映萱 李

  • Demographic Differences in Patient Population and C5 root viability in Adult Traumatic Pan Brachial Plexus Injuries of Two Brachial Plexus Centers

    Background: Complete brachial plexus injuries (BPI) are devastating life altering injuries. A viable C5 nerve root can offer additional sources of axons and alters surgical treatment strategies. We aimed to determine if demographic differences affected C5 nerve root viability and to determine factors that portened C5 nerve root avulsion.
    Methods: A retrospective study was performed of 200 consecutive patients with complete BPIs at two international centers, one in the United States (US) and one in Taiwan. Demographic information, concominant injuries as well as mechanisms and details of the injury including speed of accident was determined from medical reports or by patient contact and used to calculate kinetic energy of the accident and injury Severity Score (ISS). C5 nerve root viability was measured, a nerve root was considered viable if it was grafted during surgery.
    Results: Significant differences were found between several demographic variables between the two institutions (including age of injury, body mass index (BMI), time to surgery, vehicle type, speed of injury, kinetic energy, ISS score and presence of vascular injury). Complete five nerve root avulsions of the brachial plexus was present in 62% of US pateints and 44% of Taiwanese patients. The number of ruptured C5 nerve roots was significantly less in the US, however rates of rupture of C6 and C7 did not differ. Statistical analysis showed increasing age at injury, the time from injury to surgery, weight of patient, BMI of patient, motor vehicle accident (MVA), speed, kinetic energy, ISS score and presence of vascular injury all significantly increased the risk of C5 avulsion. Moped or bicycle accident decreased the risk of avulsion.
    Conclusion: The rate of complete avulsion injury was high in both centers. Although there are a number of demographic differences between the US and Taiwan, overall the kinetic energy of the accident increased the risk of C5 avulsion at both institutions. MVA and vascular injury were the strongest predictors of C5 avulsion.

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