Dexterous hand motor functions are highly flexible and finely controlled by complex neural commands from the motor cortex. However, in patients with brain injuries such as stroke, restoring fine motor control from the perilesional cortex remains extremely challenging. A major obstacle is the absence of appropriate non-human primate models to elucidate the behavioral and neural signatures of hand motor function during recovery following treatments. Here, we present a new non-human primate model that reflects the motor function recovery processes following lesion-induced hand paralysis after contralateral C7 nerve transfer (CC7) surgery, which establishes a new neural pathway from the ipsilateral cortex to control the paralyzed hand. By developing a hand reach-to-pinch task and quantifying finger kinematics, we established systematic, objective profiles of fine motor recovery in human patients and monkey models following CC7 treatment. Furthermore, when considering behavioral aspects, spontaneous recovery of hand motor skills was notably limited in human patients and monkey models, as indicated by the consistently abnormal “thumb-in-palm” patterns observed in finger kinematic analysis. However, the CC7 surgery gradually restored the finger kinematic patterns during hand-pinch actions to nearly identical patterns to those of the healthy hand. In addition, the human functional MRI and macaque electrophysiology results revealed, on a neural level, the emergence of a new command area and its spiking-based motor-command refinements specifically for the paralyzed hand in the contralesional M1 and premotor cortex (PMC) after CC7 treatment. Thus, our findings strongly support the notion that modifying peripheral nerve pathways greatly promotes the recovery of dexterous motor function in a paralyzed hand by reconstructing new motor-control neural mechanisms within the ipsilateral healthy motor cortex.

Objective To evaluate whether right neurotomy of the seventh cervical nerve (C7) at the intervertebral foramen plus intensive speech and language therapy (SLT) improves language function compared intensive SLT alone in patients with chronic aphasia after stroke. Design Multicentre, assessor blinded, randomised controlled trial. Setting Four centres in mainland China. Participants 50 adults aged 40-65 years with aphasia for more than one year after a single left hemispheric stroke. Interventions Participants were randomised 1:1 to receive either C7 neurotomy plus three weeks of intensive SLT or three weeks of intensive SLT only, stratified by treatment centre. Main outcome measures The primary outcome was change in score on the 60 item Boston naming test (BNT, scores 0-60, with higher scores indicating better naming function) from baseline to one week after C7 neurotomy plus intensive SLT for three weeks or intensive SLT for three weeks after deferral for one week (control group). Secondary outcomes included change in severity of aphasia using the aphasia quotient, calculated using the western aphasia battery, and patient reported outcomes on quality of life and depression after stroke. Results From 25 July 2022 to 31 July 2023, 322 out of 1086 patients received a diagnosis of post-stroke aphasia and were screened for eligibility. 50 eligible participants were randomly assigned to treatment groups (25 in each). Mean increase in BNT score was 11.16 points in the neurotomy plus SLT group and 2.72 points in the control group at one month (difference 8.51 points, 95% confidence interval (CI) 5.31 to 11.71, P<0.001). The between group difference in BNT score remained stable at six months (difference 8.26 points, 4.16 to 12.35, P<0.001). In addition, the aphasia quotient improved significantly in the neurotomy plus SLT group versus control group (difference at one month 7.06 points, 4.41 to 9.72, P<0.001), as did patient reported activities of daily living and post-stroke depression. No treatment related severe adverse events were reported. Conclusions C7 neurotomy plus three weeks of intensive SLT was associated with a greater improvement in language function compared with three weeks of intensive SLT alone over a period of six months. No severe adverse events or long term troublesome symptoms or functional loss were reported. Trial registration Chinese Clinical Trial Register ChiCTR2200057180.

Peripheral nerves connect the central nervous system to the limbs. Crossing nerve transfer (CNT) promotes motor recovery after unilateral brain injury by inducing functional reorganization in central neural circuits. However, how specific circuits reorganize following peripheral nerve injury (PNI) under intact central pathways remains unclear. This study examines cortical neural circuit changes associated with motor recovery using a PNI mouse model with unilateral brachial plexus injury. CNT effectively restores motor function in the impaired forelimb. This cross-transferred pathway reconstructs sensory representations of the impaired forelimb in the ipsilateral sensorimotor cortex and enhances both inter- and intrahemispheric cortico-cortical projections, particularly interhemispheric projections from the ipsilateral to the contralateral sensorimotor cortices. Specifically, the contralateral motor cortex functionally reinnervates the injured forelimb through regenerated corticorubral and rubrospinal projections rather than corticospinal projections. These findings elucidate the circuit mechanisms underlying CNT-induced forelimb recovery and suggest potential targets for promoting functional restoration in PNI.

