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健侧颈神经移位术治疗上肢痉挛瘫的临床试验
Trial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis


Mou-Xiong Zheng ... 心脑血管疾病 其他 • 2018.01.04
相关阅读
• 通过健侧C7神经移位术治疗上肢痉挛瘫

健侧C7神经移位术成功治疗上肢痉挛瘫

 

Daniel J. Nagle

Northwestern Feinberg School of Medicine, Chicago, IL, USA

 

发表于2018年1月4日的《健侧颈神经移位术治疗上肢痉挛瘫的临床试验》介绍了健侧C7神经移位术治疗脑卒中、脑外伤和脑瘫后的上肢痉挛性偏瘫1。这项工作是建立在顾玉东医生及其团队报道的、在1986年所做的首创性工作——健侧C7神经移位术治疗臂丛神经损伤基础上的。当前的这项工作与顾医生此前的工作又有较大不同,其研究的是将健侧C7神经移位术用于治疗中枢神经系统损伤后的上肢功能损害与痉挛。

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摘要


背景

大脑半球损伤引起的上肢痉挛瘫可造成长期残疾。本课题旨在研究健侧颈神经移位术(将健侧上肢的C7神经移位到患侧上肢的C7神经)治疗大脑损伤后慢性期上肢痉挛瘫的疗效。

 

方法

我们将36例一侧上肢瘫痪5年以上的患者随机分为2组:一组患者(18例)进行健侧C7神经移位术加康复治疗;另一组患者(18例)进行单纯康复治疗。主要结局是Fugl-Meyer上肢量表评分(总分0~66分,分数较高表示功能较好)从基线到12个月的改变量。

 

结果

手术组和对照组患者与基线相比,患肢Fugl-Meyer评分分别平均增加了17.7分和2.6分(两组差异为15.1分;95%置信区间[CI],12.2~17.9;P<0.001)。改良Ashworth量表用于检测患肢痉挛程度(检测5个关节,评分标准为0~5分,评分较高表示痉挛较严重)。两组痉挛变化的组间差异最小的为拇指,手术组分别有6例、9例和3例患肢拇指的痉挛评分下降2分、1分和0分,而对照组分别有1例、6例和7例患肢拇指痉挛评分下降2分、1分和0分(P=0.02)。经颅磁刺激和功能显像结果显示患肢与同侧大脑半球之间建立了连接。从基线到12个月随访,两组患者健侧上肢的肌力、触觉阈值和两点辨别觉都未发生显著改变。

 

结论

在本项单中心临床试验中,我们对脑损伤后慢性期一侧上肢痉挛瘫患者接受健侧上肢的C7神经移位到患侧上肢C7神经手术加康复治疗的手术组与接受单纯康复治疗的对照组进行比较。12个月随访时,手术组患肢功能改善和痉挛程度下降均较对照组更为显著。其潜在机制是该手术在患肢和同侧大脑半球(未损伤半球)之间建立了生理上的连接(由中国国家自然科学基金委等资助;在中国临床试验注册中心注册号为13004466)。





作者信息

Mou-Xiong Zheng, M.D., Ph.D., Xu-Yun Hua, M.D., Ph.D., Jun-Tao Feng, M.D., Tie Li, M.D., Ph.D., Ye-Chen Lu, M.D., Yun-Dong Shen, M.D., Ph.D., Xiao-Hua Cao, Ph.D., Nai-Qing Zhao, M.S., Jia-Ying Lyu, B.S., Jian-Guang Xu, M.D., Ph.D., Yu-Dong Gu, M.D., and Wen-Dong Xu, M.D., Ph.D.
From the Department of Hand Surgery, Huashan Hospital (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), the National Clinical Research Center for Aging and Medicine (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), Department of Biostatistics, School of Public Health (N.-Q.Z., J.-Y.L.), and State Key Laboratory of Medical Neurobiology (W.-D.X.), Fudan University, the Key Laboratory of Hand Reconstruction, Ministry of Health (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), the Shanghai Key Laboratory of Peripheral Nerve and Microsurgery (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., J.-G.X., Y.-D.G., W.-D.X.), the Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital (M.-X.Z., X.-Y.H., J.-T.F., T.L., Y.-C.L., Y.-D.S., W.-D.X.), and the Key Laboratory of Brain Functional Genomics (Ministry of Education) and Shanghai Key Laboratory of Brain Functional Genomics, East China Normal University (X.-H.C.) — all in Shanghai, China. Address reprint requests to Dr. Xu at the Department of Hand Surgery, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Rd., Shanghai 200040, China, or at wendongxu@fudan.edu.cn.

 

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