Title: Long-term outcome of contralateral C_7 nerve transfer
Abstract: Objective To evaluate the long-term functional recovery following contralateral C_7 transfer for total brachial plexus root avulsion injuries and the impact on healthy limb function.Methods 28 patients treated with contralateral C_7 transfer for brachial plexus root avulsion and followed-up for over 2 years were involved in this study. Recipient nerves included median nerve in 20 eases,radial nerve in 3 cases,muscnlocutaneous nerve in 2 cases,both median and radial nerves in 2 cases,and both median and musculocutaneous nerves in 1 case.Healthy limb function, electrophysiologic evidence of recovery and the motor and sensory function of the recipient nerves in the affected limb were evaluated.Coordination between the affected and healthy limbs was also observed.Results There was no impairment of healthy limb function.(1)10 patients(10/20) of C_7 to median nerve transfer demonstrated simple-mixed phase or simple phase in motor unit recruitment.Wrist flexors reached≥M_3 power in 12 patients(12/20),while finger flexors reached≥M_3 in 9 patients(9/20).S_3 or better sensory recovery was seen in 10 patients (10/20).(2)Both patients of C_7 to museuloeataneous nerve transfer showed simple-mixed phase or simple phase in their eleetrophysiologie tests.Elbow flexion strength was≥M_3 and the sensation reached≥S_3 in 1 patient(1/2).(3)For C_7 to radial nerve transfer,1 patient(1/3)showed simple-mixed phase or simple phase in motor recruitment.Wrist extensor power recovered to≥M_3 in 2 patients(2/3) while finger extensor power was≥M_3 in 1 patient(1/3).Sensation reached≥S_3 in 2 patients(2/3).(4) Following simultaneous neurotization of both median and radial nerves,wrist flexion was≥M_3 in 2 patients(2/2) while finger flexion≥M_3 in 1 patient(1/2).Median nerve sensory recovery of both eases reached S_2 but radial nerve motor function was only M_2 and MO.Sensory recovery was graded as S_1.(5)The patient of simultaneous neurotization of both median and musculocutaneous nerves showed simple phase in the EMG study.Both elbow flexion and wrist flexion reached≥M_3.Co-contraction was noted in 22 patients of this series.The patients needed to force their latissimus dorsi muscle of the healthy side to move the affected limb.There were only 6 patients (6/28) who could move their affected limbs independently.Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of braehial plexus root avulsion injuries.When two nerves are to be nenrotized simultaneously,nerves of synergistic function should be combined.
Publication Year: 2006
Publication Date: 2006-01-01
Language: en
Type: article
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