Achieving tension-free end-to-end sutures is crucial for optimal nerve recovery; however, it presents significant challenges in the contralateral C7 nerve transfer (cC7 transfer) procedure for patients with hemiplegic arms. This paper presents a modified surgical technique for cC7 transfer, featuring an aesthetically pleasing incision design. Key steps of the technique include precise incision planning, careful exposure and identification of the brachial plexus, meticulous tracing of the cC7 nerve, protection of the phrenic nerve and vertebral vessels, and the creation of a prevertebral space to facilitate the nerve transfer. We illustrate this method step by step in a hemiplegic patient. In conclusion, our approach offers a safe and effective strategy for performing modified contralateral C7 transfer surgery, ensuring tension-free end-to-end sutures for improved patient outcomes.

Vagus nerve stimulation (VNS) represents a neuromodulation technique that has shown potential in the treatment of various diseases. However, conventional VNS therapy is constrained by the requirement for implanted electrodes, primarily due to the scarcity of appropriate vagal cutaneous branches. Here, a neural bridging method was employed to connect the sensory nerve with the vagus nerve, thereby facilitating transcutaneous modulation of autonomic nerve function and addressing depressive disorders. Results showed that end-to-side neurorrhaphy induced robust axonal regeneration while preserving vagus nerve integrity. Neural tracing confirmed cervical nerve-to-nucleus tractus solitarius projections. Postoperative auricular stimulation significantly evoked 3.46-fold higher c-Fos+ neurons in the nucleus tractus solitarius versus sham controls. In depressed mice, this approach normalized behavioral deficits. Further investigations revealed concomitant improvements in non-rapid eye movement sleep architecture and suppression of hippocampal neuroinflammatory pathways (e.g., TNF, RNA-seq p ​< ​0.001). Together, this study developed a neural-bridging approach in mice that surgically connected a cutaneous sensory nerve to the cervical vagus nerve. Subsequent gentle auricular stimulation robustly activated the brainstem vagal nucleus and improved depression-like behaviors and sleep, alongside reduced hippocampal inflammatory signaling. As a preclinical proof-of-concept study, translational feasibility and long-term safety in humans require rigorous evaluation.

CC7 (contralateral cervical seventh nerve transfer) is an effective treatment for spastic hemiplegia caused by brain injury. After stroke, contralateral C7 nerve transfer facilitates the transmission of sensory information from the affected upper limb to the intact cerebral hemisphere. This process promotes cortical reorganization and ultimately enhances motor function recovery in the paralyzed limb. However, there is no effective method to accelerate motor function recovery and enhance sensory input following CC7 surgery. Electrical stimulation has been proposed as a valuable solution for nerve injuries, yet its effectiveness post-CC7 surgery remains unknown. In this study, we firstly investigated the potential of a wireless passive electrical (WPE) stimulation device in vivo as a rehabilitation approach. Subsequently, using the sciatic nerve model, we implanted the WPE electrodes to perform electrical stimulation and then evaluated nerve regeneration and motor function recovery using immunohistochemistry and behavioral analysis. Furthermore, we implanted the device in the transferred C7 nerve of CC7 mice and performed targeted electrical stimulation. We used immunofluorescence, electrophysiological, and behavioral assessments to explore the effects of repeated, targeted electrical stimulation on nerve regeneration, contralateral hemisphere remodeling, and motor function recovery in the paralyzed arm. The WPE stimulation protocol can effectively promote the regeneration of sensorimotor fibers after nerve repair. When applied to CC7 mice, it can accelerate the remodeling of the contralesional hemisphere by enhancing the ipsilateral sensory input and restore the impaired limb function. This stimulation modality can be considered a potential rehabilitation means to accelerate the efficacy of CC7 surgery.

