[The clinical study of reconstruction of traumatic brachial plexus root avulsion injury in children].

OBJECTIVE: To observe the primary result of finger flexion reconstruction in the procedure of direct anastomosis of contralateral C(7) transferred through the prespinal route with lower trunk in children suffered traumatic brachial plexus root avulsion injury. METHODS: On the healthy side, the C(7) nerve root was identified anatomically and transected at the level of division by dissecting its anterior and posterior division as far distal as possible up to the level where the nerve fibers interweaving with other division, then the contralateral C(7) nerve root was dissected proximally up to the neuroforamina. The contralateral C(7) nerve root was transferred to contralateral side through the prespinal route. The entire brachial plexus of suffered side was exposed through the union incision superior and inferior to the clavicle, The lower trunk was identified and dissected proximally to the C(8) and T(1) nerve root which were severed at the lateral margin of anterior scalenus, and then the dorsal division and anterior medial pectoral nerve of lower trunk were severed. The median nerve, ulnar nerve and medial antebrachial cutaneous nerve were identified from the origin and dissected distally continue to the midpoint of upper arm, and lateral head of the median nerve was severed so that the lower trunk, medial cord and median nerve, ulnar nerve and medial antebrachial cutaneous nerve can be fully mobilized. Anteriorly flexion and adduction of the should at 0 degrees and flexion elbow at 90 degrees , this could allow considerable length to be gained when pulling the lower trunk proximally, direct anastomosis of contralateral C(7) with lower trunk was performed. If there was any tension exist, the appropriate humerus shorten osteotomy should be performed. From August 2004 to December 2008, 20 children including 13 cases with total brachial plexus nerve root avulsion injury and 7 cases with middle and lower trunk avulsion injury were repaired by this procedure. Twenty cases including 16 males and 4 females, the average age was 13 years with a range of 5 to 18 years. The interval from injury to operation ranged 1 to 11 months with a mean of 4.6 months. Eleven patients were performed the humeral shorten osteotomy, the length of the humeral shorten was 2.0 - 4.5 cm, with the mean of (3.1 +/- 0.7) cm. RESULTS: The follow up period was 12 to 51 months, with the average of 26 months. The muscle strength of finger flexion attained M 4 in 18 cases, M 2 in 2 cases. The motor function of thumb flexion gained M 4 in 10 cases, M 3 in 8 cases, M2 in 2 cases. Of the 2 cases achieved motor function of intrinsic muscles of the hand of M3. CONCLUSIONS: The direct anastomosis of contralateral C(7) with lower trunk in children with traumatic brachial plexus avulsion injury can improve the effect of reconstructing the function of finger flexion because it reduces one never anastomosis site and decreases the distance of nerve regeneration compared with the traditional method. With this modified procedure, the functional recovery of intrinsic muscles of the hand in children with traumatic brachial plexus avulsion injury is becoming possible.