Artikel
Tendon transfer surgery after contralateral C7 nerve transfer to reconstruct the finger extension function in spastic arm paralysis patients after central neurological injury
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Autoren
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Juntao Feng
- Huashan Hospital, Fudan University, Shanghai, China
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Gaowei Lei
- Huashan Hospital, Fudan University, Shanghai, China
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Yundong Shen
- Huashan Hospital, Fudan University, Shanghai, China
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Wendong Xu
- Huashan Hospital, Fudan University, Shanghai, China
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Spastic arm paralysis after central neurological injury was difficult to treat. Conventional means such as tendon transfer could not be applied since the forearm muscles were in a high level of spasticity. Contralateral C7 nerve transfer provided a good method for the control and reduction of the spasticity of the paralyzed forearm muscles. Here we reported the use of forearm muscles innervated by the contralateral C7 nerve as the donor for tendon transfer to reconstruction finger extension function in central neurological injury patients.
Methods: Before the surgery, the spasticity of the flexors of the forearm was high, and surface EMG detected persisted contraction waveform in the flexor carpi radialis (FCR). Intuitive control of the spastic arm was not possible; therefore, the patients was not able to perform hand opening tasks. Contralateral C7 nerve transfer surgery was performed firstly, and the spasticity was significantly lower, while intuitive control was better in both of the patients at one-year follow-up. After this, tendon transfer surgery was performed with the following strategy: the FCR transposed to the extensor digitorum communis (EDC) via subcutaneous tunnel. The hand function was evaluated again after the surgery including the range of motion, muscle strength and hand function evaluation (Fugl-Meyer scale).
Results and Conclusions: After the contralateral C7 nerve transfer surgery, the surface EMG detected shows the low-level of spasticity of the FCR. No detectable functional loss was reported from the patients. Three months after the tendon transfer surgery, the finger extension motion range increased from 0-3° to 0-30° while the mean increase in hand function score in the paralyzed arm was 7 points comparing to the one-year follow-up results after the contralateral C7 nerve transfer surgery.
In conclusion, contralateral C7 nerve transfer surgery connected the paralyzed upper limb to the contralesional hemisphere, and provided good intuitive control and reduction in spasticity of the FCR. This provided good donor muscle for tendon transfer to further improve the hand open function and acquired good clinical outcome in our preliminary study.