PURPOSE:Contralateral C7 nerve transfer (CC7) surgery has demonstrated success in restoring upper limb motor function after central nervous system injuries. However, deficits in finger extension limit patient independence. This study evaluates a nerve transfer that transfers the motor branch of the flexor carpi radialis (FCR) to the posterior interosseous nerve (PIN) to improve finger extension. METHODS:Two patients with chronic brain injuries, who showed minimal finger extension recovery for over 1 year after CC7 surgery, were enrolled. Both patients then underwent the nerve transfer procedure. Upper extremity motor function was measured using the Fugl-Meyer upper extremity scale (UEFM), and changes in muscle tone were quantified with the Modified Ashworth Scale (MAS). Regular follow-up evaluations were conducted over an 18-month postoperative period to monitor motor recovery and spasticity. RESULTS:Within the first postoperative month, both patients exhibited significant improvements in spasticity. Although a minor rebound occurred in the second month, spasticity levels stabilized in subsequent evaluations. By 18 months after surgery, one patient regained functional finger extension, underscoring the potential efficacy of the procedure. Importantly, wrist flexion, governed by the flexor carpi radialis, remained unaffected throughout recovery. CONCLUSION:FCR-to-PIN nerve transfer alleviates spasticity and partially restores finger extension in patients with limited recovery following contralateral C7 nerve transfer. Although full motor recovery was not achieved, these findings offer promising clinical implications. Overall, the results support the procedure's value in clinical practice. Further studies with larger cohorts are needed to confirm these results and elucidate underlying mechanisms.

INTRODUCTION:This study presents an innovative arthroscopy-assisted total wrist arthrodesis technique utilising three hollow screws, aimed at improving clinical outcomes for patients with severe wrist arthritis. MATERIALS AND METHODS:The technique involved the placement of three hollow screws to facilitate wrist bone fusion. Between August 2019 and August 2023, four patients diagnosed with severe wrist arthritis underwent the arthroscopy-assisted procedure. Each patient was followed postoperatively for at least 1 year. Clinical evaluations included the Visual Analogue Scale (VAS), the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire, and the Patient-Rated Wrist Evaluation (PRWE). Radiographic imaging was performed to confirm successful bone fusion. Postoperative complications and scar length were also recorded. RESULTS:At the final follow-up, all patients exhibited decreased scores on the VAS, Quick DASH, and PRWE assessments, indicating reduced pain and improved wrist function. Radiographic imaging confirmed successful wrist bone fusion. No major complications arose, with an average scar length of 2.8 cm. CONCLUSION:The novel arthroscopy-assisted total wrist arthrodesis technique offers a simple and minimally invasive method that effectively improves joint function and alleviates pain in patients with severe wrist arthritis, while reducing the risk of complications.

Contralateral C7 nerve root transfer has been proven to improve post-stroke spastic arm function. In contrast, prolonged flaccidity is rare, but current methods offer little support for recovery. Shoulder inferior subluxation is common due to flaccidity of the shoulder abductor muscles, which are innervated by the C5 root. Since hemiplegia limits the use of the ipsilateral nerves and muscles for reconstruction, we therefore transferred the contralateral C7 (cC7) root to C5 and C7 (cC7-C5C7) in an attempt to restore voluntary control of the shoulder and distal upper limb. Two patients with prolonged flaccidity for more than one year were recruited. After 18 months of follow-up, the shoulder subluxation was reduced and S2 protective sensory function was restored in both patients. Patient one recovered with M3 shoulder strenght and hand grasp function, and patient two recovered with M3 elbow strength. Flaccid hand transited to severe spastic hand in patient one. In these two cases, cC7-C5C7 surgery could improve function and reduce shoulder subluxation in post-stroke flaccid upper limb. Further anti-spasticity management could be taken to improve hand function if severe spasticity occurs.

AbstractBackgroundCentral nervous system (CNS) disorders, such as stroke, often lead to spasticity, which result in limb deformities and significant reduction in quality of life. Spasticity arises from disruptions in the normal functioning of cortical and descending inhibitory pathways in the brainstem, leading to abnormal muscle contractions. Contralateral seventh cervical nerve cross transfer (CC7) surgery has been proven to effectively reduce spasticity, but the specific mechanism for its effectiveness is unclear.MethodsThis study aimed to investigate the changes in the dorsal root ganglia (DRG) following CC7 surgery. A comprehensive anatomical analysis was conducted through cadaveric study and magnetic resonance imaging (MRI) study, to accurately measure the regional anatomy of the C7 DRG. DRG perfusion changes were quantitatively assessed by comparing pre‐ and postoperative dynamic contrast‐enhanced (DCE) MRI.ResultsIn CC7 surgery, the C7 nerve root on the affected side is cut close to the DRG (3.6 ± 1.0 mm), while the C7 nerve root on the healthy side is cut further away from the DRG (65.0 ± 10.0 mm). MRI studies revealed that after C7 proximal neurotomy on the affected side, there was an increase in DRG volume, vascular permeability, and perfusion; after C7 distal neurotomy on the healthy side, there was a decrease in DRG volume, with no significant changes in vascular permeability and perfusion.ConclusionThis study provides preliminary insights into the mechanisms of spasticity reduction following CC7 surgery, indicating that changes in the DRG, such as increased vascular permeability and perfusion, could disrupt abnormal spinal γ‐circuits. The resulting high‐perfusion state of DRG, possibly due to heightened neuronal activity and metabolic demands, necessitating further research to verify this hypothesis.

