Objective To investigate the quantity and distribution of motor fiber of rat’s C7 nerve root. Methods Motor fiber quantity and section area in the main nerves of the upper extremity and the fascicles of C7 in 30 SD rats were analyzed.Results Fascicles and certain amount (207) of motor fibers from the anterior division of C7 were distributed to musculocutaneous nerve and median nerve, the orientation of these fibers were not clear. The ones (323) from posterior division were to the axillary, radial, and dorsal thoracic nerves, thus the orientation of these fascicles was relatively definite. Conclusion Thedistribution of the motor fibers and fascicles in the divisions of C7 in rat is similar to human beings, so rat is a relatively good model for the study of selective C7 nerve root transfer.
The results of nerve transposition for root avulsion of brachial plexas in 21 cases were reported. The methods of the nerve transposition were divided into four groups as followings: By transfer of phrenic nerve, accesory nerve, the motor branches of cervical plexus and intercostal nerves in cease; By transfer of phrenic nerve, accessory nerve and the motor branches of cervical plexus in 6 cases; By transfer of phrenic nerve and accessory nerve in 9 cases, and by transfer of phrenic nerve or the motor branches of cervical plexus or intercostal nerve in 5 cases. During operation, in 1 cases variation of the brachial plexus was found. Injury to the subclavian artery occurred in 4 cases and they were repaired, which is good for the blood circulation of the upper arm and nerve regeneration. Nineteen cases were followed up with good results. The overall excellent and good rate was 73.7%. It was considered that transposition of nerve should be a routine operation for the treatment of root avulsion of brachial plexus and the accompanied arterial injury should be repaired at the same time during operation, and the latter would be advantageous to enhance functional recovery of nerve.
The report of brachial plexus injuries following radical mastectomy in patients with breast cancer was rare even though the operation was a main measure in treating with breast cancer. Nine patients treated from Oct. 1989 to Feb.1991 were summarized. The results were not ideal.
OBJECTIVE: To investigate the variation of neurotrophic factors expression in spinal cord and muscle after root avulsion of brachial plexus. METHODS: Forty-eight Wistar rats were involved in this study and according to the observing time in 1st day, 1st week, 4th week, 8th week, and 12th week after avulsion, and the control, were divided into 6 groups. By immunohistochemical and hybridization in situ assays, the expression of nerve growth factor (NGF) on muscle, basic fibroblast growth factor(bFGF) and its mRNA on the neurons of corresponding spinal cord was detected. Computer image analysis system was used to calculate the result. RESULTS: After the root avulsion of brachial plexus occurred, expression of NGF increased and reached to the peak at the 1st day. It subsided subsequently but was still higher than normal control until the 12th week. While expression of bFGF and its mRNA increased in the neurons of spinal cord and reached to the peak at the 1st week. Then it dropped down and at the 12th week it turned lower than normal control. CONCLUSION: After root avulsion of brachial plexus, neurotrophic factors expression increase on target muscle and neurons of corresponding spinal cord. It maybe the autoregulation and may protect neuron and improve nerve regeneration.
Objective To investigate the results of two stage multiple nerves transfer for treatment of complete brachial plexus root avulsion. Methods Eight patients with complete brachial plexus avulsion, aging 18-38 years andwith a mean 6 months interval of injury and repair, were surgically treated with the following procedures. One stage surgical procedure was that the contralateral C7 never root was transferred to the ulnar nerve, the phrenic nerve to theanterior division of upper trunci plexus brachialis and the accessory nerve to the suprascapular nerve. Two stage surgical procedure was that the ulnar nerve was transferredto the median nerve , the intercostal nerves to the radial nerve and the thoracodorsal nerve. Results All patients were followed upfrom 13 months to 25 months(21 months on average), muscle reinnervation was observed in all patients. Return of muscle power of M3 or better are regarded as effective. The effective recovery results were 75% in musculocutaneous nerve, 37.5% in suprascapular nerve, 37.5% in radial nerve, 75% in thoracodorsal nerve and 62.5% in median nerve. In sensory recovery of the median nerve, 4 patients obtained S3, 3 patients S2 and 1 patient S1. Conclusion Two stage multiple nerves transfer for treatment of root avulsion of brachial plexus can achieve better motor function results and is safe and effective. The procedure should be recommended for treatmentof root avulsion of brachial plexus in selected patients with complete brachial plexus root avulsion, especially in young patients with a short interval between injury and repair. It isone of the alternative options.
