The toe-spreading reflex of the rabbit revisited--functional evaluation of complete peroneal nerve lesions.

Although a variety of electrophysiological and morphological tests are available for studying nerve regeneration in animals, these endpoints do not necessarily correlate with the return of muscle function. Recent efforts have focused on the assessment of function as the endpoint of nerve regeneration. One of the best known of these tests is the sciatic function index in rats. For rabbits, the toe-spreading reflex has been suggested as a valuable index of peroneal function. We examined the reliability and sensitivity of the toe-spreading reflex in a study of nerve regeneration of the peroneal nerve in 10 New Zealand White rabbits. Eleven weeks after the transection and immediate suturing of the peroneal nerve in both hind legs (at two slightly different sites), a toe-spreading reflex could always be elicited on that side where the level of the severed nerve was closer to the dependent muscles. Also on this hind leg the muscle weight of the peroneal target muscles was significantly higher (P = 0.031) than on the contralateral side, which corresponds well to the results of the toe-spreading reflex. The toe-spreading reflex is an excellent and sensitive indicator of the onset of motor recovery in the peroneal nerve-dependent muscles of rabbits. Even small differences in the localization of lesions in both hind legs can be differentiated with this test.     

Target-specific nerve regeneration through a nerve guide in the rat

Nerve regeneration across a gap in peripheral nerve has been achieved through various nonneural nerve guides in both lower and primate species. This technique can only be useful if the regenerated nerve cable grows specifically to and reinnervates the appropriate distal target. In this study, the proximal peroneal fascicle of rat sciatic nerve was inserted into the proximal limb of a Y-shaped nerve guide. Distal peroneal and tibial fascicles were placed within the two distal limbs of the same Y. The proximal peroneal nerve grew preferentially by a 2:1 ratio to the appropriate distal peroneal fascicle suggesting that target-specific reinnervation is possible through a nerve guide.     

A Rabbit Model for Peripheral Nerve Reconstruction Studies Avoiding Automutilation Behavior

Background  The rabbit sciatic nerve injury model may represent a valuable alternative for critical gap distance seen in humans but often leads to automutilation. In this study, we modified the complete sciatic nerve injury model for avoiding autophagy. Materials and Methods  In 20 adult female New Zealand White rabbits, instead of transecting the complete sciatic nerve, we unilaterally transected the tibial portion and preserved the peroneal portion. Thereby loss of sensation in the dorsal aspect of the paw was avoided. The tibial portion was repaired in a reversed autograft approach in a length of 2.6 cm. In an alternative repair approach, a gap of 2.6 cm in length was repaired with a chitosan-based nerve guide. Results  During the 6-month follow-up period, there were no incidents of autotomy. Nerve regeneration of the tibial portion of the sciatic nerve was evaluated histologically and morphometrically. A clear difference between the distal segments of the healthy contralateral and the repaired tibial portion of the sciatic nerve was detectable, validating the model. Conclusion  By transecting the isolated tibial portion of the rabbit sciatic nerve and leaving the peroneal portion intact, it was possible to eliminate automutilation behavior.     

在不同的交感中枢活动水平时刺激腓深神经对肾神经发放的影响

本工作记录家免肾神经冲动和动脉血压,观察电刺激腓深神经的效应。在用减少通气量、切断双侧迷走神经、切断双侧缓冲神经等方法使交感中枢活动水平升高时,刺激腓深神经(3V、10Hz、0.3ms 持续15min)对血压无明显影响,但可以抑制肾神经的发放。相反,用过度通气或刺激一侧降压神经的方法使交感中枢活动水平降低时,同样的参数刺激腓深神经,则使肾神经发放增加。刺激腓深神经对肾神经发放的抑制效应,可为静脉注射纳洛酮阻断,而兴奋效应则被静脉注射东莨菪碱阻断。上述结果表明:低频低强度刺激腓深神经可引起肾神经发放的抑制或增强,其效应取决于交感中枢的活动状态。躯体传入对肾神经发放的抑制效应有内源性阿片样物质参与,而躯体传入对肾神经发放的兴奋效应则和中枢胆碱能系统的激活有关。     

Taurine in the developing rabbit visual system: changes in concentration and axonal transport including a comparison with axonally transported proteins.