Left hemisphere injury can cause right spastic arm paralysis and aphasia, and recovery of both motor and language functions shares similar compensatory mechanisms and processes. Contralateral cervical seventh cross transfer (CC7) surgery can provide motor recovery for spastic arm paralysis by triggering interhemispheric plasticity, and self-reports from patients indicate spontaneous improvement in language function but still need to be verified. To explore the improvements in motor and language function after CC7 surgery, we performed this prospective observational cohort study. The Upper Extremity part of Fugl-Meyer scale (UEFM) and Modified Ashworth Scale were used to evaluate motor function, and Aphasia Quotient calculated by Mandarin version of the Western Aphasia Battery (WAB-AQ, larger score indicates better language function) was assessed for language function. In 20 patients included, the average scores of UEFM increased by .40 and 3.70 points from baseline to 1-week and 6-month post-surgery, respectively. The spasticity of the elbow and fingers decreased significantly at 1-week post-surgery, although partially recurred at 6-month follow-up. The average scores of WAB-AQ were increased by 9.14 and 10.69 points at 1-week and 6-month post-surgery (P < .001 for both), respectively. Post-surgical fMRI scans revealed increased activity in the bilateral hemispheres related to language centrals, including the right precentral cortex and right gyrus rectus. These findings suggest that CC7 surgery not only enhances motor function but may also improve the aphasia quotient in patients with right arm paralysis and aphasia due to left hemisphere injuries.

Background Augmented reality (AR), a form of 3D imaging technology, has been preliminarily applied in tumor surgery of the head and spine, both are rigid bodies. However, there is a lack of research evaluating the clinical value of AR in tumor surgery of the brachial plexus, a non-rigid body, where the anatomical position varies with patient posture. Methods Prior to surgery in 8 patients diagnosed with brachial plexus tumors, conventional MRI scans were performed to obtain conventional 2D MRI images. The MRI data were then differentiated automatically and converted into AR-based 3D models. After point-to-point relocation and registration, the 3D models were projected onto the patient’s body using a head-mounted display for navigation. To evaluate the clinical value of AR-based 3D models compared to the conventional 2D MRI images, 2 senior hand surgeons completed questionnaires on the evaluation of anatomical structures (tumor, arteries, veins, nerves, bones, and muscles), ranging from 1 (strongly disagree) to 5 (strongly agree). Results Surgeons rated AR-based 3D models as superior to conventional MRI images for all anatomical structures, including tumors. Furthermore, AR-based 3D models were preferred for preoperative planning and intraoperative navigation, demonstrating their added value. The mean positional error between the 3D models and intraoperative findings was approximately 1 cm. Conclusions This study evaluated, for the first time, the clinical value of an AR-based 3D navigation system in preoperative planning and intraoperative navigation for brachial plexus tumor surgery. By providing more direct spatial visualization, compared with conventional 2D MRI images, this 3D navigation system significantly improved the clinical accuracy and safety of tumor surgery in non-rigid bodies.

Background This study aims to assess the recovery patterns and factors influencing outcomes in patients with common peroneal nerve (CPN) injury. Methods This retrospective study included 45 patients with CPN injuries treated between 2009 and 2019 in Jing’an District Central Hospital. The surgical interventions were categorized into three groups: neurolysis (group A; n = 34 patients), nerve repair (group B; n = 5 patients) and tendon transfer (group C; n = 6 patients). Preoperative and postoperative sensorimotor functions were evaluated using the British Medical Research Council grading system. The outcome of measures included the numeric rating scale, walking ability, numbness and satisfaction. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal time interval between injury and surgery for predicting postoperative foot dorsiflexion function, toe dorsiflexion function, and sensory function. Results Surgical interventions led to improvements in foot dorsiflexion strength in all patient groups, enabling most to regain independent walking ability. Group A (underwent neurolysis) had significant sensory function restoration ( P < 0.001), and three patients in Group B (underwent nerve repair) had sensory improvements. ROC analysis revealed that the optimal time interval for achieving M3 foot dorsiflexion recovery was 9.5 months, with an area under the curve (AUC) of 0.871 (95% CI = 0.661–1.000, P = 0.040). For M4 foot dorsiflexion recovery, the optimal cut-off was 5.5 months, with an AUC of 0.785 (95% CI = 0.575–0.995, P = 0.020). When using M3 toe dorsiflexion recovery or S4 sensory function recovery as the gold standard, the optimal cut-off remained at 5.5 months, with AUCs of 0.768 (95% CI = 0.582–0.953, P = 0.025) and 0.853 (95% CI = 0.693–1.000, P = 0.001), respectively. Conclusions Our study highlights the importance of early surgical intervention in CPN injury recovery, with optimal outcomes achieved when surgery is performed within 5.5 to 9.5 months post-injury. These findings provide guidance for clinicians in tailoring treatment plans to the specific characteristics and requirements of CPN injury patients.

