改良健侧颈七神经转位治疗上肢痉挛性偏瘫的临床研究

Clinical Study of Modified Contralateral Seventh Cervical Nerve Transposition for Upper Limb Spastic Hemiplegia

摘要: 背景：中枢神经系统损伤后上肢痉挛性偏瘫是导致患者长期功能障碍和生活能力下降的重要原因，传统康复治疗对慢性期患者的功能改善有限。健侧颈七神经转位术为中枢性偏瘫的治疗提供了新的外科思路，但传统术式在手内部肌功能恢复方面仍存在一定局限。本研究旨在探讨改良健侧颈七神经转位术在治疗中枢神经系统损伤后上肢痉挛性偏瘫中的临床疗效与安全性。方法：回顾性分析2023年9月至2026年1月华中科技大学同济医学院附属协和医院收治的47例中枢神经损伤后上肢痉挛性偏瘫患者。根据治疗方式不同分为三组：改良健侧C7神经转位组11例、传统健侧C7神经转位组15例、康复治疗组21例。分别在治疗后1、3、6及12个月采用Fugl-Meyer上肢运动功能量表(FMA-UE)、改良Ashworth量表(MAS)、关节活动度(ROM)及Barthel指数(BI)评估疗效，并记录术后不良反应。结果：两种手术组在FMA-UE评分、ROM及Barthel指数改善方面均显著优于康复组(P < 0.05)。MAS评分显示手术组肌张力在术后1个月显著下降，3个月轻度回升，随后在6–12个月再次下降并趋于稳定。在屈伸肘、前臂旋转及腕关节相关肌群痉挛改善方面，两种术式差异无统计学意义(P > 0.05)；但在拇指对掌及2~5指分/并指等反映手内部肌功能的指标中，改良术式改善程度明显优于传统术式(P < 0.05)。两组手术患者均出现短期疼痛、感觉减退及健侧肌力下降等不良反应，但多在术后6个月内逐渐恢复。结论：改良健侧C7神经转位术可显著改善中枢神经损伤后上肢痉挛性偏瘫患者的运动功能和肌张力，并在手内部肌痉挛缓解及精细运动恢复方面优于传统术式，且具有良好的安全性。

Abstract: Background: Spastic hemiplegia of the upper limb caused by central nervous system injury is a major factor leading to long-term disability, and conventional rehabilitation often shows limited effectiveness in patients with chronic motor impairment. Contralateral C7 nerve transfer has emerged as a promising surgical approach for improving upper-limb function; however, the conventional procedure has limited effects on intrinsic hand muscle recovery. This study aimed to investigate the clinical efficacy and safety of a modified contralateral C7 nerve transfer in the treatment of spastic hemiplegia following central nervous system injury. Methods: A retrospective analysis was conducted on 47 patients with spastic upper-limb hemiplegia secondary to central nervous system injury who were treated at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from September 2023 to January 2026. According to treatment modality, patients were divided into three groups: modified contralateral C7 nerve transfer group (n = 11), conventional contralateral C7 nerve transfer group (n = 15), and rehabilitation group (n = 21). Clinical outcomes were evaluated at 1, 3, 6, and 12 months after treatment using the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Range Of Motion (ROM), and Barthel Index (BI). Postoperative adverse events were also recorded. Results: Both surgical groups showed significantly greater improvements in FMA-UE score, ROM, and BI than the rehabilitation group (P < 0.05). MAS scores showed that muscle tone in the surgical groups decreased markedly at 1 month after surgery, rebounded slightly at 3 months, and then decreased again and gradually stabilized during months 6 to 12. No statistically significant difference was found between the two surgical procedures in the improvement of spasticity involving elbow flexion-extension, forearm rotation, and wrist-related muscle groups (P > 0.05). However, in indicators reflecting intrinsic hand muscle function, including thumb opposition and separation/approximation of the second to fifth fingers, the modified procedure showed significantly greater improvement than the conventional procedure (P < 0.05). Short-term adverse events, including pain, sensory decline, and reduced muscle strength of the contralateral limb, were observed in both surgical groups, but most gradually resolved within 6 months after surgery. Conclusion: Modified contralateral C7 nerve transfer can significantly improve motor function and muscle tone in patients with spastic upper-limb hemiplegia after central nervous system injury. It is superior to the conventional procedure in relieving intrinsic hand muscle spasticity and restoring fine motor function, while maintaining a favorable safety profile.