مقايسه درمان كندگي ريشه هاي عصبي در فلج شكبه بازويي با روش انتقال عصب

Nerve Transfer for Root Avulsion in Brachial Plexus Injury

Background: Brachial plexus avulsion injuries cause major devastating neurological dysfunction. Microsurgical repair with nerve transfer from either intraplexus or extraplexus origin, sometimes in combination with free muscle transfer, may produce acceptable functional improvement. Materials and Methods: 62 cases of brachial plexus injury who were treated with nerve transfer and have a 3 year follow-up, are reported here. The aim was to obtain elbow flexion. 44 patients (group 1) received trasfer of spinal accessory nerve either to musculocutaneous nerve or directly to suprascapular nerve. 12 patients (group 2) were treated by transfer of intercostal nerves to musculocutaneous nerve. Part of ulnar nerve was used as nerve transfer in 6 more patients (group 3). Results: Elbow flexion power of 3 or 4 was achieved in 29 cases of group 1 (91%). 9 patients in group 2 (75%) and 5 cases of group 3 (83%). Pneumothorax in 5 cases in group 2 and muscle weakness in 6 cases in group 3 (flexor carpi ulnaris weakness in 4 and interossei in 2) were the observed complications. Conclusion: Avulsion injuries of brachial plexus injury are best treated by nerve transfer. Accessory nerve transfer to musculocutaneous nerve is the preferred technique with less complication.