The Recovery Of Brachial Muscle And Brachial Branch Of Musculocutaneous After Phrenic Nerve Transfer: Base Study

The recovery of brachial muscle and brachial branch of musculocutaneous after phrenic nerve transfer: an experimental study.Objective To observe and compare the recovery of brachial muscle and brachial branch of musculocutaneous. by two phrenic nerve transfer methods, discuss the possibility of reuse of the two.Methods Forty-eight SD rats, weighing 150-200g, were randomized into two group (with 24 in each):phrenic to anterior divisions of upper truck group (group A) and phrenic nerve transfer to musculocutaneous group(group B),take saphenus nerve as graft nerve. In both group the right side as experimental side and left side as control side.The general observation, electrophysiological and histological examination were performed on 1,2,3 months respectively after operation.General observation:observe the appear time of elbow flexor action accompany with respiration. After 3 months, when all rats could flexor elbow, cut down the brachial branch of musculocutaneous then observe the change of elbow flexor action by the stander of Terzis.Electrophysiological examination:reporter 4 channel electrophysiological apparatus(Esaote Biomediaca,Italy) was applied to record the compound muscle action potential(CMAP) of brachial muscle, then the biggest amplitude of experimental side were divided by the control side to get the CMAP recovery rateMuscle histological examination: free brachial muscle of both side completely without connect tissue, then weighted by analytic balance immediately. After that the cross section of brachial muscle were stained by hematoxylin and eosin(HE), and then the cross-section area fo muscle fibers were measure by imagine analysis system(Leica).Nerve histological examination:the regenerating myelinated axon of phrenic nerve, musculocutaneous and brachial branch were counted by the imagine analysis system(Lecia), and also get the recovery rate.Result Elbow flexion appear at the same pace of respiration in the upper truck group on days 17-20, in the musculocutaneous group on days 20-25 postoperatively. There was no significant difference between the two groups in amplitude of compound muscle action potential(CMAP) recovery rate, brachial muscle wet weight recovery rate and cross-section area of brachial muscle fiber recovery rate after 3 months of operation (P>0.05). There was different between the two groups in passing rate of regenerating myelinated nerve after 3 months of operation (P<0.05), and the upper truck group was superior to the musculocutaneous group.Conclusion Both the two methods can make brachial muscle and brachial branch of musculocutaneous get recovery, of which the recovery of brachial muscle has no different, but for the brachial branch, the upper truck group is superior to the musculocutaneous group after long time observation. The recovery of brachial muscle and brachial branch of musculocutaneous after phrenic nerve transfer:clinical electrophysiological researchObjective To study the functional recovery of brachial muscle and brachial branch of musculocutaneous by electrophysiological technology after phrenic nerve transfer, discuss the clinical possibility of reuse of the two. Find a way to evaluate the muscle strength of brachial muscle.Methods Collect 30 cases diagnosed with total brachial plexus injury or upper truck injury-randomly, and transferred phrenic nerve to musculocutaneous nerve. The latency and amplitude of the compound muscle action potential(CMAP) of brachial muscle,recruiting response (RF) of brachial muscle and muscle strength of elbow flexion were-detected and compared with ipsolateral biceps brachii at the time of half year, one year and two years after operation.Result After half year, for the latency and amplitude of CMAP, there was no significant difference between brachial muscle and biceps brachii, (P>0.05) the RF mainly displayed chance pattern, the muscle strength graded M0-1. After one year, for latency of CMAP, there was still no significant difference between brachial muscle and.biceps (P>0.05), but for the amplitude of CMAP there was significant difference between brachial muscle and biceps (P<0.05), and biceps was superio to brachial muscle, the RF mainly showed few pattern, the muscle strength graded M2-3. After two years or more, for the latency and amplitude of CMAP, there was no significant difference between brachial muscle and biceps. (P>0.05), the RF mainly displayed single pattern, the muscle strength graded M3-4.Conclusions The function of brachial muscle and brachial branch both have recovery after phrenic nerve transfer to musculocutaneous nerve. After two years, the brachial muscle and biceps get recovery to the same extent, and the strength of elbow flexion combined with electrophysical examination can reflect that of brachial muscle. It is possible in some patient to reuse the brachial muscle or nerve.