A Clinical Analysis of Repairing the Whole Brachial Plexus Nerve Root Avulsion by Transferring C7 Nerve Root from the Uninjured Side
American Journal of Clinical and Experimental Medicine
Volume 7, Issue 4, July 2019, Pages: 97-102
Received: Aug. 31, 2019;
Published: Sep. 27, 2019
Views 206 Downloads 52
Boyang Wang, Department of Orthopaedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
Yuewen Wang, Department of Orthopaedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
Objective to perform a C7 transfer from the uninjured side for the patients with whole brachial plexus nerve root avulsion, conduct follow-up observations of the recovery conditions of the affected limb, and discuss the degree of the effect on the limb on the uninjured side and the mechanism. Method The 36 patients with whole brachial plexus nerve avulsion who received a C7 transfer from the uninjured side for repair by stages from January 2011-December 2011 in our hospital were selected as the objects to analyse the data of cases, carry out follow-up visits, evaluate of the limb functions on the uninjured side, and make comprehensive assessment in accordance with U.K. MRC scale for sensation and U.K. amended MRC scale for muscular strength. Result The follow-up visit results regarding the motor functions of the affected limb have indicated that there were 2 patients with effective recovery of supraspinatus muscular strength, 2 patients with effective recovery of deltoid muscular strength, 6 patients with effective recovery of biceps brachii muscular strength, 7 patients with effective recovery of triceps brachii muscular strength, 4 patients with effective recovery of extensor carpi muscular strength, and 5 patients with effective recovery of flexor carpi and flexor digitorum muscular strength. There were 7 patients whose latissimus dorsi muscular strength reached M5-, 7 patients whose triceps brachii muscular strength reached M5-, and 10 patients whose extensor digitorum muscular strength reached M5- 6 months after operation. There were 3 patients whose limb on the uninjured side reached Sensation Grade S4, 12 patients whose limb on the uninjured side reached Sensation Grade S3+, 11 patients whose limb on the uninjured side reached Sensation Grade S3, and 10 patients whose limb on the uninjured side reached Sensation Grade S2 3 days after operation. The sensory functions of the majority of the patients recovered to S4 and their two-point discrimination approximately recovered to normal at the follow-up visit 1 year after operation. Conclusion Repair with C7 transfer from the uninjured side is currently an effective and feasible method to repair the functions of the affected limb in brachial plexus nerve root avulsion.
A Clinical Analysis of Repairing the Whole Brachial Plexus Nerve Root Avulsion by Transferring C7 Nerve Root from the Uninjured Side, American Journal of Clinical and Experimental Medicine.
Vol. 7, No. 4,
2019, pp. 97-102.
Tu YK. Tsai YJ. et al. Surgical treatment for total root avulsion type brachial plexus injuries by neurotization: A prospective comparison study between total and hemicontralateral C7 nerve root transfer [J]. Microsurgery, 2017, 34 (2): 91-101.
Wang SF. Li PC. et al. Contralateral C7 nerve transfer with direct coaptation to restore lower trunk function after traumatic brachial plexus avulsion [J]. J Bone Joint Surg Am, 2017, 95 (9): 821-7.
Chuang DC. Hernon C. et al. Minimum 4-year follow-up on contralateral C7 nerve transfers for brachial plexus injuries [J]. J Hand Surg Am, 2018, 37 (2): 270-6.
Lin H. Sheng J. et al. The effectiveness of contralateral C7 nerve root transfer for the repair of avulsed C7 nerve root in total brachial plexus injury: an experimental study in rats [J]. J Reconstr Microsurg, 2018, 29 (3): 325-30.
Soldado F. Bertelli J. Free gracilis transfer reinnervated by the nerve to the supinator for the reconstruction of finger and thumb extension in longstanding C7-T1 brachial plexus root avulsion [J]. J Hand Surg Am, 2017, 38 (5): 941-6.
Wang S. Yiu HW. et al. Contralateral C7 nerve root transfer to neurotize the upper trunk via a modified prespinal route in repair of brachial plexus avulsion injury [J]. Microsurgery, 2017, 32 (3): 183-8.
Coulet B. Boretto JG. et al. A comparison of intercostal and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5-C6+/-C7) [J]. J Hand Surg Am, 2018, 35 (8): 1297-303.
Dong Z. Gu YD. et al. Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7-T1 brachial plexus palsies [J]. J Neurosurg, 2018, 113 (1): 113-7.
Bertelli JA. Ghizoni MF. Transfer of supinator motor branches to the posterior interosseous nerve in C7-T1 brachial plexus palsy [J]. J Neurosurg, 2018, 113 (1): 129-32.