[35S]Taurine injected intravitreally into rabbits was transported axonally to the optic nerve terminals. Considerably more [35S]taurine was transported in young rabbits than in mature rabbits. The time course of taurine transport did not parallel that of proteins labeled with [3H]proline in the same system. The concentration of taurine in all components of the visual system, except retina, was greater in young animals than in mature animals, and was especially high in optic nerve. The possible functions of the high concentrations of taurine and the greater amount of axonally transported taurine in developing mammalian CNS are discussed.     

Crossed leg palsy; with report of a recurrent case

A form of peroneal palsy may be caused by crossing the legs. Two physical factors-pressure and tension - are the basic causes, although other factors may be contributory. Direct pressure is applied by the bones of the two legs, compressing the peroneal nerve between them at its superficial part near the head and neck of the fibula. The palsy may be overlooked as an integral part of a widespread disorder so that careful evaluation and observation of the patient's habits are required. Detection becomes especially difficult when the palsy is bilateral, for then the lesion by virtue of its symmetry blends more readily with associated polyneuritis. A case of recurrent peroneal palsy due to crossing the legs in a prolonged postoperative convalescence is reported in detail.     

CROSSED LEG PALSY with Report of a Recurrent Case

A form of peroneal palsy may be caused by crossing the legs. Two physical factors—pressure and tension — are the basic causes, although other factors may be contributory. Direct pressure is applied by the bones of the two legs, compressing the peroneal nerve between them at its superficial part near the head and neck of the fibula.The palsy may be overlooked as an integral part of a widespread disorder so that careful evaluation and observation of the patient''s habits are required. Detection becomes especially difficult when the palsy is bilateral, for then the lesion by virtue of its symmetry blends more readily with associated polyneuritis. A case of recurrent peroneal palsy due to crossing the legs in a prolonged postoperative convalescence is reported in detail.     

不同激光照射方法对周围神经再生的影响

为研究不同半导体激光照射方法对周围神经损伤的影响,将96只家兔随机分为3周,6周,9周,12周4个观察期组,每个观察期组又随机分为不同照射方法的治疗组和对照组。建立动物模型后,各照射组在术后1d开始照射治疗,激光功率为10mw,每次照射10rain,每天一次,连续照射10d。照射治疗A组对准损伤神经吻合部位进行照射,照射治疗B组照射家兔L5、L6脊髓节段,照射治疗c组在对准吻合处进行照射同时还要照射L5、L6脊髓节段,对照组激光输出功率为零。实验结果表明低能量半导体激光照射能促进轴突再生,改善再生神经功能,以同时照射损伤周围神经部位和相应脊髓节段效果最为显著。     

Decompression of the common peroneal nerve: experience with 20 consecutive cases

A retrospective review of 20 patients with common peroneal nerve palsy treated with decompression between 1986 and 1997 was undertaken. Subjects were evaluated preoperatively and postoperatively by electromyography, nerve conduction, and clinical measures. The mean interval between the onset of symptoms to surgery (operative delay) was 15.9 months. The mean postoperative follow-up was 32.2 months with a minimum follow-up of 1 year. Decompression was performed at the level of the fibular neck and slightly distally at the tendinous origin of the peroneus longus using a standard approach to release tight fascial structures or scar tissue. External neurolysis was performed using the operating microscope in two cases for which scarring of the nerve was identified intraoperatively. Postoperatively, 19 of 20 patients showed improvement in ankle dorsiflexion as assessed by the Medical Research Council scale. Electromyographic examination was useful in the preoperative evaluation and selection of patients for decompression surgery. In conclusion, decompression even after a 1-year delay may offer benefit and suggest early intervention in patients with a severe lesion.     

