ABSTRACT
Objective To investigate the quality of life on brachial plexus injury patients in crosssectional study method and acquire related data. To analysis the effect factors and try to study on the methods which help to improve the quality of life of these patients. To our knowledge, this is the first study that measures quality of life of the brachial plexus injury patients in China. Methods Research participants completed the Chinese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and the 5-items version of International Index of Erectile Dysfunction Questionnaire (IIEF-5) for male.Data were typed into computer and analyzed with SPSS version 13.0. Correlations between domain scores and hospital stay, age, and family monthly income variables were analyzed with Spearman non-parameter correlation analysis. Results Fifty-one valid questionnaires were retrieved. The average score of these patients in physical, psychological, environment domains were 11.47 ± 2.36, 12.37 ± 2.28 and 11.62 ± 2.22, respectively. They were significantly lower than the norm groups in national studies which were 15.8 ± 2.9, 14.3 ±2.5 and 13.2 ± 2.4 (P ＜ 0.01 ). The average score of IIEF-5 was ( 17.83 ± 4.65), significantly lower than the normal score of 22 (P ＜ 0.01 ). Significant correlation was found among physical domain and age(P ＜ 0.05),family monthly income (P ＜ 0.05) and IIEF-5 score(P ＜ 0.01). Psychological domain also has significant correlation with IIEF-5 score (P ＜ 0.05) and so does environment domain with family monthly income (P ＜0.05). Conclusion Brachial plexus injury patients showed a reduction in quality of life scores. Even though the physical aspect was the most affected, there is evidence that the psychological, environmental domains and erectile function remained far from the ideal conditions expected for the general population. The effect factors are complex and there still remain much work to do.
ABSTRACT
Objective To explore the clinical design and therapeutic effect of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation. Methods Twelve cases of total roots avulsion of brachial plexus were operated at 1 month to 3 months after injury.The contralateral C_7 nerve was successfully transferred to directly repair avulsed C_8T_1 roots or lower trunk via prespinal route.At 2nd operation stage after 4 to 8 months,the functioning gracills transplantation was preformed to reconstruct the elbow flexion and fingers extension. Results Follow-ups were carried out in all 12 cases who had been discharged for 9 to 36 months after the first operation.The positive Tinel signs of ulnar or median nerves were located in the proximal arm at 3 months after 1st operation,in the elbow or proximal forarm at 6 months,and in the wrist or distal forarm at 9 months.At 12 months the positive Tinel signs were found in the plam or fingers in 9 cases.The contraction of sternocostal part of pectoralis major was found at 9 mooths in 7 cases.There were the restoration of the taction-pain sensation in the palm, finger, and medial side of forearm and the contraction of flexor carpi ulnaris and flexor digitorum(M_3)in 5 cases at 15 to 18 months after 1st operation.In 7 patients the flexion of elbow and extension of fingers and thumb restored at 9 to 12 months after the 2nd operation.Their elbow flexion was 90°-120°and M_3(Highet's method),and their finger and thumb extension M_3. Conclusion There is the possibility of the operative design and clinical application of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation.There are not only the restoration of sensation and flexion of wrist and fingers,but also the restoration of elbow flexion and fingers extension.