Artikel
Comparison between with or without axillary nerve neurotization for the management of upper brachial plexus palsy
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Autoren
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Krishna Priya Das
- BSMMU, Dhaka, Bangladesh
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Restoration of elbow flexion & shoulder abduction is the aim in the treatment of upper brachial plexus injury. Intraplexus surgery is the mainstay of treatment but most of the time is not possible. Our objective is to assess the result of neurotization for the management of upper brachial plexus palsy.
Methods: From January 2014 to June 2018, we have operated 48 cases of upper brachial plexus palsy cases, duration >3 months with C5, C6 ± C7 root avulsion or disruption close to the foramina. Age <60 years old. SAN to SSN transfer and double fasicular neurotization of MCN was done is all cases. Axillary nerve neurotization was done in 16 cases out of 48 patientS.
Results and Conclusions: Among 48 patients, 45 (93.75%) were male & 3 (6.25%) were female, with the mean age of 24.8 years, mean time from injury was 4.8 months & mean follow-up was 18 months (range 6 to 48 months). With double fascicular neurotization of MCN (Oberlim-II), Grade M4 elbow flexion was restored in 45 (93.75%) cases remaining 3 (6.25%) patient elbow flexion power was M3 and age of those patient was >45 years. We achieved mean shoulder abduction 900 (range 500 to 1100) in those patients who are treated only SAN to SSN neurotization procedure but neurotization of SSN and axillary nerve case mean shoulder abduction was 1100 (900-1700). Average strength of elbow flexion was also improves in both SSN & axillary nerve neurotization cases that was 4.5 kg in comparison with only SSN neurotization cases, 3.8 kg elbow flexion we achieved. Grip strength decreased by a mean 3 kg in the first week postoperatively, then gradually increased on average of 18.2 kg pre-operatively to 24.3kg at the end point follow-up at 1 year.
Our results of neurotization technique for upper brachial plexus injury cases reveal a high percentage of success with excellent results in elbow flexion strength. In cases of shoulder abduction, neurotization of both SSN & axillary nerve reveals excellent result but only SSN neurotization cases, shown limited shoulder abduction.
