The Retrospective Study On Peripheral Nerve Injury

Part I : Clinical Analysis andFollow-up Studies on Brachial Plexus InjuryObjective To evaluate the long-term results of brachial plexus injuries. Methods This study was designed to review 41 cases of brachial plexus injuries, who were treated in department of orthopedics from October 1995 to October 2005.They were divided into three groups:the group of nonoperation, the group of neurolysis, the group of nerve repairing. Retrospective analysis of the charts and follow-up survey of the functional recovery of shoulder and elbow and hand were carried out. The results were evaluated according to Mallett's shoulder and Gilbert's elbow rating system and Raimondi's hand scale system . Results Functional recovery results of shoulder and elbow : In 11 cases of non-operation group, 9 cases were graded as excellent,1ease as good , 1 case as bad. In 17 cases of neurolysis group, 2 cases were graded as excellent and good. In 13 cases of never repair group, 2 cases of shoulder joint obtained excellent ,4 cases of elbow joint excellent and good. The group of nonoperation were better than the group of neurolysis or the group of nerve repairing ( P < 0.05). The function of hand was bad for giving up the lower roots repaired. For 3 cases of upper brachial plexus injuries, Side-to-side neurorrhaphy of C₆, and C₇was done. The functions of elbow were good,fair and poor respectively. Conclusion 1 .Conservative treatment might be adapted for the closed brachial plexus injuries for 3-6 months. 2. The surgical results were not satisfactory. Postoperative rehabilitation should not be ignored. Comprehensive control measures must be carried out to improve the surgical results.3 .Side-to-side neurorrhaphy of C₆ and C₇ is worth investigating.Part II: Application value of EMG in patients with peripheral nerve lesions and the reasons of misdiagnosisObjective To investigate the clinical value of preoperative EMG examination in peripheral nerve lesions and to analyze the reasons of misdiagnosis. Methods From October 1996 to October 2005 , the results of electrophysiological examinations of 111 nerves in 86 inpatients for operation were compared with the findings on operation and operative methods. Results 111 muscles were all neurogenous damage. In the complete lesion group of EMG, neuroanastomosis account for 47.9%;in the incomplete lesion group of EMG ,the diagnostic accuracy rate of EMG was 70. 0 %, the false negative rate was 30.0 %. Conclusion 1. Preoperative EMG examination is valuable in judging degree of lesions and selecting the proper operative methods in patients with peripheral nerve injury.Depending on the clinical symptoms and signs and findings of operation,the proper operative methods were selected.2. MUP, MCV, SCV can be recorded in 15 patients of incomplete never injuries, the accuracy of diagnosis reached 88.2 %, the false negative rate was 11.8 %.