The Study Of The Treatment For Total Brachial Plexus Avulsion Injury By Selective Contralateral C7Nerve Transfer

Part1Outcome of selective contralateral C7nerve transferring to median nerve in thetreatment of total brachial plexus avulsion injuryPurpose To evaluate the outcome of patients treated with partial contralateral C7transfer and to determine the factors affecting the outcomes of treatment. Methods A retrospective review of46patients with totally root avulsion brachial plexus injuries who underwent contralateral C7transfer was conducted. All of the surgeries were performed by two surgery stages and median nerve was the recipient nerve. The contralateral C7nerve was used in three different ways. The entire C7root was used in8patients; the posterior division together with the lateral part of the anterior division was used in14patients; the anterior or the posterior division alone was used in24patients. The mean follow-up period was6.4years.Results The efficient of these46patients was47.83%(22/46) in motor and56.52%(26/46) in sensory function. The patients with entire C7root transfer obtained significantly better recovery in both motor and sensory function than the patients with partial C7transfer. The best function recovery could be induced if the interval between two stages was4to8months.Conclusion Selective contralateral C7transfer to median nerve could be an option for the treatment of total brachial plexus avulsion injury. But using the entire C7root as the donor can achieve better recovery and we emphasize using the entire root as the donor. The optimal interval between two surgery stages is4to8months. The posttrauma time should be another key factor for the recovery of this procedure, and the surgery ought to be performed as early as possible. Part2Outcome of selective contralateral C7nerve transfer to two recipient nerves in the treatment of total brachial plexus avulsion injury patientsPurpose The purpose of this report is to present our experience on the use of the contralateral C7(cC7) transfer to reinnervate two recipient nerves in the patients with total brachial plexus avulsion injury and determine the key factors that inference this procedure.Methods We retrospectively reviewed data from22patients with total brachial plexus avulsion injury. Eight patients aged20years or younger and14aged over20years at the time of surgery. The entire cC7was transferred to pedicled ulnar nerve (1st stage of cC7transfer) within6months after injury in12patients and10underwent the procedure longer than6months. The ulnar nerve was transferred to recipients in2n stage which was2to13months after the1st stage. Recipients were median nerve and biceps branch in12patients and median nerve and triceps branch in10.Results Of all the22patients, recovery rate was68.18%in wrist and finger flexor,45.45%in median nerve area sensation,66.67%in elbow flexor, and20%in elbow extensor. The function recovery of median nerve in biceps and triceps groups were equal (p>.05) while functional recovery of biceps branch was significantly better than that of triceps branch (p<.05). There are no statistically significant differences in median nerve function recovery regarding either age or interval between trauma and surgery (p>.05).Conclusions The use of cC7transfer for simultaneous repair of median nerve and biceps branch has shown some recoveries in patients with brachial plexus avulsion injury in this series. This technique may become an option for treatment of total brachial plexus avulsion injury. The entire root of cC7nerve should be used as the donor and the two recipient nerves shoulder be collaborative in motor function. Part3The experimental study of selective contralateral C7nerve transfer in the treatment of total brachial plexus avulsion injuryPurpose The purpose of this experiment is to evaluate the effeciency of selective contralateral C7nerve transfer in the treatment of total brachial plexus avulsion injury and determine the key factors that inference this procedure.Methods Fifty-four SD rats were divided into3groups randomly. Group A:The entire root of contralateral C7nerve was transected and transferred to median nerve on the affected limb bridged by the ulnar nerve of the affected limb via subcutaneous route; Group B:The posterior division of contralateral C7nerve was transected and transferred to median nerve on the affected limb bridged by the ulnar nerve of the affected limb via subcutaneous route; Group C:The entire root of contralateral C7nerve was transected and only the posterior division was transferred to median nerve on the affected limb bridged by the ulnar nerve of the affected limb via subcutaneous route, the anterior division of contralateral C7nerve was transferred to pectoralis major bridged by a free nerve. The electrophysiological examination, muscle tension test, muscle fibers sectional area, neuromorphology and muscle wet weight recovery rate were performed to evaluate the outcome of each group in the8th,12th and16th week postoperatively.Results1. Electrophysiological examination:In the8th,12th and16th week postoperatively, there were no statistical differences in the results of amplitude of median nerve between group A and C (P>0.05) but the results of amplitude of group A and group C were significantly better than that of group B (P<0.05). In the8th,12th week postoperatively, there were no statistical differences in the results of latency of median nerve among group A, B and C (P>0.05), however, in the16th week postoperatively, the results of latency of group A and group C were significantly better than that of group B (P<0.05).2. Muscle tension test:In the8th,12th and16th week postoperatively, there were no statistical differences in the results of muscle tension between group A and C (P>0.05) but the results of muscle tension of group A and group C were significantly better than that of group B (P<0.05).3. Muscle fibers sectional area:In the8th and12th week postoperatively, there were no statistical differences in the results of muscle fibers sectional area between group A and C (P>0.05) but the results of muscle tension of group A and group C were significantly better than that of group B (P＜0.05); In the16th week postoperatively, the result of muscle fibers sectional area of group A was significantly better than those of group B and group C (P<0.05) and the result of group C was significantly better than that of group B (P<0.05).4. Neuromorphology:In the8th,12th, and16th week postoperatively, the result of neuromorphology of median nerve in group A was significantly better than those of group B and group C (P<0.05) and the result of group C was significantly better than that of group B (P＜0.05).5. Muscle wet weight recovery rate:In the8th,12th, and16th week postoperatively, there were no statistical differences in the results of muscle wet weight recovery rate between group A and group C (P>0.05), but the results of muscle wet weight recovery rate of group A and group C were significantly better than that of group B (P＜0.05).Conclusion The motor function recovery of entire contralateral C7nerve transferring even if only the posterior division was transferred was significant better than that of the posterior division of contralateral C7nerve transferring. So we emphasize using the entire contralateral C7nerve as the donor.