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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

The avulsed C5-6 nerve root and the anatomically separated C3-4 nerve root (long green arrow indicates C3, short green arrow C4, long black arrow C5, short black arrow C6).
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Figure 6: The avulsed C5-6 nerve root and the anatomically separated C3-4 nerve root (long green arrow indicates C3, short green arrow C4, long black arrow C5, short black arrow C6).

Mentions: Establishment of right brachial plexus upper trunk avulsion models and intervention: rats were intraperitoneally anesthetized with ketamine hydrochloride (100 mg/kg). A 4 cm long anterior cervical paramedian incision was made extending to the middle clavicle, upward along the trachea then right for a distance equal to one-third of the paramedian incision. The skin and subcutaneous tissues were removed and the platysma was cut, bluntly separated along the sternocleidomastoid muscle medial margin, with dissection continuing downward to the lateral carotid sheath, thus protecting the carotid artery and vagus nerve and exposing the brachial plexus upper trunk and C3-4 nerve root. The brachial plexus upper trunk was stripped in a retrograde direction to the C5-6 nerve root under × 6 surgical magnification (Gx-SS-ZZ-3, Shanghai Medical Optical Instrument Factory, Shanghai, China), freeing the nerve root. Along with the brachial plexus nerve roots, the phrenic nerve was set free and protected then the C5-6 nerve root was avulsed from the spinal cord using a self-made nerve hook (Figure 6).


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)

The avulsed C5-6 nerve root and the anatomically separated C3-4 nerve root (long green arrow indicates C3, short green arrow C4, long black arrow C5, short black arrow C6).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: The avulsed C5-6 nerve root and the anatomically separated C3-4 nerve root (long green arrow indicates C3, short green arrow C4, long black arrow C5, short black arrow C6).
Mentions: Establishment of right brachial plexus upper trunk avulsion models and intervention: rats were intraperitoneally anesthetized with ketamine hydrochloride (100 mg/kg). A 4 cm long anterior cervical paramedian incision was made extending to the middle clavicle, upward along the trachea then right for a distance equal to one-third of the paramedian incision. The skin and subcutaneous tissues were removed and the platysma was cut, bluntly separated along the sternocleidomastoid muscle medial margin, with dissection continuing downward to the lateral carotid sheath, thus protecting the carotid artery and vagus nerve and exposing the brachial plexus upper trunk and C3-4 nerve root. The brachial plexus upper trunk was stripped in a retrograde direction to the C5-6 nerve root under × 6 surgical magnification (Gx-SS-ZZ-3, Shanghai Medical Optical Instrument Factory, Shanghai, China), freeing the nerve root. Along with the brachial plexus nerve roots, the phrenic nerve was set free and protected then the C5-6 nerve root was avulsed from the spinal cord using a self-made nerve hook (Figure 6).

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