健侧颈7神经移位术治疗中枢性上肢痉挛性偏瘫的初步临床观察

目的初步观察采用健侧颈7神经移位术治疗中枢性上肢痉挛性偏瘫患者的疗效。方法回顾性研究2018年11月至2019年3月滨州医学院附属医院神经外科采用健侧颈7神经移位术治疗的6例中枢性上肢痉挛性偏瘫患者的临床资料。术后所有患者均给予综合康复治疗。观察手术相关并发症和疗效.:采用Fugl-Meyer(FM)运动功能评分量表和Brunnstrom偏瘫功能恢复分期量表评估运动功能的变化,采用改良Ashworth分级标准评估肌张力的变化,采用运动诱发电位(MEP)评估移位神经生长的效果。结果6例患者术中均未发生血管、神经的损伤。术后健侧上肢出现不同程度的一过性肌力减退和感觉麻木,均于术后1~3个月恢复正常。术后随访时间为(17.3±1.4)个月(15~19个月)。术后1,12个月偏瘫侧FM运动功能评分、Brunnstrom偏瘫功能恢复分期及改良Ashworth分级显示患者的运动功能和肌张力均呈逐渐改善的趋势,与术前比较,差异均有统计学意义(均P<0.01)。6例患者中,术前指总伸肌MEP检查显示5例患侧未引出波形的患者,术后12个月均可以引出波形。1例患者术前指总伸肌MEP检查显示潜伏期为29.7 ms,波幅为0.8 mV;术后12个月潜伏期为22.0 ms,波幅为1.9 mV。结论初步临床观察显示,健侧颈7神经移位术治疗中枢性上肢痉挛性偏瘫的手术并发症少,术后在联合康复治疗的基础上疗效好。

Preliminary study of clinical efficacy of seventh cervical nerve transfer for central spastic paralysis in the contralateral upper limb

Objective To preliminarily investigate the surgical method and clinical effect of contralateral seventh cervical nerve transfer in the treatment of central spastic paralysis in the contralateral upper limb.Methods A retrospective analysis was conducted on six patients with central spaslic paralysis in unilateral upper limb underwent contralateral seventh cervical nerve transfer at Department of Neurosurgery,Affiliated Hospital of Binzhou Medical University from November 2018 to March 2019.Postoperative comprehensive rehabilitation treatment was administered for all patients.The change of motor function were evaluated based on Fugl-Meyer(FM)motor function rating scale and Brunnstrom functional recovery stage table.The change of muscle tension was evaluated based on modified Ashworth grading standard(MAS),and motor evoked potential(MEP)was used to evaluate the growth of transferred nerve.Results None of the 6 patients had vascular or nerve injury during operation.Transient weakness and numbness to varying degrees were reported in the upper limb on the healthy side,and both recovered at 1 to 3 months post operation.Postoperative follow-up duration was 17.3±1.4 months(15-19 months).The postoperative(at 1 month and 1 year post surgery)scores of FM motor function rating scale and Brunnstrom functional recovery stage table both gradually increased compared wth preoperative scores and the differences were statistically significant(all P<0.01).Among the 6 patients,preoperative MEP examination showed no waveforms on the affected side in 5 patients,and waveforms could be induced in all at 1 year post surgery.In 1 patient,the latency and amplitude of preoperative MEP were 29.7 ms and 0.8 mV respectively,and those at 1 year post operation were 22.0 ms and 1.9 mV respectively.Conclusion Preliminary clinical observation has suggested that the contralateral seventh cervical nerve transfer is effective with few complications in the treatment of central spastic upper limb paralysis.