Partial median and ulnar nerve transfer for functional reconstruction in brachial plexus injury

Objective To treat upper and middle trunks or C 5～7 avulsion of brachial plexus by neurotization using a part of median nerve and ulnar nerve Methods All patients were divided into 2 groups according to the surgical procedures Eleven cases were involved in the first group The phrenic nerve was chosen to anastomose with musculocutaneous nerve or through a sural nerve graft and the spinal accessory nerve was anastomosed with suprascapular nerve Eleven cases from 1997 were classified into the second group A part of the fascicles of median nerve was transferred to coapt with the motor fascicle of musculocutaneous nerve and a part of fascicles of ulnar nerve was transferred to harvest with axillary nerve The cases were followed up from 0 5 to 3 years and the clinical outcome was compared between the two groups Results There were 2 cases(16 6%)who got the recovery of M 4 strength of biceps muscle in the first group and 7 cases(63 6%)in the second group,and the difference was statistically significant( P 0 05) But it was not statistically different in the recovery of shoulder function between the two groups Conclusion Partial nerve transfer,phrenic and spinal accessary nerve transfer all were effective for the reconstruction of elbow or shoulder function in brachial plexus injury,but the neurotization using a part of median nerve could obtain more powerful muscle strength than the other nerve transfer procedures