"Donor" muscle structure and function after end-to-side neurorrhaphy

End-to-end nerve coaptation is the preferred surgical technique for peripheral nerve reconstruction after injury or tumor extirpation. However, if the proximal nerve stump is not available for primary repair, then end-to-side neurorrhaphy may be a reasonable alternative. Numerous studies have demonstrated the effectiveness of this technique for muscle reinnervation. However, very little information is available regarding the potential adverse sequelae of end-to-side neurorrhaphy on the innervation and function of muscles innervated by the "donor" nerve. End-to-side neurorrhaphy is hypothesized to (1) acutely produce partial donor muscle denervation and (2) chronically produce no structural or functional deficits in muscles innervated by the donor nerve. Adult Lewis rats were allocated to one of two studies to determine the acute (2 weeks) and chronic (6 months) effects of end-to-side neurorrhaphy on donor muscle structure and function. In the acute study, animals underwent either sham exposure of the peroneal nerve (n = 13) or end-to-side neurorrhaphy between the end of the tibial nerve and the side of the peroneal nerve (n = 7). After a 2-week recovery period, isometric force (F(0) was measured, and specific force (sF(0) was calculated for the extensor digitorum longus muscle ("donor" muscle) for each animal. Immunohistochemical staining for neural cell adhesion molecule (NCAM) was performed to identify populations of denervated muscle fibers. In the chronic study, animals underwent either end-to-side neurorrhaphy between the end of the peroneal nerve and the side of the tibial nerve (n = 6) or sham exposure of the tibial nerve with performance of a peroneal nerve end-to-end nerve coaptation approximately 6), to match the period of anterior compartment muscle denervation in the end-to-side neurorrhaphy group. After a 6-month recovery period, contractile properties of the medial gastrocnemius muscle ("donor" muscle) were measured. Acutely, a fivefold increase in the percentage of denervated muscle fibers (1 +/0 0.7 percent to 5.4 +/-2.7 percent) was identified in the donor muscles of the animals with end-to-side neurorrhaphy (p < 0.001). However, no skeletal muscle force deficits were identified in these donor muscles. Chronically, the contractile properties of the medial gastrocnemius muscles were identical in the sham and end-to-side neurorrhaphy groups. These data support our two hypotheses that end-to-side neurorrhaphy causes acute donor muscle denervation, suggesting that there is physical disruption of axons at the time of nerve coaptation. However, end-to-side neurorrhaphy does not affect the long-term structure or function of muscles innervated by the donor nerve.     

Taurine in the developing rabbit visual system: Changes in concentration and axonal transport including a comparison with axonally transported proteins

[³⁵S]Taurine injected intravitreally into rabbits was transported axonally to the optic nerve terminals. Considerably more [³⁵S]taurine was transported in young rabbits than in mature rabbits. The time course of taurine transport did not parallel that of proteins labeled with [³H]proline in the same system. The concentration of taurine in all components of the visual system, except retina, was greater in young animals than in mature animals, and was especially high in optic nerve. The possible functions of the high concentrations of taurine and the greater amount of axonally transported taurine in developing mammalian CNS are discussed.     

Functional evaluation of complete sciatic, peroneal, and posterior tibial nerve lesions in the rat

Quantification of peripheral nerve regeneration in animal studies of nerve injury and repair by histologic, morphologic, and electrophysiologic parameters has been controversial because such studies may not necessarily correlate with actual nerve function. This study modifies the previously described sciatic functional index (SFI), tibial functional index (TFI), and peroneal functional index (PFI) based on multiple linear regression analysis of factors derived from measurements of walking tracks in rats with defined nerve injuries. The factors that contributed to these formulas were print-length factor (PLF), toe-spread factor (TSF), and intermediary toe-spread factor (ITF). It was shown that animals with selective nerve injuries gave walking tracks that were consistent, predictable, and based on known neuromuscular deficits. The new formula for sciatic functional index was compared with previously described indices. The sciatic functional index, tibial functional index, and peroneal functional index offer the peripheral nerve investigator a noninvasive quantitative assessment of hindlimb motor function in the rat with selective hindlimb nerve injury.     

缓冲神经在刺激兔下丘脑诱发室性期前收缩中的作用

1.静脉注射氰化钾(0.3mg/kg)可引起血压升高和室性心律失常,并能使刺激下丘脑诱发的室性期前收缩增多。去除双侧窦神经后,上述现象消失。2.刺激降压神经时,刺激下丘脑诱发的室性期前收缩显著减少。3.切断双侧缓冲神经后短时内,刺激下丘脑诱发的室性期前收缩极度增多,并且不易被躯体传入冲动所抑制。二小时后,这种室性期前收缩减少,且可为刺激腓深神经所抑制。4.电刺激延髓中线区不仅可以降低血压,而且能减弱刺激下丘脑诱发的升压反应、抑制刺激下丘脑诱发的室性期前收缩。损毁该区后,刺激腓深神经不再能抑制刺激下丘脑诱发的室性期前收缩。5.上述结果表明:化学感受性反射能易化刺激下丘脑诱发的室性期前收缩,而压力感受性反射可以抑制这种室性期前收缩,但躯体传入冲动对这种心律失常的抑制作用并不依赖于缓冲神经的存在,而有赖于延髓中线核群的完整性。     