Background Contralateral C7 to C7 cross nerve transfer has been proved to be safe and effective for patients with spastic arm paralysis due to stroke and traumatic brain injury. For the lower limb, contralateral L5 to S1 cross nerve transfer serves as a novel surgical approach. In many cases, patients with hemiplegia have both upper and lower limb dysfunction and hope to restore all limb functions within one operation. To cope with this demand, we performed combined contralateral C7 to C7 and L5 to S1 cross nerve transfer in two cases successfully. Case description Two patients were enrolled in this study. The first patient is a 36-year-old woman who had spasticity and hemiplegia in both upper and lower limbs on the left side after a right cerebral hemorrhage 14 years prior. The second patient is a 64-year-old man who suffered from permanent muscle weakness in his right limbs, especially the leg, after a left cerebral hemorrhage 7 years prior. Both patients underwent the combined nerve transfer to improve upper and lower limb motor functions simultaneously. During the 10-month follow-up after surgery, the limb functions of both patients improved significantly. Conclusions This study demonstrates the safety and benefits of combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for hemiplegic patients after stroke. This novel combined surgical approach could provide an optimal choice for patients suffering from both upper and lower limb dysfunction, to reduce hospital stay while reducing financial burden.

Selective tibial neurotomy (STN) is a surgical procedure for treating spastic equinovarus foot. Hyperselective neurectomy (HSN) of tibial nerve is a modified STN procedure, which was rarely discussed. This study aimed to describe the branching patterns of the tibial nerve and propose an optimal surgical incision of HSN for treatment of spastic equinovarus foot. Sixteen lower limbs were dissected to determine the various branching patterns of the tibial nerve and categorized according to these branching patterns. The mean distances from the nerve entry points to the tip of femur’s medial epicondyle were measured, as well as their percentage to the overall length of the leg. The surgical incision was designed according to the range of these nerve entry points. The tibial nerve sent out proximal and distal motor branches based on their position relative to the soleus muscle’s tendinous arch. For proximal motor branches, the branches innervating the medial gastrocnemius, lateral gastrocnemius and proximal soleus were categorized into types I (9/16), II (5/16) and III (2/16). Measurements from the medial epicondyle to the nerve entry points into the medial gastrocnemius, lateral gastrocnemius and proximal soleus ranged from 14 to 33 mm (4–9

Objective Hyperselective neurectomy is used to treat spastic arm paralysis. The aim of the study was to analyze the nerve branching patterns of elbow and wrist flexors/pronator to inform hyperselective neurectomy approached. Methods Eighteen upper extremities of fresh cadaver specimen were dissected. The number of motor branches from the musculocutaneous nerve to biceps brachii and brachialis, median nerve to pronator teres, flexor carpi radialis and ulnar nerve to flexor carpi ulnaris were counted. The origin site of each primary motor branch was documented. Results Either biceps or brachialis was innervated by one or two primary motor branches. Pronator teres was innervated by one to three motor trunks and the pattern for flexor carpi radialis was a common trunk with other branches. The origin of the biceps and brachialis nerve trunk was located approximately 30% to 60% of the length of the arm. The median nerve branched to pronator teres and flexor carpi radialis at the region about 34mm (SD 18.8mm) above and 50mm (SD 14.9mm) below the medial epicondyle. Flexor carpi ulnaris was innervated by one to three motor trunks and the mean distance from the medial epicondyle to the origin of flexor carpi ulnaris nerve on ulnar nerve was 18.7 mm (SD 6.5mm). Conclusion Primary motor branches to elbow flexors, wrist flexors and pronators were various, while the regions of their origins were relatively settled. It was recommended the incisions be designed according to the location of the primary motor trunks.

