Objective To recover the loss of the shoulder and elbow function after superior trunks injury of brachial plexus through multi ple nerves branch transfer simultaneously near the nerve entering points of reci pient nerves. Methods Four male patients (aged 21-39 years) with superior trunks injury of brachial plexus were treated from February to September 2007. All cases were injured in the traffic accident, left side in 1 case and right side in 3 cases, resulting in the loss of shoulder abduction, shoulder extorsion, shoulder l ift and elbow flexion, and the increase of muscle strength of shoulder shrug, elbow extension and finger flexion to above or equal to 4th grade. Patients were hospital ized 3-11 months afterinjury. Electromyography showed that the functions of accessory nerve, ulnar nerve and the branch to long head of tricepsbrachii were good, but the function of median nerve was injured partially. The following multiple donor nerves transfer were performed under general anaesthesia, namely from posterior approach accessory nerve to suprascapular nerve, from triceps to axillary nerve, from the partial branch of ulnar nerve to the biceps and/or brachial is muscular branch of musculocutaneous nerve. Results All incisions healed by first intention. One case suffered postoperative numbness on the ulnar side of hand and was symptomatically rel ieved after expectant treatment, while 3 cases had no manifestation of the motor and sensory functional injury related to donor nerve. All patients were followed up for 7-12 months. All patients regained the shoulder abduction and the elbow flexion 3-4 months after operation and electromyography showed that there was the regenerative potential in 3 recipient muscles. The shoulder abduction, elbow flexion and the muscle strength of the patients was 30-65°, 90-120° and 3-4 grade, respectively, 6-7 months after operation. Twelve months after operation, the first patient’s shoulder abduction, external rotation, superduction and elbow flexion almost returned to normal, and his shape of triangular muscle and biceps muscle were nearly normal. Conclusion Adopting donor nerves with similar functions to conduct the multiple donor nerves transfer in cord level has the advantages of l ittle functional loss at the donor sites, and fast and sound functional recovery at the reci pient sites. It is especially suitable for the superior trunks injury patient with delayed treatment and for the patient with the great risk in supraclavicular exploration, providing a new approach for treating superior trunks injury of brachial plexus.
OBJECTIVE: To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI). METHODS: Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. RESULTS: Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months. CONCLUSION: The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.
ObjectiveTo review the research progress on the establishment of prevertebral pathway in the treatment of unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury by contralateral C7 nerve root transfer.MethodsThe literature about contralateral C7 nerve root transfer via prevertebral pathway at home and abroad was extensively reviewed, and the development, changes, advantages and disadvantages of various operation methods were analyzed and summarized.ResultsAfter unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury, it can be repaired by a variety of surgical methods of the contralateral C7 nerve root transfer via prevertebral pathway, which include the anterior subcutaneous tissue tunnel of the vertebral body, the passage under the sternocleidomastoid muscle, the posterior pharyngeal space and the anterior vertebral fascia passage, the modified posterior esophageal anterior vertebral passage, the anterior vertebral passage that cuts off the bilateral anterior scalene, and Huashan anterior pathway, etc. Among them, how to establish the shortest, safe, and effective way of anterior vertebral canal has been paid more attention and discussed by peripheral nerve repair doctors.ConclusionIt is a safe and effective surgical method to repair unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury patients with contralateral C7 nerve root transfer via prevertebral pathway.