A Clinical Study Of Phrenic Nerve Transfer To Treat Brachial Plexus Injury

Objective: this study via observes the functional recovery of elbow flexion oftwo surgical procedures that the full-length phrenic nerve harvested underthoracoscope was transferred to musculoctltaneous nerve or to anterior divisionof the upper trunk, and change of the respiratory function in patients aftertransfer of phrenic nerve. Based on the study,we can make clear the advantagesof the thoracoscopic surgical technique and can explore some possible factorswhich influenced its clinical efficacy with which we can provide reliableevidence for its clinical application and can expect a better clinical efficacy.Methods：102patients with brachial plexus injury have been carried outoperations with two phrenic nerve transfer procedures respectively in ourdepartment from January2007to December2013．Finally a total of58patients，which involves19patients in the group one and39patients in the group two，could achieve at least6months of follow-up. We recorded the time of theappearance of biceps muscle contraction for the first time and observed thepostoperative clinical symptoms of difficulty breathing. The final results wereanalyzed by a computer software program for Microsoft Windows(SPSS，16.0)，and a value equal to0.05was considered as test standard． Results：(1) Finally a total of58patients could achieve at least6months offollow-up, The average period of follow-up studies is19.71±10.10months(6～42months)．(2) For the first time, The time of appearance of biceps musclecontraction of The full-length phrenic nerve harvested under thoracoscopetransfer to musculoctltaneous nerve and phrenic nerve transfer to the anteriordivision of the upper trunk5.5±1.2months and9.2±1.8months, There isstatistically difference between two groups(P<0.05).(3)The excellent andgood rate of group one is52.6％，and group two is79.5％．There is statisticallydifference between two groups (P<0.05). No cases of severe difficulty breathingand complaints can not take care of themselves in two groups.Conclusion：1. The surgical procedure of the full-length phrenic nerveharvested under thoracoscopy transfer to musculoctltaneous nerve is a relativelyreliable procedure in treating brachial plexus injury and restoring elbow flexion.its functional restoration is faster and the excellent and good rate is also high,soit can be used as a preferred surgical treating brachial plexus injury in restoringelbow flexion by phrenic nerve.2. When selecting the phrenic nerve transfer totreat brachial plexus injury, we should pay attention to the needs of patients withrespiratory function, concerning some factors including patient age, physique,living environment, occupation and so on.