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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

Axillary nerve (upper) and musculocutaneous nerve (lower) motor evoked potentials before (A) and 1 year after surgery (B).
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Figure 3: Axillary nerve (upper) and musculocutaneous nerve (lower) motor evoked potentials before (A) and 1 year after surgery (B).

Mentions: A 33-year-old, male patient was admitted to the hospital in September 2003 for right shoulder and right upper arm sensory and motor impairments due to a mechanical stretch injury which occurred 3 months previously. Physical examination revealed right upper extremity overhang, loss of right upper arm skin sensation, muscle strength level 0, pectoralis major and latissimus dorsi muscle strength level 0. Right upper brachial plexus complete injury was confirmed by electromyogram (Figure 3). Surgical investigation showed a C5-6 root avulsion in the right arm with the proximal end not seen until the intervertebral foramen. C3-4 was separated to the distal end along each nerve branch and the muscle was transected, freeing the phrenic nerve and allowing direct anastomosis with the torn ends of C6. The sural nerve was isolated for graft bridging at C3-5 and C4-6 and the phrenic nerve stump was anastomosed with C6 (supplementary Figure 2 online). At 6 months post-surgery, the patient felt coarse skin sensations in the right upper arm and complained about right upper limb abduction (muscle strength level II). At 14 months post-surgery, skin sensation in the right upper arm was restored, and the right shoulder showed 45° abduction and 30° anterior flexion. Right biceps brachii muscle contraction was palpable, but the elbow joint could not flex (muscle strength level I). At 18 months post-surgery, the right biceps brachii and deltoid muscles recovered to level 0 muscle strength (supplementary Figure 3 online), scapular peripheral muscle strength recovered to level IV-V, the elbow joint could flex normally, shoulder abduction, flexion and adduction were normal, and latissimus dorsi and pectoral muscle strength recovered to level IV-V. However, triceps brachii muscle strength was not restored. Electromyography displayed some regenerative potentials in the right triceps brachii, but no action potential was seen. Latissimus dorsi muscle flap transposition was performed to reconstruct elbow extension function in December 2006, and the patient recovered normal function of the right upper extremity at 1 year post-surgery (supplementary Figure 4 online; Figures 4, 5).


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)

Axillary nerve (upper) and musculocutaneous nerve (lower) motor evoked potentials before (A) and 1 year after surgery (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Axillary nerve (upper) and musculocutaneous nerve (lower) motor evoked potentials before (A) and 1 year after surgery (B).
Mentions: A 33-year-old, male patient was admitted to the hospital in September 2003 for right shoulder and right upper arm sensory and motor impairments due to a mechanical stretch injury which occurred 3 months previously. Physical examination revealed right upper extremity overhang, loss of right upper arm skin sensation, muscle strength level 0, pectoralis major and latissimus dorsi muscle strength level 0. Right upper brachial plexus complete injury was confirmed by electromyogram (Figure 3). Surgical investigation showed a C5-6 root avulsion in the right arm with the proximal end not seen until the intervertebral foramen. C3-4 was separated to the distal end along each nerve branch and the muscle was transected, freeing the phrenic nerve and allowing direct anastomosis with the torn ends of C6. The sural nerve was isolated for graft bridging at C3-5 and C4-6 and the phrenic nerve stump was anastomosed with C6 (supplementary Figure 2 online). At 6 months post-surgery, the patient felt coarse skin sensations in the right upper arm and complained about right upper limb abduction (muscle strength level II). At 14 months post-surgery, skin sensation in the right upper arm was restored, and the right shoulder showed 45° abduction and 30° anterior flexion. Right biceps brachii muscle contraction was palpable, but the elbow joint could not flex (muscle strength level I). At 18 months post-surgery, the right biceps brachii and deltoid muscles recovered to level 0 muscle strength (supplementary Figure 3 online), scapular peripheral muscle strength recovered to level IV-V, the elbow joint could flex normally, shoulder abduction, flexion and adduction were normal, and latissimus dorsi and pectoral muscle strength recovered to level IV-V. However, triceps brachii muscle strength was not restored. Electromyography displayed some regenerative potentials in the right triceps brachii, but no action potential was seen. Latissimus dorsi muscle flap transposition was performed to reconstruct elbow extension function in December 2006, and the patient recovered normal function of the right upper extremity at 1 year post-surgery (supplementary Figure 4 online; Figures 4, 5).

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