Application of nerve grafting and nerve transfer for treatment of early obstetrical brachial plexus palsy / 中华骨科杂志

ABSTRACT

Objective To evaluate the efficacy of the nerve grafting and nerve transfer (neurotization) in the treatment of early obstetrical brachial plexus palsy(OBPP). Methods 48 cases with TassinⅡ-Ⅳ lesion who had no any recovery of elbow flexion, the brachial plexus were explored from 3 to 14 months after birth. The method of nerve repair depended on findings during operation. For the traumatic neuroma, it should be resected and the defect be repaired by nerve grafting with neurotization; the root avulsion was repaired by neurotization; neurolysis was only performed to those plexus that looked nearly normal and had a positive reaction of neurophysiology as tested intra-operatively. The reconstructive procedures included C5→upper trunk, accessory →supraspinal nerve (2 cases); C5,6→the posterior and the anterior division of the upper trunk respectively, accessory →supraspinal nerve (25 cases); C5,6→the posterior and anterior divisions of the upper trunk respectively, C7→middle trunk, accessory →supraspinal nerve (4 cases); C5→posterior cord, C6→lateral cord, accessory →supraspinal nerve (5 cases); C5→anterior division of the upper trunk, C6→C8, accessory →supraspinal nerve (1 case); C5-7→the posterior, lateral and medial cords respectively, accessory →supraspinal nerve (4 cases); C5→upper trunk, C6→lower trunk (or medial cord), accessory →supraspinal nerve (2 cases); C5,6→the lateral and medial cords respectively, accessory →supraspinal nerve (3 cases); neurolysis (2 cases). Results All the patients were available at follow-up at least for 36 months, who were studied according to both of the Gilberts shoulder and elbow rating system and the Raimondis hand scale system. The score of shoulder, elbow, and hand in 13 cases with Tassin Ⅱ lesion improved from preoperative 0.54, 1.92 and 3.23 to postoperative 3.77, 4.92 and 4.31 respectively; 11 cases with Tassin Ⅲ rose from 0.46, 1.82 and 1.91 to 3.27, 4.18 and 3.64, and 24 cases with Tassin Ⅳ had an elevation from 0.25, 1.25 and 0.33 to 2.92, 3.46 and 2.83. The medial rotation contracture of the shoulder without subluxation and dislocation was found in 7 cases(14.6%) in the process of recovery. Conclusion The resection of the traumatic neuroma combined with nerve grafting and neurotization is really effective in the treatment of early OBPP.