The Research About The Normal S1 Nerve Root As A New Source Of Power And Its Clinical Application

Nowadays,with the development of national economy and modernization,the use of cars increased year by year.Severe pelvic fracture,sacrum fracture caused by the traffic accidents is also rising,there are some patients with sacral plexus injury.As is well-known,nerve injury is one of the common types of injuries that we often encounter in the work of the department of trauma.And the treatment of nerve injury is difficult for orthopaedic doctor.Several factors that influence the repair effect of peripheral nerve injury,mainly include: the extent of nerve injury,surgical time,surgical technique,surgeon experiences,rehabilitation training after surgery or injury,the patient's age and its potential comorbidities.Nerve root avulsion injury is one of the most serious injury.At present,the most commonly used method of treatment is to repair the injured nerve by nerve transfer.Nerve transfer operation method has been widely used in the upper limb of the brachial plexus root avulsion,and achieved good results.But the surgical method is rarely used in treatment of lower extremity sacral plexus root avulsion injury,mainly because of lacking effective donor nerves.Finding effective donor nerves is meaningful in treatment of lower extremity sacral plexus root avulsion injury.Our study intends to use ten months to achieve a group of data about sacral plexus through the study of autopsy,which can guide orthopedics doctors' surgery,provide a theoretical basis for the clinical treatment of the lumbosacral plexus injury and lay the foundation of further research.Part oneObjective:Through anatomy experiment of normal sacral plexus root which can obtain a group of data about them.These data playing a guiding role in the surgical treatment of the sacral plexus nerve root avulsion.Methods:Observation 10 adult sacral plexus specimens.The specimens were provided by the department of anatomy,Second Military Medical University.Of them,5 were male and 5 were female,the average age is 45.5 years old(21-62 years old),skin of all the specimens is complete,excluding those of the lumbar and sacral deformity,trauma and surgical specimens.Spinal nerve root was observed.We use the vernier caliper(0.02 mm)to measure transverse diameter(a)and longitudinal diameter(b)of L4-5 and Sl-3 spinal nerve root out the intervertebral foramen,then according to the formula: Area(s)= A* B / 4 to calculate the cross-sectional area.Then the lumbar sacral nerve roots in the intervertebral foramen were cut,specimens,paraffin,HE staining and counting under microscope has the number of myelinated nerve fiber,the number three times and take the average value.Then we take the samples,paraffin,HE staining,counting the number of myelinated nerve fibers for three times to get the average number using the microscope.Measure the distance between sacral 1 nerve root and nerve hole.Measure the distance between sacral 1 nerve roots to the rest of the sacral plexus.Statistical software was used to analyze the whole data.Results:The length of the S1 nerve root to the hole is 24.10±0.10 mm,The distance of S1 to the contralateral L4,L5,S1,S2,S4 nerve root were 43 + 4.0mm,21.8 + 2.0mm,15.80±0.40 mm,22.90±1.4mm,29.06±0.50 mm,respectively.Conclusion:The present study basically defined the anatomical structure of sacral plexus.Normal S1 nerve root cutting off in the sacral hole after can be directly anastomosed with the contralateral L5,S1,S2 nerve root.S1 fiber number reach the theoretical requirements,which can be used for clinical treatment of lumbosacral plexus injury.Part TWOObjective:We used the measured data to guide the operation of the sacral plexus root avulsion in the normal sacral 1 nerve root as a donor nerves for nerve transfer.Methods:We treated 3 patients with sacral plexus avulsion diagnosed by spinal canal radiography or electrophysiological examination,2 of them were men and the other 1 were women,average age was 29 years(19-43),1 cases injuried in the left,2 in the right,in which the contralateral S1 nerve root was cut off for the repair of sacral roots avulsion injury.All patients had been given a consent before surgery,which let patients know that this was a new treatment method.All patients were followed up for 18.3 months(12-30).In all 3 cases,the contralateral limb were evaluated in detail one week later after the surgery,the follow-up time node were a month,three months,six months and one year after the operation.Every half a year then after the first year.Results:Loss of sense of the contralateral limb appeared in the postoperative week,and complete recovery in 6 months.The EMG examination revealed that the function of the affected limb of the patients had different degrees of recovery after surgery.Conclusion:Clinical evaluation and nerve electrophysiological testing revealed that cut off the normal S1 nerve root will not damage the healthy body function.S1 nerve can be used as donor nerves to repair the lumbosacral plexus nerve avulsion injuries.