Long-term Observation of Respiratory Function After Unilateral Phrenic Nerve and Multiple Intercostal Nerve Transfer for Avulsed Brachial Plexus Injury
Mou-Xiong Zheng, MD; Wen-Dong Xu, MD; Yan-Qun Qiu, MD; and Jian-Guang Xu, MD
Hand Surgery Department, Huashan Hospital, Fudan University, Shanghai, China
Objective: Either phrenic nerve transfer (PNT) or multiple intercostal nerves transfer (MIT) alone was reported having no significant impact upon pulmonary function in short or medium term. But it has rarely been reported whether the combination of PNT-MIT could influence respiratory function in the long term. In this study, pulmonary and diaphragmatic function were compared between PNT and PNT-MIT after 7 to 19 years (mean 10 years) postoperatively.
Methods: 23 adult patients with brachial plexus avulsion injuries (BPAI) underwent PNT-MIT were compared with 19 corresponding adult patients who underwent PNT only. Pulmonary function testing, phrenic nerve conduction study, chest fluoroscopy were performed to assess ventilation, diaphragmatic response and excursion. In the PNT-MIT group, further comparison was performed to investigate whether transferred intercostal nerves number and the timing of MIT would influence the results.
Results: In PNT-MIT group, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and total lung capacity (TLC) were 73.69%, 72.04% and 74.81% of predicted without significant differences from PNT group. Diaphragmatic paralysis permanently existed with hemidiaphragm elevation of 1 to 1.5 intercostal spaces (ICSs) and near one ICS reduced excursion. But no statistically significant difference was found between PNT and PNT-MIT groups. Furthermore, in the PNT-MIT group, three and four intercostal nerves transfer resulted in no further decrease in pulmonary function than two intercostal nerves. No significant difference was found when PNT-MIT was performed at the same stage or at an interval of 1 or 2 months.
Conclusion: In the long term observation, PNT-MIT didnít result in additional impairment in respiratory function in adult patients compared with PNT alone. Two to four intercostal nerves transfer performed for 1 to 2 months delay after PNT is a safe method for treating BPAI.
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