into the lateral thoracic wall tunnel. The
thoracodorsal artery and venous were exposed and anastomosed
end-to-end to superior ulnar collateral vessels. The pudendal nerve,
posterior cutaneous nerve of thigh and sciatic nerve were dissected in
a hip incision. The ulnar nerve was bridged to the pudendal nerve with
a reversed fascia pedical posterior cutaneous nerve of thigh. The deep
branch and dorsal hand branch of the ulnar nerve were anastomosized to
the sciatic nerve or the femoral nerve. The superficial and flexor
carpi ulnaris muscle have been bridged by sural nerve, anastomosed to
the lumbosacral trunk.
Results: Three and five years follow-up
of four patients got basic function recovery of the done nerves. No
significant claw hand was found in the donor site, and hand sensory
improved to S3 and
recovered to the original region.
Conclusion: Vascularized ulnar nerve
transfer can reconstruct partial neurological function of complete
transverse injury of the thoracic spinal cord.
Paraplegia Treated With Intradural Microsurgical Releasing
Department of Orthopedics, Changhai Hospital, Shanghai, 200433
Objective: Accelerate medullispinal
function recovery by releasing the intradural scar and adhesion
compressing spinal cord with microsurgery technique.
Method: Incise the dura mater, release
the adhesion to spinal cord of pia mater, denticulate ligament,
original part of nerve root and release the peripheral fibrous bind
with microsurgery technique.
Results: At two to four years follow-up
post-operatively, all 16 cases have lowered down the levels of the
dermatomes, and muscle strength improved at least to above one muscle
grade. In six of them, the muscle strength of main mass of double
lower limbs has improved to above three muscle grades and recovered
the ability to walk.
Conclusion: Release of the intradural
adhesion and scar tissues has good effect on treatment of incomplete
Sensation Function Reconstruction In Complete Paraplegia
Shaocheng, Yu Baoquing, Ji Rongming, et al; Department
of. Orthopedics, Changhai Hospital, Shanghai, 200433
Objective: To reconstruct the sensation of
buttock, lateral thigh, medial thigh and vulva in paraplegia caused by
thoraco-lumbar fracture whose sensory level is between the T9 and T11.
Methods: 1-2 segments of vascularized
intercostals nerve skin branch above the paraplegic level were taken.
The vascularized nerve was transferred to the lateral abdominal wall
from a subcutaneous tunnel and anastomosed to the excised ilioinguinal
nerve and lateral cutaneous nerve of thigh in the distal end by sural
Results: Six cases got 10-14 months
follow-up. Five of them got a grade S2-3 recovery of sensory function
in lateral buttock, lateral and medial thigh, and vulva, and this
sensory area was expanded with time. No obvious sensory function
abnormalities were found in the donor area.
Conclusion: The results of this operation
demonstrated that patients with T9-11 paraplegia can get sensory
recovery down of 3-4 segments. It is especially beneficial to the
patients that their sensory function of vulva, lateral buttock, and
thigh has recovered, and this operation has no further damage to their
general condition and primary function.
Transplantation of Peripheral Nerve to Treat the Later Injury of Spinal
Shaocheng, Pang Yu, Zhao Yongjiang, Zhang Chuansen;
Department of Orthopedic Surgery, Changhai Hospital, Shanghai, 200433
Objective: Supplying nerve fibers, nerve
cells, and factors included in them to spinal cord improves the
recovery of the function of the spinal cord.
Method: After releasing the spinal cord,
incises it vertically at the appropriate length and depth.
own peripheral nerve (usually the sural nerve), which is removed its
epineurium, nearilemma and incised it open and cut off a proportion of
nerve fibers with microsurgery technique so that its character and
appearance looks like cauda equine is transplanted in a multi-striped
fashion, vertically inside the spinal cord incised and fastened
appropriately to dura mater with 8"0"nylon thread and
covered with sacrospinal muscle flap.
Results: At 1/2-3 years follow up
post-operation, according to classification of Frankel: four cases
recovered above 2 grade, and 2 cases recovered above 1 grade.
Conclusion: This method can supply good
environment of nerve growth and function of bridge and plank to
segment of injured spinal cord, thus accelerating the recovery of
Treated with Neuroanastamosis
C. Zhang, M.D., and J. Zhao;
Department of Orthopedics, Changhai Hospital
To solve Gatism (loss of control of bowel and bladder due to
authors advised a method for anastamosing an intercostals nerve to the
pudendal nerve. The transplanted nerve was conjoined to the pudendal
nerve using vascularized nerve bridging. The procedure was performed
on 20 cadavers prior to use in humans. The procedure has been done on
six patients. During emergency surgery, the patient's spinal cord was
found to be completely destroyed. Electromyogram (EMG) confirmed loss
of the nervi erigens. Six months after this severe injury, the above
anastamosis was performed, joining the pudendal nerve with an
intercostals nerve using a 16-21 cm piece of the nervi suralis along
with the saphena parva. One-three year follow-up, perineal sensation
returned on the patient's right side, and EMG showed a conductive
potential of 30 msec. For this measurement, the intercostals nerve was
stimulated even though the action potential of the rectal and urethral
sphincters was not marked. This patient can now sense imminent
excretal contamination and, prior to bowel evacuation, can ask for
help. The benefit of this procedure for Gatism in paraplegic patients
seems clear, provided the patient is below the age of 40, and it has
been proved that the spinal cord injury is irreversible.
Degeneration of Lower Extremity After Paraplegia
Shaocheng, Xiu Xianlun, Li Quanhua, Zhao Jie, Yu Jinguo, Yu Baoqing,
Zhang Xuesong; Department of Orthopedics,
Changhai Hospital, Second Military Medical University, Shanghai,
Objective: To study the nerve degeneration
of lower extremity after paraplegia.
Methods: (1) The spinal cords of
experimental dogs were severed between T11-12. The section
of main nerve trunks of lower extremities were studied under
microscope after 3-6 weeks; (2) The sural nerve of later paraplegic
experimental dogs and later paraplegic patients.
Conclusion: No obvious degeneration is found
in lower extremity nerve if the injury place is higher than T11.
for Paraplegia with Bridging Vascularized Intercostal Nerve to Spinal
Cord Nerve Root
Shaocheng, Ji Rongming, Yu Baoqing, et al.;
Department of Orthopedics, Changhai Hospital, Shanghai, 200433.
Objective: To reconstruct partial function
for the later paraplegic patients.
Method: After releasing and
decompressing the injured part of the spinal cord microsurgically, two
intercostal nerves with vessels, of which the distal ends were handled
by microsurgical technique, were transferred and bridged to the spinal
cord nerve root, commonly anastomosed to caude equine. Sometimes the
sural nerve with small saphena vein grafted if necessary.
Results: 31 patients followed up for 1-3
years (average 2.5 years) postoperatively, regained the muscular power
of the lower extremities obviously and could stand up and walk a short
distance with crutches and braces. Of the 31 cases, 9 cases had got
obvious improvement of stool and urination function, means from
Frankel's classification A or B to D, 17 cases had the proprioception
recovered completely, the stool and urination function improved
slightly and no movable function, means from Franckel's A to B or C; 4
cases only had descending of sensational plane and recovery of
noumenon deep sensation of two feet, means from Frankel's A to B; one
Conclusion: The results show that this
method is effective for the younger patients who have had no
recoveries after 1/2-1 year since injury and the continuity of spinal
cord was still present as confirmed by MRI.