{"title":"THE LOCAL EXTENSION OF NERVE FIBRES INTO DENERVATED AREAS OF SKIN.","authors":"G. Weddell, L. Guttmann, E. Gutmann","doi":"10.1093/OXFORDJOURNALS.BMB.A070230","DOIUrl":null,"url":null,"abstract":"Introduction THE existence of extensive overlap between the cutaneous nerve fibres derived from successive nerve roots was first demonstrated by Sherrington (1893) in a study of residual sensibility after section of one or more roots. Other methods, such as that involving local strychninization of the dorsal spinal roots employed by Dusser de Barenne (1910), have been found to give essentially similar results. The method of antidromic stimulation (originally used by Stricker (1876) and Bayliss (1901)) and the study of residual sensibility after the section of dorsal nerve roots were both employed by Foerster (1936) to determine the extent of each human dermatome, and again the correspondence between the results obtained by both methods was close. The amount of overlap which exists between the peripheral cutaneous nerves of the limbs has been determined by a number of methods, which include anatomical dissection, the successive anesthetization of nerves supplying contiguous areas of skin followed by sensory tests (Woollard et al., 1940), electrical stimulation methods through the intact skin (Thompson et al., 1934), and finally by the analysis of the sensory loss following peripheral nerve injuries in a large series of patients (Foerster, 1917, 1929). The correspondence between the stimulation and anwsthetization methods is reasonably close. On the other hand, the analysis of sensory loss and sweat secretion (Guttmann, 1940) following nerve injuries shows in many cases very large degrees of overlap which are not demonstrated by the other methods. This finding, taken in conjunction with the clinical observation by Pollock (1920) that the areas of sensory loss following nerve injuries shrink circumferentially before any regeneration can have taken place from the central stump, suggests either that the method of recording residual sensibility is not entirely accurate or that a proportion of overlapping nerve fibres do not transmit impulses giving rise to sensations for some time following a nerve lesion (Pollock, 1919). It is also possible that a new growth of fibres from surrounding normal nerves towards the area of sensory loss takes place (Schuh, 191 1, and Weddell and Glees, 1941). The method of staining nerve fibres throughout large whole preparations of skin by local injection of methylene blue (Weddell, 1941) has been applied 206","PeriodicalId":54783,"journal":{"name":"Journal of Neurology and Psychiatry","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"1943-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.BMB.A070230","citationCount":"56","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neurology and Psychiatry","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/OXFORDJOURNALS.BMB.A070230","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 56
Abstract
Introduction THE existence of extensive overlap between the cutaneous nerve fibres derived from successive nerve roots was first demonstrated by Sherrington (1893) in a study of residual sensibility after section of one or more roots. Other methods, such as that involving local strychninization of the dorsal spinal roots employed by Dusser de Barenne (1910), have been found to give essentially similar results. The method of antidromic stimulation (originally used by Stricker (1876) and Bayliss (1901)) and the study of residual sensibility after the section of dorsal nerve roots were both employed by Foerster (1936) to determine the extent of each human dermatome, and again the correspondence between the results obtained by both methods was close. The amount of overlap which exists between the peripheral cutaneous nerves of the limbs has been determined by a number of methods, which include anatomical dissection, the successive anesthetization of nerves supplying contiguous areas of skin followed by sensory tests (Woollard et al., 1940), electrical stimulation methods through the intact skin (Thompson et al., 1934), and finally by the analysis of the sensory loss following peripheral nerve injuries in a large series of patients (Foerster, 1917, 1929). The correspondence between the stimulation and anwsthetization methods is reasonably close. On the other hand, the analysis of sensory loss and sweat secretion (Guttmann, 1940) following nerve injuries shows in many cases very large degrees of overlap which are not demonstrated by the other methods. This finding, taken in conjunction with the clinical observation by Pollock (1920) that the areas of sensory loss following nerve injuries shrink circumferentially before any regeneration can have taken place from the central stump, suggests either that the method of recording residual sensibility is not entirely accurate or that a proportion of overlapping nerve fibres do not transmit impulses giving rise to sensations for some time following a nerve lesion (Pollock, 1919). It is also possible that a new growth of fibres from surrounding normal nerves towards the area of sensory loss takes place (Schuh, 191 1, and Weddell and Glees, 1941). The method of staining nerve fibres throughout large whole preparations of skin by local injection of methylene blue (Weddell, 1941) has been applied 206
Sherrington(1893)在对一个或多个神经根切除后残余敏感性的研究中首次证实了来源于连续神经根的皮神经纤维之间存在广泛的重叠。其他方法,如Dusser de Barenne(1910)所采用的脊髓后根局部strychninization,也得到了基本相似的结果。Foerster(1936)采用反角刺激法(最初由Stricker(1876)和Bayliss(1901)使用)和背神经根切片后残余敏感性的研究来确定人体每个皮节的范围,两种方法得到的结果也非常吻合。肢体周围皮神经之间存在的重叠量已通过多种方法确定,包括解剖解剖,连续麻醉供应连续皮肤区域的神经,然后进行感觉测试(woolard等人,1940),通过完整皮肤的电刺激方法(Thompson等人,1934),最后通过对大量患者周围神经损伤后感觉丧失的分析(Foerster, 1917, 1929)。刺激和激励方法之间的对应关系相当密切。另一方面,对神经损伤后感觉丧失和汗液分泌的分析(Guttmann, 1940)显示,在许多情况下,其他方法没有显示出非常大程度的重叠。这一发现与Pollock(1920)的临床观察相结合,即神经损伤后的感觉丧失区域在中央残端再生之前会呈周向收缩,这表明要么记录残余敏感性的方法并不完全准确,要么部分重叠的神经纤维在神经损伤后的一段时间内不能传递产生感觉的冲动(Pollock, 1919)。也有可能是周围正常神经的纤维向感觉丧失区域生长(Schuh, 1991, and Weddell and Glees, 1941)。通过局部注射亚甲基蓝染色神经纤维的方法已经应用于整个皮肤的大制剂(Weddell, 1941)