Recurrent ulnar nerve compression after primary anterior subcutaneous transposition is relatively rare, and revision surgery is challenging. This study retrospectively evaluated the clinical outcomes of revision anterior subcutaneous transposition for recurrent ulnar nerve compression. Eight patients who underwent revision anterior subcutaneous transposition for recurrent ulnar nerve compression were enrolled in this study. The outcomes were based on preoperative and postoperative symptoms, physical examination findings, and electromyographic evaluation. Ulnar nerve enlargement was preoperatively found in all patients with a mean cross sectional area of 0.15 cm2 (range, 0.14–0.18 cm2). Intraoperative findings showed that recurrent compression occurred in three areas, including the medial intermuscular septum (n = 5), the medial epicondyle (n = 6) and nerve entrance to forearm fascia (n = 1). Post-operation, significant improvements were observed in ring/little finger numbness (from severe to mild, p = 0.031), grip strength (from 48.00

We describe a modified metaphyseal ulnar osteotomy to treat ulnar impaction syndrome with a reverse oblique sigmoid notch. Based on a computational analysis of radiographs, a modified wedge metaphyseal ulnar osteotomy was devised with its apex positioned at the ulnar styloid base to avoid impaction between the sigmoid notch and ulnar head. Subsequently, nine patients with ulnar impaction syndrome and a reverse oblique sigmoid notch underwent this operation, combined with arthroscopic exploration and transosseous triangular fibrocartilage complex repair. The mean follow-up was 14 months. All patients achieved bone union within 5 weeks, with no degenerative changes being observed during the follow-up assessments. The final follow-up assessments revealed decreases in ulnar variance and in the scores for Visual Analogue Scale, Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Patient-Rated Wrist Evaluation. All patients achieved excellent or good grades on the Modified Mayo Wrist Score. This technique is effective in treating the ulnar impaction syndrome with a reverse oblique sigmoid notch. Level of evidence: IV

ABSTRACT Background Post-stroke aphasia is a common but intractable sequela which still needs new and more effective treatments. Evidence from follow-ups after contralateral seventh cervical nerve transfer surgery indicated that nerve transection leads to immediate language improvements in patients with right post-stroke aphasia. Objective Through a prospective cohort design, this study aims to prove that C7 neurotomy at the intervertebral foramen (NC7) combined with a 3-week intensive speech and language therapy (iSLT) can improve the language function in post-stroke aphasia patients. Methods In this study, patients aged over 18 years old and had been diagnosed with post-stroke aphasia for 1 year or longer were included. Primary outcomes were the change in the ability to retrieve personally relevant words in Boston Naming Test (BNT) with follow-up assessment after three-weeks’ iSLT post-operatively. As well as several secondary outcome measures including the Western Aphasia Battery (WAB), daily communication abilities (measured by the Communication Activities of Daily Living Third Edition [CADL-3]) and Fugl-Meyer of upper limb part (UEFM). Results The average increase of BNT score was 11.2 points from baseline to 3 weeks post-operatively (P=0.001, 95%CI: 8.1-14.1). The WAB and CADL-3 assessment showed 9.4, 10.4 points increasing in average (P<0.005, 95%CI: 4.6 to 14.1; P<0.001, 95%CI:6.7 to 14.1) from baseline to 4-week follow-up, respectively. The mean difference from baseline to 3 weeks post-operatively in UEFM score decreased 0.8 points (95% CI: -3.2 to 1.6; p<0.405). Conclusions NC7 plus iSLT significantly improved the language function in patients with post-stroke aphasia, and did not significantly affect the motor function of the right limb. The mechanism of this surgery needs to be further explored.

肢体痉挛是中枢神经系统疾病的常见后遗症，遗留的运动功能障碍给患者带来极大痛苦，并给社会带来沉重负担。非手术治疗效果不佳时，外科手术治疗成为临床选择。本文对解除痉挛的神经手术"高选择性神经切断术"与"选择性脊神经后根切断术"两种术式展开综述，对比分析其临床应用。结果显示两种术式均可有效改善中枢神经系统损伤患者的肢体痉挛情况，高选择性神经切断术更适用于痉挛靶肌肉较为局限的、支配神经明确的患者，对肢体远端关节如腕、指关节活动功能的改善更为明显。选择性脊神经后根切断术更适用于存在广泛痉挛的肢体，对肢体近端关节如肩、肘等大关节痉挛的改善效果较明显。