Repair The Axillary Nerve In The Patinets With Brachial Plexusi Injury:Anatomical And Clinical Studies

Objective:(1) Combined with clinical data and autopsy, to Investigate the incidence probability of axillary nerve injury in the quadrilateral space in brachial plexus injury patients, provide a theoretical basis to improve the clinical effects of nerve transfer repair the axillary nerve.(2) the surgical anatomy of the triceps motor branches and the axillary nerve was studied with the goal of providing anatomic basis for transferring the triceps motor branches to axillary through a posterior approach.Methods:(1) Case study:40brachial plexus injury patients who nerve transfers were indicated for the repair the axillary nerve received the quadrilateral space and axillary nerve exploration through the posterior approach.(2)Anatomic study:both upper extremities of15embalmed cadavers were dissected. the relationship of the axillary nerve to internal structure of the space was recorded. The radial nerve was dissected together with the triceps motor branches.Results:(1) Case study:12cases(30%) presented the axillary never injury Anatomic study:the range of movement of the axillary nerve in the quadrilateral was only1cm up and down. the quadrilateral space exists tendon fibers in26 cases (87%). with the shoulder Subluxation, the axillary nerve tension increases; with the shoulder flexion and extension, the axillary nerve close to the joint capsule, tendon fibers, the long head of triceps tendon, and with friction.(2) Triceps motor branchs of anatomical features:in medial to lateral direction, the motor branch to the triceps long head(LoHM) was the first branch to be identified, followed by the upper branch to the medial head(UMHM), then the lower branch to the triceps medial head(LMHM) and anconeus muscle, and finally the upper lateral head motor branch(ULaHM). the average diameter of LoHM was2.15±0.44mm and the lengthBC was19.64±4.72mm; the average diameter of UMHM was1.65±0.41mm and the lengthBC was49.80±8.93mm; the average diameter of LMHM was1.87±0.32mm and the lengthBC was85.14±6.75mm;the average diameter of ULaHM was1.75±0.31mm and the lengthBC was43.55±9.17mm.Conclusions:(1) Patients with brachial plexus injury is often associated with the axillary nerve injury in the quadrilateral space, who underwent nerve transfer repair the axillary nerve, it is necessary to probe whether the injury.(2) Any one branch of triceps motor branchs can be chosen to transfer to repair the axillary nerve. the long head branch should be preferred。...