الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 322 |  |  |
| | | from | 322 | | |
Abstract
Introduction: Posttraumatic brachial plexus palsy is a severe injury primarily affecting young individuals at the prime of their life. The devastating neurological dysfunction inflicted in those patients is usually lifelong and creates significant socioeconomic issues. Critical motor function in the limb may be lost, sensation in the hands may be impaired, and disabling pain may ensue. At many centers around the world, leading surgeons have introduced new microsurgical techniques and reported a variety of different philosophies for the reconstruction of the plexus. Microneurolysis, nerve grafting, recruitment of intra plexus and extra plexus donors, and local and free-muscle transfers are used to achieve optimal outcomes. However, there is yet no consensus on the priorities and final goals of reconstruction among various centers
Aim of work: The aim of this study is to evaluate nerve reconstructive strategies for management of cases of traumatic brachial plexus injury and to make appropriate selection of them.
Patients and methods: In the period between 1995 to 2009, 127 patients with traumatic brachial plexus injury were managed by microsurgical reconstruction of the brachial plexus in the Hand and Reconstructive Microsurgery Unit in Assuit University Hospital and Upper Limb Surgery Unit in Mansoura University Hospital and were followed up for at least 2 years. Patients with partial or total traumatic brachial plexus injury of both genders, younger than 50 years old with denervation time not exceeding 10 months, were selected in this study. They were 114 males (89.8%) and 13 females (10.2%). The right side was affected in 58 cases (45.7%) while the left side was affected in 69 cases (54.3%).
Results: The mechanism of injury was motor vehicle accident in 87 cases (68.5%), stab wounds in 7 cases (5.5%) and gunshots in 9 cases (7.1%). The mean denervation time (time elapsed between injury and reconstructive procedure) was 4.63 ± 2.50 months (0.33 – 16.0 months). 30 cases (23.6%) had concomitant fractures were encountered. 13 cases were associated with vascular injury that necessitated urgent surgical intervention. Clinical assessment included detailed history, the range of motion of all joints of the upper limb and cervical spine were assessed both actively and passively, the muscle power, sensation and vascularity. Tinel’s sign was elicited by tapping the supraclavicular area in craniocaudal fashion. Horner’s syndrome (ptosis, myosis and anhydrosis) was observed in 12 cases and its sensitivity to detect lower roots avulsion was 32.43%. CT Myelography was obtained in 17 cases. Its sensitivity was 65%. It was more sensitive for detection of root avulsion. MRI was not routinely used in this study, it was used in 8 cases only. MRI angiography (MRA) was performed in 3 cases with scapulothoracic dissociation
Conclusions: Horner’s syndrome is specific for detection of lower roots avulsion. CT Myelogram has high percentage of false results with upper roots of brachial plexus. The pattern of brachial plexus injury determines the outcome of brachial plexus reconstruction. Both axillary and Suprascapular nerves reconstruction have better results in shoulder function than single nerve reconstruction. Oberlin procedure is reliable technique for restoration of elbow flexion without significant neurological deficit in upper trunk brachial plexus. Oberlin procedure has inferior outcome in cases of C5, 6, 7 root avulsions.