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Improved C3-4 transfer for treatment of root avulsion of the brachial plexus upper trunk: Animal experiments and clinical application.

Zou L, Cao X, Li J, Liu L, Wang P, Cai J - Neural Regen Res (2012)

Bottom Line: Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased.Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side.Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatic Surgery, General Hospital of Jinan Military Command of Chinese PLA, Jinan 250031, Shandong Province, China.

ABSTRACT
Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C3-4 transfer for neurotization of C5-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 + phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III. Results showed that the improved C3-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

No MeSH data available.


Related in: MedlinePlus

Ultrastructure of transverse myelinated nerve fibers (transmission electron microscope) showing focal myelin thickening in rats.(A) C3 in normal control group (× 8 000);(B) C4 in normal control group (× 5 000);(C) C5 in normal control group (× 9 000);(D) C6 in normal control group (× 6 000);(E) C5 in experimental group at 3 months (× 15 000);(F) C5 in experimental group at 6 months (× 20 000);(G) C6 in experimental group at 3 months (× 8 000);(H) C6 in experimental group at 6 months (× 20 000).
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Figure 2: Ultrastructure of transverse myelinated nerve fibers (transmission electron microscope) showing focal myelin thickening in rats.(A) C3 in normal control group (× 8 000);(B) C4 in normal control group (× 5 000);(C) C5 in normal control group (× 9 000);(D) C6 in normal control group (× 6 000);(E) C5 in experimental group at 3 months (× 15 000);(F) C5 in experimental group at 6 months (× 20 000);(G) C6 in experimental group at 3 months (× 8 000);(H) C6 in experimental group at 6 months (× 20 000).

Mentions: Under transmission electron microscopy, normal myelinated nerve fibers were closely and clearly arranged, and the myelin arrangement became slightly loose at 3 and 6 months after C3 and C4 + phrenic nerve transfer in the experimental group (Figure 2). There was no significant difference in the myelin thickness among groups (P > 0.05; Table 4).


Improved C3-4 transfer for treatment of root avulsion of the brachial plexus upper trunk: Animal experiments and clinical application.

Zou L, Cao X, Li J, Liu L, Wang P, Cai J - Neural Regen Res (2012)

Ultrastructure of transverse myelinated nerve fibers (transmission electron microscope) showing focal myelin thickening in rats.(A) C3 in normal control group (× 8 000);(B) C4 in normal control group (× 5 000);(C) C5 in normal control group (× 9 000);(D) C6 in normal control group (× 6 000);(E) C5 in experimental group at 3 months (× 15 000);(F) C5 in experimental group at 6 months (× 20 000);(G) C6 in experimental group at 3 months (× 8 000);(H) C6 in experimental group at 6 months (× 20 000).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4308750&req=5

Figure 2: Ultrastructure of transverse myelinated nerve fibers (transmission electron microscope) showing focal myelin thickening in rats.(A) C3 in normal control group (× 8 000);(B) C4 in normal control group (× 5 000);(C) C5 in normal control group (× 9 000);(D) C6 in normal control group (× 6 000);(E) C5 in experimental group at 3 months (× 15 000);(F) C5 in experimental group at 6 months (× 20 000);(G) C6 in experimental group at 3 months (× 8 000);(H) C6 in experimental group at 6 months (× 20 000).
Mentions: Under transmission electron microscopy, normal myelinated nerve fibers were closely and clearly arranged, and the myelin arrangement became slightly loose at 3 and 6 months after C3 and C4 + phrenic nerve transfer in the experimental group (Figure 2). There was no significant difference in the myelin thickness among groups (P > 0.05; Table 4).

Bottom Line: Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased.Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side.Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatic Surgery, General Hospital of Jinan Military Command of Chinese PLA, Jinan 250031, Shandong Province, China.

ABSTRACT
Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C3-4 transfer for neurotization of C5-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 + phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III. Results showed that the improved C3-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

No MeSH data available.


Related in: MedlinePlus