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Upper brachial plexus injuries: grafts vs ulnar fascicle transfer to restore biceps muscle function.
- Source :
-
Neurosurgery [Neurosurgery] 2012 Dec; Vol. 71 (2 Suppl Operative), pp. ons227-32. - Publication Year :
- 2012
-
Abstract
- Background: Nerve transfers or graft repairs in upper brachial plexus palsies are 2 available options for elbow flexion recovery.<br />Objective: To assess outcomes of biceps muscle strength when treated either by grafts or nerve transfer.<br />Methods: A standard supraclavicular approach was performed in all patients. When roots were available, grafts were used directed to proximal targets. Otherwise, a distal ulnar nerve fascicle was transferred to the biceps branch. Elbow flexion strength was measured with a dynamometer, and an index comparing the healthy arm and the operated-on side was developed. Statistical analysis to compare both techniques was performed.<br />Results: Thirty-five patients (34 men) were included in this series. Mean age was 28.7 years (standard deviation, 8.7). Twenty-two patients (62.8%) presented with a C5-C6 injury, whereas 13 patients (37.2%) had a C5-C6-C7 lesion. Seventeen patients received reconstruction with grafts, and 18 patients were treated with a nerve transfer from the ulnar nerve to the biceps. The trauma to surgery interval (mean, 7.6 months in both groups), strength in the healthy arm, and follow-up duration were not statistically different. On the British Medical Research Council muscle strength scale, 8 of 17 (47%) patients with a graft achieved ≥ M3 biceps flexion postoperatively, vs 16 of 18 (88%) post nerve transfers (P = .024). This difference persisted when a muscle strength index assessing improvement relative to the healthy limb was used (P = .031).<br />Conclusion: The results obtained from ulnar nerve fascicle transfer to the biceps branch were superior to those achieved through reconstruction with grafts.
Details
- Language :
- English
- ISSN :
- 1524-4040
- Volume :
- 71
- Issue :
- 2 Suppl Operative
- Database :
- MEDLINE
- Journal :
- Neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 22791036
- Full Text :
- https://doi.org/10.1227/NEU.0b013e3182684b51