Traumatic Brachial Plexus Injury:A Study Of 510 Consecutive Cases From Multicenter Services In Guangxi

Objective To explore the epidemiological characteristics and clinical outcomes of 510 operated patients with traumatic BPI from multicenter services in Guangxi,provide more basic data for the treatment and prevention of this disease.Methods A total of 74 representative hospitals were selected according to the hospital list provided by Guangxi Health Commission and the willing of hospitals.A retrospective study was conducted on 510 operated patients with BPI recruited from these hospitals from 2004 to 2016.The epidemiological characteristics of these cases were analyzed through the clinical data includes basic information,injury history,therapeutic course etc.And the postoperative conditions include recovery,neuropathic pain,psychologic status were assessed by a follow-up survey.The VAS and Yu-Dong Gu’s brachial plexus function evaluation criteria were used to evaluate the condition of limb function.Results This study included 447 males and 63 females,with an average age of 29.04 years,the number of patients from 20 to 39 years old accounted for59.41%;and 77.65%of patients came from township;the number of patients showed an increasing trend from 2004 to 2016,and the proportion of women increased gradually.Traffic accident was the most common cause of injuries（64.71%）,especially motorcycle accident（46.27%）.Closed injuries accounted for 88.24%of cases,83.53%of patients had associated injuries,and the proportions of fracture,brain or spinal cord injury and great blood vessel injury were 76.27%,14.31%and 10.59%respectively.The preoperative predictive value of root injury of MRI and CT was 74.71%and 71.28%,respectively.Only44.71%of patients underwent an initial operation within 6 months after the trauma.Supraclavicular BPI was always frequently and worse,and the proportions of C₅-T₁,C₅-C₇ and C₅-C₆ injury were 42.66%,18.00%and 13.50%respectively.Traumatic neuroma is the most common finding during the operation.Regarding the surgery,neurolysis alone,BP reconstruction,and free gracilis graft accounted for 16.67%,75.50%and 4.51%,respectively.A total of415 patients were followed-up with an average time of 47.95（25⁶8）months,and anxiety or depression were found among 81.20%of them.276 patients suffered from neuropathic pain,with the mild,moderate and severe pain accounted for 67.03%,23.91%and 9.06%,respectively.Additionally,347patients were followed-up for more than 3 years,the patients with isolated infraclavicular lesions often exhibited better outcomes（82.86%）.The rates of successful recovery（i.e.,to Grade 3 or better）in the patients with C₅-C₆,C₅-C₇and C₅-T₁ lesions were 76.81%,58.70%,and 48.21%respectively,and the procedure of neurolysis alone demonstrated a good efficacy（79.45%）.Conclusions BPI is more common in the young men,and traffic accidents are the dominant cause.Timely and effective surgery is important for functional limb recovery.Patients often have neuropathic pain and anxiety which should be paid more attention to.