Rehabilitation outcomes and prognostic factors of nerve grafting combined with exercise therapy for high-level radial nerve injury: Results of a retrospective study.

Abstract

Radial nerve injury is one of the most common peripheral nerve injuries and can be effectively treated with nerve grafting. However, the efficacy of nerve grafting combined with exercise therapy for the treatment of radial nerve injury remains unclear. In this study, we conducted a follow-up of at least one year in 40 patients with radial nerve injuries who received nerve grafting combined with exercise therapy, to evaluate their rehabilitation outcomes and identify the prognostic factors influencing the combined treatment. 62.5 % (n = 25) patients achieved M3+ extension strength. Shorter defect length and delayed repair time and more cables of nerve graft were significantly associated with the recovery of finger extension. Moreover, multivariate analysis showed that defect length and delay in repair were the independent predictors of extensor digitorum communis reinnervation. Additionally, receiver operating characteristic (ROC) curve suggested that both delay in repair (AUC = 0.808) and cables of nerve graft (AUC = 0.837) had a high accuracy in predicting the prognosis of nerve graft combined with exercise therapy, while delay in repair+cables of nerve graft (AUC = 0.960) had the highest accuracy. The optimal time for transplantation is 6.89 months (sensitivity = 86.7 %, specificity = 58.7 %) post-injury, and the optimal number of nerve grafts is 2.5 (sensitivity = 80 %, specificity = 53.3 %). We demonstrated that the effectiveness of nerve grafting combined with exercise therapy in treating radial nerve injury, and delay in repair and cables of nerve graft may act as the prognostic predictors of nerve graft combined with exercise therapy. These findings may provide a novel therapeutic method for radial nerve injury.