Objective To observe the recovery of the sensory and motor function of the repaired l imb and the impact on the healthy l imb function after contralateral C7 nerve root transposition for treating brachial plexus root avulsion injury. Methods Between August 2008 and November 2010, 22 patients with brachial plexus root avulsion injuries were treated with contralateral C7 nerve root transposition. All patients were male, aged 14 to 47 years (mean, 33.3 years). Total brachialplexus root avulsion was confirmed by preoperative cl inical examination and electrophysiological tests. In 22 cases, median nerve was repaired in 16 cases, radial nerve in 3 cases, and musculocutaneous nerve in 3 cases; primary operation was performed in 2 patients, and two-stage operation was performed in 20 patients. The sensory and motor functional recovery of the repaired limb was observed after operation. Results Twenty-one patients were followed up 7-25 months (mean, 18.4 months). In 16 cases of contralateral C7 nerve root transposition to the median nerve, wrist flexors reached more than M3 in 10 cases, while finger flexors reached more than M3 in 7 cases; sensation reached more than S3 in 11 cases. In 3 cases of contralateral C7 nerve root transposition to the musculocutaneous nerve, elbow flexors reached more than M3 in 2 cases; sensation reached more than S3 in 2 cases. In 3 cases of contralateral C7 nerve root transposition to the radial nerve, wrist extensor reached more than M3 in 1 case; sensation reached more than S3 in 1 case. Conclusion Contralateral C7 nerve root transposition is a good procedure for the treatment of brachial plexus root avulsion injury. Staged operation is one of important factors influencing treatment outcome.
ObjectiveTo investigate the management strategies of clavicular fracture combined with brachial plexus injury and its effectiveness. MethodsBetween January 2006 and January 2012, 27 cases of clavicular fracture combined with brachial plexus injury were treated. There were 18 males and 9 females, aged 18-42 years (mean, 25.3 years). The causes of injury were traffic accident in 12 cases, falling from height in 10 cases, bruise in 3 cases, machinery injury in 2 cases. According to the Robinson classification, the clavicular fractures were rated as type Ⅰ in 2 cases, as typeⅡin 20 cases, and as type Ⅲ in 5 cases; there were 12 cases of total brachial plexus root avulsion injury, 10 cases of bundle branch injury, and 5 cases of hematoma formation and local nerve compression or injury. The injury to operation time was 6 hours to 14 days (mean, 4 days). Brachial plexus injury was repaired by epineurium neurolysis, nerve anastomosis, or nerve transposition after the exploration of the plexus; and fracture was fixed after open reduction. Sensory grading standard (S0-S4) by UK Medical Research Council (MRC) was used to evaluate the recovery of sensory function, and muscle strength grading standard (M0-M5) by MRC to evaluate the innervating muscle strength. ResultsThe incisions healed by first intention. All patients were followed up 18-36 months (mean, 26.3 months). All fracture achieved cl inical healing at 12-17 weeks (mean, 15 weeks). No complication of loosening or breakage of internal fixation occurred. The patients had no pain of shoulder in abduction. At 18 months after operation, the shoulder abduction was more than or equal to 60° in 8 cases, 30-60° in 8 cases, and less than 30° in 11 cases. The recovery of biceps muscle strength was more than or equal to M3 in 18 cases and less than M3 in 9 cases; the recovery of wrist flexion or flexor muscle strength was more than or equal to M3 in 13 cases and less than M3 in 14 cases. The sensory function recovery of median nerve was S3 in 14 cases, S1-S2 in 9 cases, and S0 in 4 cases. The shoulder abduction, elbow and wrist flexor motor function did not recover in 2 patients with total brachial plexus root avulsion injury. ConclusionIt is beneficial to the recovery of nerve function to early repair of the brachial plexus injury by exploration of the plexus combined with open reduction and fixation of clavicular fractures, the short-term effectiveness is good.
