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What Makes Nerve Grafting Work in Brachial Plexus Injuries: A Multivariate and Survival Analysis of Commonly Affiliated Variables

Published:November 23, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.048

      Abstract

      Introduction

      Nerve grafting in acute brachial plexus injuries remains a viable reconstructive method to restore elbow flexion. Past publications have made claims that technical factors do not significantly affect outcome, based on univariate analysis without consideration of time. The aim of this study is to analyze the effects of individual independent variables relative to other prognostic factors that can influence outcomes over time.

      Material and Methods

      49 patients with acute C5, C6 brachial plexus injuries who received autologous nerve grafting for elbow flexion were retrospectively collected from 1996 to 2016. Information regarding patient demographics, injury type, operative procedures, numbers and length of nerve graft were collected. Acceptable outcome was defined as elbow flexion ≥ MRC M3.

      Results

      36 (73%) patients have reached MRC M3 at elbow flexion, while 29 (59%) achieved M4. Average time to acceptable outcome was 18.65 months. In univariate binary logistic regression analysis, younger patients with less BMI and less time from injury to operation recovered to M3 in final stage (p=0.02 and 0.096 respectively). In multivariate logistic analysis and Cox regression, shorter nerve grafts with less cables had faster recovery at one year. Survival analysis showed graft length < 6cm (recover to M3, p<0.001) and age < 30 years (to M4, p=0.047) had significant better outcomes over time.

      Conclusion

      Shorter graft length (≤ 6 cm) in autologous nerve grafting consistently shows more reliable outcomes in elbow flexion within the first year after surgery and over time.

      Keyword

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