Characteristics of the neuronal reaction of the substantia nigra to nociceptive stimulation

The nature of neurone response of substance nigra (SN) to nociceptive stimulation of the cat's peroneal nerve has been studied. The recording of neurone SN firing rate revealed that the majority (71.0%) of the SN neurones responded to the nociceptive repetitive stimulation of the peroneal nerve. But the thresholds of nociceptive activation in SN neurones turned to be very high. As a result of it the number of SN neurones responding to repetitive peroneal stimulation was twice as many as the number of cells responding to single stimulation of the nerve. The intravenous injection of naloxone in dose 1.0 mg/kg changed both excitatory and inhibitory responses in majority (71.4%) of SN neurones responding to repetitive peroneal stimulation. Naloxone did not modify the firing rate of neurones nonresponsive to nociception.     

Aberrant cutaneous nerve of the thigh arising from the sciatic nerve in the human

An aberrant cutaneous nerve of the thigh arising from the peroneal portion of the human sciatic nerve or common peroneal nerve was observed in 9 cases (4.6% of sides). After giving a branch to the short head of the biceps femoris muscle and a branch to the knee joint, this cutaneous nerve reaches the subcutaneous tissue by passing between the short head of the biceps femoris and the vastus lateralis or by piercing through the biceps femoris. The authors presume that the cutaneous nerve shows the presence of the potential cutaneous nerve routes from the common peroneal nerve to the skin of the lateral aspect of the thigh.     

The harvest and clinical application of the superficial peroneal sensory nerve for grafting motor and sensory nerve defects.

Potential donor nerves for autografting are finite and usually limited to cutaneous nerves of the extremities. The superficial peroneal nerve is the major lateral branch of the common peroneal nerve that innervates the peroneus longus and brevis muscles and provides sensation to the lateral aspect of the lower leg and the dorsal foot. It has generally been overlooked as a potential donor of nerve autografts. Cadaver dissections were performed on 10 fresh lower extremity specimens to investigate the anatomic characteristics of the superficial peroneal nerve and to refine a harvesting technique for the nerve. Thirty-one patients underwent nerve grafting of 39 upper and lower extremity nerves using the superficial peroneal donor. There were nine median nerves, four ulnar nerves, two radial nerves, two brachial plexus lesions, 16 digital nerves, and six lower extremity nerves grafted. The superficial peroneal nerve provided a consistently long donor, comparable in length to the sural nerve. The anatomic pattern is consistent, the patient positioning is simple, the surgical harvesting technique is straightforward, and the donor defect is acceptable. The superficial peroneal nerve provides a safe and valuable donor nerve, particularly in cases where multiple or very long nerve grafts are required.     

A new surgical technique for the treatment of high common peroneal nerve palsy

In this article, the authors introduce a new procedure for the treatment of high common peroneal nerve palsy. The principle of this technique consists of the neurotization of the anterior tibial nerve (deep peroneal nerve) with the bundle composed of the nerves to the soleus and lateral head of gastrocnemius muscles. The authors used this procedure for eight children who had permanent common peroneal nerve palsy caused by the injection of diclofenac in the gluteal region and for a 25-year-old male patient whose common peroneal nerve was transected near the gluteal region by a stab wound. For the cases in which paralysis was less than 8 months in duration, the results are satisfactory.     

Nerve regeneration through side-to-side neurorrhaphy sites in a rat model: a new concept in peripheral nerve surgery

Despite great improvement and refinements in nerve repair techniques, there were still problems in repair of peripheral nerve injuries for which proximal stumps were not available. In these circumstances for which classic end-to-end neurorrhaphy was impossible, new treatment modalities, benefiting by an adjacent healthy nerve, have been under investigation to overcome this problem. Therefore, end-to-side nerve repair with its modifications came to view and axonal passages through this site were shown. Moreover, the results were unsatisfactory or necessitating sacrifice of another healthy nerve. Three groups, containing 10 rats each, were included in the study. First was the control group, with end-to-end repair of the peroneal nerve. Second was the end-to-side repair group, in which the distal stump of the peroneal nerve trunk was anastomosed to the lateral side of the tibial nerve. The third was the side-to-side repair group. In this technique, 1-mm diameter epineural windows, both from peroneal and tibial nerve trunks facing each other, were removed and side-to-side neurorrhaphy was performed. After 3 weeks, as the second step, the peroneal nerve was sectioned proximally. At 2, 4, 8, 12, 20, and 28 weeks, functional assessment of nerve regeneration was performed by using walking track analysis. The number of myelinated fibers and fiber diameters were measured and an electron microscopic evaluation was carried out. Statistically, both in morphometric and gait analysis, the differences in values between the groups were significant in favor of the control group, followed by the side-to-side group. The study showed that axonal passage was possible with side-to-side technique and the functional results were satisfactory and superior to the end-to-side technique. Continuous supply of neurotrophic factors from their target cells was the probable cause of superior functional return in side-to-side repair, because both joining nerves were intact and healthy during the anastomosis procedure and after 3 weeks. It was concluded that this technique could be indicated in salvage of nerves in cases for which any intermediate segments would be removed, as in tumor ablation surgery, harvesting of nerve grafts, or both.     