Objective To review the recent development of extraplexal neurotization as a treatment for brachial plexus injuries. Methods Relevant literature was extensively reviewed.The new development, the advantages and disadvantages of extraplexal neurotization were comprehensively evaluated and analyzed. Results After many years of clinical research, great improvement in treatment of brachial plexus injuries was achieved. There were more donor nerves and better use of every donor nerve was made.Conclusion Extraplexal neurotization is an effective treatment for brachial plexus injuries.
ObjectiveTo investigate the mechanisms,diagnosis,and surgical procedures of simultaneous lesions of the rotator cuff and the brachial plexus. MethodsBetween July 2006 and June 2012,7 patients with rotator cuff tear associated with brachial plexus injury were treated.There were 3 males and 4 females with a mean age of 47.3 years (range,37-72 years).The reasons of injury were traumatic shoulder dislocation in 6 cases and falling injury from height in 1 case,with a mean disease duration of 17 days (range,5-31 days).The average American Shoulder and Elbow Surgeons (ASES) score was 55.86±9.42,and visual analogue scale (VAS) score was 7.14±1.35.There were 3 cases of large rotator cuff tears (>3 cm) and 4 cases of massive rotator cuff tears (>5 cm) according to Gerber standard;1 case had upper trunk injury of the brachial plexus and 6 cases had bundle branch injury of the brachial plexus according to GU Yudong's classification.The functional score of brachial plexus score was 7.43±1.27 according to the functional assessment standard by Hand Surgery Branch of Chinese Medical Association.All patients accepted arthroscopic rotator cuff repairing,and 1 case received surgical neurolysis of brachial plexus. ResultsAll incisions healed by first intention without complication.All the 7 patients were followed up 18 to 25 months (mean,20.4 months).The function,muscle strength,and sensation of the shoulder were improved obviously.The shoulder ASES score was 84.71±8.06 and was significantly better than preoperative score (t=-8.194,P=0.000).The VAS score was 2.71±1.50 and was significantly better than preoperative score (t=7.750,P=0.000).The functional score of brachial plexus was 14.00±1.16 and was significantly better than preoperative score (t=-11.500,P=0.000). ConclusionIt is difficult to simultaneously diagnose lesions of the rotator cuff and the brachial plexus;orthopedists should pay attention to possible patients to avoid missed diagnosis and diagnostic errors.Nerve nutrition,physical therapy,and arthroscopic rotator cuff repair can achieve good effectiveness.
ObjectiveTo explore the MRI manifestations and its diagnostic value for brachial plexus injury. MethodsMRI manifestations and surgery-related materials of 21 patients confirmed to have brachial plexus injury from January 2011 to April 2013 were retrospectively analyzed. ResultsAccording to the classification of brachial plexus injury, preganglionic brachial plexus injury occurred in 13 cases (23 nerves) and postganglionic injury occurred in 8 cases (24 nerves). The manifestations of preganglionic brachial plexus injury in MRI included nerve root disappearance (11) or enlargement (9), nerve root sleeve form abnormality (3), meningeal cyst (9), catheter thickening (6), and spinal cord edema, deformation and displacement (3). Postganglionic injury MRI findings showed nerve trunk enlargement (8), continuity interrupt line (12), rigidity (4), and adjacent structure disorder and edema (6). Surgery confirmed preganglionic brachial plexus injury in 27 nerves and postganglionic injury in 29 nerves. Compared with surgery, the sensitivity, specificity and accuracy of MRI in diagnosing preganglionic brachial plexus injury were 81.5%, 80.0%, and 81.3%, respectively. The sensitivity, specificity and accuracy of MRI in diagnosing postganglionic brachial plexus injury were 79.3%, 85.7%, and 80.6%, respectively. ConclusionsMRI is excellent in revealing preganglionic brachial plexus injury and postganglionic injury. MRI diagnosis accuracy is high, and it is optimal for clinical diagnosis and treatment with no invasion.