| Brachial plexus is the general origin of peripheral nerve at upper limbs. Its injury is one common disease that can cause severe disabled. The prognosis of these injuries are usually poor, especially when brachial plexus roots avulsion or post-ganglionic root lesion closed to spinal cord is involved. For hi these cases, The nerve cells are easily being hurted and it is almost impossible to anastomose the scathing nerve root. Currently the best way to restore the brachial plexus in these situations is depending on healthy nerve transfer. Phrenic nerve is acknowledged as the best healthy nerve for transfer, for it possesses such advantages as unceasing electrical impulsion and more nerve fiber.The restoration of elbow flexion should be given priority in those patients with brachial plexus injuries. Biceps brachii muscle is the primary muscle for elbow flexion and it is controlled by musculocutaneous nerve. So it become a common way to use healthy phrenic nerve transfer to musculocutaneous nerve to restore elbow flexion in those patients with brachial plexus injuries. The conventional way is using nerve graft to connect phrenic nerve with musculocutaneous nerve. It was found that nerve regeneration were severely disturbed by nerve graft, and the outcome of the transfer were unsatisfactory. In order to improve curative effect, some doctors attempted to transfer the phrenic nerve to anterior division of the upper trunk of brachial plexus. Bythis way, the transfer distance became short enough to make it possible for anastomosis the scathing nerve root directly. There are few cases of clinical application of this new surgical procedure reported up to now. The indication and contraindication of this new surgical procedure are not roundly clear and need further study in order to avoid disappointment. In this study, the clinical data and follow-up results of the brachial plexus injuries treated in our department in recent years were retrospectively analyzed. These injuries had been respectively performed by two procedures with phrenic nerve transfer to musculocutaneous nerve.Objective: Based on the contrast of the fellow-up results of two surgical procedures, we can make clear the advantages of the new surgical procedure and can summarized some possible causes that greatly influenced its curative effect, with which we can provide reliable evidence for its clinical application and can expect a better curative effect.Methods: 55 patients have been carried out operations with two phrenic nerve transfer procedures respectively from Aug. 1996 to Mar.2003. This study involves 35 patients who have been followed up over 15 months. They were divided into two groups according to different nerve transfer procedures. In the group one, the phrenic nerve had been transferred to anterior division of the upper trunk in 14 cases, and to the musculocutaneous nerve with nerve graft in 21 cases in the group two. The relief of the strain at nerve commissure was attempted in the group one. The operation index of two groups such as blood loss, operation time and incision length were reviewed. The average period of follow-up studies is 20 months (15~42months). Recovery state of musculocutaneous nerve was measured with Nerve-Electrophysiological instrument. The earliest time of the appearance of biceps muscle contraction was recorded. The function of musculocutaneous nerve was evaluated according to the probation criterions established by The Hand Surgery Institute of Chinese Medical Association, and its good rate were calculated. The results were analyzed by SPSS for windows 11.0 statistical software, and a value equal to 0.05 was considered as test standard.Results: 1). In the group of phrenic nerve transfer to upper trunk of brachial plexus,the length of operation incision and the operation time were short, and the blood loss was relatively little. 2). The earliest time of appearance of biceps muscle contraction of phrenic nerve transfer to the anterior division of the upper trunk and to themusculocutaneous ner...
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