Use of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injuries

When patients enter the Rehabilitation Centre a therapeutic electrical stimulation programme is immediately initiated. Three groups of patients were identified: (i) those in whom an improvement of both voluntary and stimulated muscle force was observed, (ii) those with an increase in stimulation response only, and (iii) patients in whom no effect of electrical stimulation training could be recorded. Isometric measurement of voluntary and stimulated knee joint torque revealed that in a great number of patients one leg was severely paralysed while the other leg was under sufficient voluntary control. Unilateral two-channel stimulation of knee extensors and the peroneal nerve was proposed as an orthotic aid for this group of patients. Exaggerated extensor tone was observed by assessment of spasticity around the knee joint. A two-channel peroneal stimulator was found to be a useful approach in order to inhibit this tone and thereby help the patients to initiate a step.     

Moderately Different NADPH-Diaphorase Positivity in the Selected Peripheral Nerves after Ischemia/ Reperfusion Injury of the Spinal Cord in Rabbit

1. To vicariously investigate the nitric oxide synthase (NOS) production after spinal cord injury, NADPH-d histochemistry was performed on the selected peripheral nerves of adult rabbits 7 days after ischemia. The effect of transient spinal cord ischemia (15 min) on possible degenerative changes in the motor and mixed peripheral nerves of Chinchilla rabbits was evaluated.2. The NADPH-diaphorase histochemistry was used to determine NADPH-diaphorase activity after ischemia/reperfusion injury in radial nerve and mediane nerve isolated from the fore-limb and femoral nerve, saphenous nerve and sciatic nerve separated from the hind-limb of rabbits. The qualitative analysis of the optical density of NADPH-diaphorase in selected peripheral nerves demonstrated different frequency of staining intensity (attained by UTHSCSA Image Tool 2 analysis for each determined nerve).3. On the seventh postsurgery day, the ischemic spinal cord injury resulted in an extensive increase of NADPH-d positivity in isolated nerves. The transient ischemia caused neurological disorders related to the neurological injury—a partial paraplegia. The sciatic, femoral, and saphenous nerves of paraplegic animals presented the noticeable increase of NADPH-d activity. The mean of NADPH-diaphorase intensity staining per unit area ranged from 134.87 (±32.81) pixels to 141.65 (±35.06) pixels (using a 256-unit gray scale where 0 denotes black, 256 denotes white) depending on the determined nerve as the consequence of spinal cord ischemia. The obtained data were compared to the mean values of staining intensity in the same nerves in the limbs of control animals (163.69 (±25.66) pixels/unit area in the femoral nerve, 173.00 (±32.93) pixels/unit area in saphenous nerve, 186.01 (±29.65) pixels/unit area in sciatic nerve). Based on the statistical analysis of the data (two-way unpaired Mann–Whitney test), a significant increase (p≤0.05) of NADPH-d activity in femoral and saphenous nerve, and also in sciatic nerve (p≤0.001) has been found. On the other hand, there was no significant difference between the histochemically stained nerves of fore-limbs after ischemia/reperfusion injury and the same histochemically stained nerves of fore-limbs in control animals.4. The neurodegenerative changes of the hind-limbs, characterized by damage of their motor function exhibiting a partial paraplegia after 15 min spinal cord ischemia and subsequent 7 days of reperfusions resulted in the different sensitivity of peripheral nerves to transient ischemia. Finally, we suppose that activation of NOS indirectly demonstrable through the NADPH-d study may contribute to the explanation of neurodegenerative processes and the production of nitric oxide could be involved in the pathophysiology of spinal cord injury by transient ischemia.