Diagnostic Value Of Emg And Mri In The Root Injury Of Brachial Plexus

Objective: The root of brachial plexus injury caused by trauma is verycommon in clinical work, it shows a gradual upward trend in recent years,with its difficulty to be cured, poor prognosis and high morbidity, it carriedgreat harm to the patient's family and social. The current medical techniquescan not achieve a complete cure of the disease. To the surgical treatment,many experts believed that it is better to use of nerve transposition surgery forthe root complete injury as use the neurolysis, nerve decompression, nervesuture or nerve grafting for the root incomplete injury depending on the degreeof injury. It is beneficial of earlier precise position and qualitative diagnosisfor the damage nerve roots to selected a right treatment, then conducted to themaximum recovery of limb function. EMG and MRI is the method ofclinical judgment in location and qualitative of brachial plexus injury, both canmake a certain extent evaluations to the continuity and function of the nerveroot and its filamentous structure, and there are also some limitations inclinical applications.This project aims to explore the clinical value of the two methods in thediagnosis of complete and incomplete brachial plexus injury, and expect toprovide the basis for clinical treatment.Methods: A retrospective analysis was conducted on a certain hospital's20inpatient medical records that were diagnosis with brachial plexus injuryfrom March,2010to March,2012. Male19cases, female1case, age15to59,average33.3; the left side2cases, right side8cases,3days to180daysmedical history, average46days. Sensitivity, specificity, accuracy, positivepredictive value and negative predictive value was calculated at differentcutoff value given by the result of surgery and Electrophysiologicalexamination. Compare the difference between these two diagnosis methods. Results: Within the100nerve root examined by postoperativeElectrophysiological examination, the number of complete injury, partialinjury and normal nerve root were40,16,44; Within the100nerve rootexamined by preoperative EMG, the number of complete injury, incompleteinjury and normal nerve root were30,25,45, Sensitivity, specificity, accuracy,positive predictive value and negative predictive values is87.1%,90.1%,89%,87.1%,90.1%for complete injury,61.5%,90.7%,83.9%,66.6%,90.7%forpartial injury. Examined by MRI the number of complete injury, partial injuryand normal nerve root were38,16,46, Sensitivity, specificity, accuracy,positive predictive value and negative predictive values is89.5%,94.7%,92.1%,94.4%,90%for complete injury,61.5%,90.7%,83.9%,66.6%,90.7%for partial injury; There is no difference between these two diagnosismethods(P=0.2, Wilcoxon signed ranks test). A combination of the twomethods diagnosis of sensitivity, specificity, and accuracy increased to98.2%,95.5%,97%.Conclusion:1The sensitivity, specificity and accuracy of brachial plexus completeinjury diagnosis given by MRI higher then EMG, MRI can be used as the firstchoice of examination of serious injury and the acute phase of disease.2MRI shows lower sensitivity and higher specificity then EMG fordiagnosis of partial injury. Patients who was diagnosis brachial plexus injurylighter suggested for the two examination.3The positive rate of these two diagnosis methods is almost the same,May have different options for patients with complex injuries injuries,Diagnosis accuracy of brachial plexus injury can be improved by combiningthe preoperative EMG and MRI examination.