Bertelli JA. Kechele PR. et al. Anatomical feasibility of transferring supinator motor branches to the posterior interosseous nerve in C7-T1 brachial plexus palsies. Laboratory investigation [J]. J Neurosurg, 2019, 111 (2): 326-31.
Kasperczak J. The avulsion of subclavian artery from brachiocephalic trunk and subclavian vein from right brachiocephalic vein with brachial plexus injury [J]. Wiad Lek, 2018, 66 (3): 241-3.
Hattori Y. Doi K. et al. Complete avulsion of brachial plexus with associated vascular trauma: feasibility of reconstruction using the double free muscle technique [J]. Plast Reconstr Surg, 2017, 132 (6): 1504-12.
Song J. Chen L. et al. Effect of ipsilateral C7 nerve root transfer on restoration of rat upper trunk muscle and nerve function after brachial plexus root avulsion [J]. Orthopedics, 2018, 33 (10): 886-9.
Aysel I. Topcu I. et al. Ultrasound guided brachial plexus block can be advantageous in patients with avulsion type upper extremity injuries [J]. Agri, 2017, 25 (3): 145-6.
Karaoglu P. Yis U. et al. Phrenic nerve palsy associated with brachial plexus avulsion in a pediatric patient with multitrauma [J]. Pediatr Emerg Care, 2017, 29 (8): 922-3.
Qiu TM. Chen L. et al. Sensorimotor cortical changes assessed with resting-state fMRI following total brachial plexus root avulsion [J]. J Neurol Neurosurg Psychiatry, 2018, 85 (1): 99-105.
Matsuura Y. Iwakura N. et al. The effect of Anti-NGF receptor (p75 Neurotrophin Receptor) antibodies on nociceptive behavior and activation of spinal microglia in the rat brachial plexus avulsion model [J]. Spine (Phila Pa 1976), 2018, 38 (6): 332-8.
Gao K. Lao J. et al. Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury [J]. J Neurosurg, 2018, 118 (3): 606-10.
Dong S. Hu YS. et al. Changes in spontaneous dorsal horn potentials after dorsal root entry zone lesioning in patients with pain after brachial plexus avulsion [J]. J Int Med Res, 2017, 40 (4): 1499-506.
Fabbro L. Borges Filho C. et al. Effects of Se-phenyl thiazolidine-4-carboselenoate on mechanical and thermal hyperalgesia in brachial plexus avulsion in mice: mediation by cannabinoid CB1 and CB2 receptors [J]. Brain Res, 2017, 1475 (1): 31-6.
Liu Y. Lao J. et al. Functional outcome of nerve transfers for traumatic global brachial plexus avulsion [J]. Injury, 2016, 44 (5): 655-60.
Lin H. Hou C. et al. Full-length phrenic nerve transfer as the treatment for brachial plexus avulsion injury to restore wrist and finger extension [J]. Muscle Nerve, 2018, 45 (1): 39-42.
Carlstedt T. Misra VP. et al. Return of spinal reflex after spinal cord surgery for brachial plexus avulsion injury [J]. J Neurosurg, 2018, 116 (2): 414-7.
Lin H. Lv D. et al. Modified C-7 neurotization in the treatment of brachial plexus avulsion injury [J]. J Neurosurg, 2017, 115 (4): 865-9.
Wang LL. Zhao XC. et al. C-jun phosphorylation contributes to down regulation of neuronal nitric oxide synthase protein and motoneurons death in injured spinal cords following root-avulsion of the brachial plexus [J]. Neuroscience, 2018, 189 (1): 397-407.
Aichaoui F. Mertens P. et al. Dorsal root entry zone lesioning for pain after brachial plexus avulsion: results with special emphasis on differential effects on the paroxysmal versus the continuous components. A prospective study in a 29-patient consecutive series [J]. Pain, 2017, 152 (8): 1923-30.
Ali M. Saitoh Y. et al. Differential efficacy of electric motor cortex stimulation and lesioning of the dorsal root entry zone for continuous vs paroxysmal pain after brachial plexus avulsion [J]. Neurosurgery, 2018, 68 (5): 1252-7.
Bertelli JA. Ghizoni MF. Transfer of the platysma motor branch to the accessory nerve in a patient with trapezius muscle palsy and total avulsion of the brachial plexus: case report [J]. Neurosurgery, 2017, 68 (2): 567-70.
Kachramanoglou C. Li D. et al. Novel strategies in brachial plexus repair after traumatic avulsion [J]. Br J Neurosurg, 2017, 25 (1): 16-27.
Siqueira MG. Martins RS. Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it? [J]. Neurosurgery, 2019, 65 (4): 125-31.