Retrospective Analysis Of The Treatment Of Brachial Plexus Neuritis With Neurolysis And Latissimus Dorsi Flap Transplantation

Aim:To investigate the effect of nerve relaxation combined with latissimus dorsi flap transplantation in the treatment of radiation brachial plexus neuritis.Methods: Sixteen patients with radiation brachial plexus neuritis were treated in the First Affiliated Hospital of Guangxi Medical University from January 2005 to January 2017,14 cases of postoperative radiotherapy for breast cancer,1 case of postoperative radiotherapy for laryngeal cancer,and 1 case of postoperative radiotherapy for nasopharyngeal carcinoma.12 cases underwent neurolysis and latissimus dorsi flap transplantation,1 case of unilateral brachial plexus neurolysis,and 3 cases of distant metastasis of the tumor without surgical treatment.We collect the patients with disease progression and treatment in 16 cases with the follow-up data,to understand the situation of pain,muscle strength,improve skin feeling and hand function of patients after surgery,contrast before and after the operation of symptoms and remission to evaluate neurolysis and latissimus dorsi flap transplantation for the treatment of radiation-induced brachial neuritis treatment.Results: Of the 16 patients,3 died,4 were lost,and 9 patients were followed up successfully.The brachial plexus neurolysis and latissimus dorsi flap transplantation were performed.The patients were followed up for 3 months to 7 years.Pain: VRS pain score: preoperative I class 3 cases,II class 5 cases,III class 1 cases.Postoperative pain improved in 7 cases,4 cases recovered from grade I-II to grade 0,and 2 cases improved from grade II to grade I,1 cases improved from grade III to grade II,and 2 cases gradually increased,all of them increased from grade II to grade III.Muscle strength: flexor MRC grading:preoperative II grade 4 cases,IV grade 3 cases,V grade 2 cases,1 cases of postoperative recovery from grade II to grade III;2 cases of grade IV restored by V,but respectively after 3 and 5 months decreased again at IV level in 2 cases;II recovery is not obvious,but were not aggravated in 2 cases;1 cases of serious gradually,from II down to I level,1 cases from IV down to II level.Wrist muscle MRC grading: preoperative I grade 1 cases,II grade 2 cases,III grade 1cases,IV grade 1 cases,4 cases of grade V,III grade,I grade 1 cases recovered after 1 cases of grade IV to grade V,but respectively after 4 and 6 months of strength again down to the level before the operation;1 cases of grade II and 1cases of grade III had no obvious recovery,but not with time increase;2 cases of progressive,1 cases from V down to II level,1 cases from II down to I level.Elbow flexion strength MRC classification: preoperative III class 1 cases,IV class 4 cases,V class 4 cases.After operation,1 cases of grade III restored by IV;1 cases from grade IV improved to V,but after 3 months of muscle strength decreased again to grade IV;1 cases of grade IV had no improvement,but not with time increase;2 cases gradually decreased from IV to II and III class.Shoulder abductor muscle strength MRC classification: preoperative II grade 1cases,III class 2 cases,IV class 2 cases,V class 4 cases.After operation,1 casesfrom grade IV to grade V,but at 6 months after the operation strength dropped again to grade IV;1 cases of grade II,1 cases of grade III had no improvement,but also aggravate;2 cases of progressive,1 cases from IV down to II level,III level decreased by 1 cases I.The hand feeling: check the hand feeling:preoperative grading of 2 cases of S2,4 cases S3,1 cases of S4 and 2 S5 after operation,3 cases were significantly improved by S3-S4,restored to S5;2 cases improved gradually,by S2-S3 improved to S4;2 cases gradually increased,decreased by S2-S3 to S1.Conclusion: The nerve relaxation and latissimus dorsi flap transplantation can relieve pain,improve skin sensation and control the development of patients with radiation brachial plexus neuritis,so as to improve the quality of life of the patients.