Nerve transfer for upper extremity reanimation in people with spinal cord injury: A 2-year follow-up case series

To describe the 2-year functional outcomes of nerve transfer (NT) for upper extremity reanimation. A prospective case series. A highly specialized rehabilitation hospital for spinal cord injury (SCI) in Italy. Upper limb nerve transfer (32 NTs, 15 upper limbs). Twelve male individuals with traumatic SCI (AIS A or B, neurological level from C4 to C7) were enrolled; 24-month follow-up data were available for 11. We evaluated the strength recovery of recipient muscles through the Medical Research Council (MRC) Scale for Muscle Strength. Upper limb function and independence were assessed with the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) test version 1 and the Spinal Cord Independent Measure III (SCIM III). Patient satisfaction was also evaluated. After 24 months, median MRC scores (range) were: triceps 2 (1–2); extensor digitorum communis 3 (1–4); extensor pollicis longus 2.5 (1–4); flexor digitorum profundus 2 (0–4); flexor pollicis longus 2 (0–4). No complication occurred. GRASSP prehension ability and prehension performance total scores significantly improved at 24 months from 1 (0–4) to 2 (0–7) and from 1 (0–8) to 5 (0–-22), respectively. The SCIM III self-care sub-scale score improved at 24-month follow-up (<i>p</i> = 0.009). This study has important limitations, including a limited generalizability of the results and a small sample size that does not allow definitive conclusions to be drawn. A large multicenter prospective study is needed to confirm our findings. NT represents a functional surgery option with few complications for the resuscitation of upper limbs in persons with tetraplegia.

本研究旨在阐述上肢神经移位术（nerve transfer, NT）术后2年的功能预后。本研究为前瞻性病例系列研究，研究地点为意大利一所专注于脊髓损伤（spinal cord injury, SCI）的高端康复专科医院。共实施32例次上肢神经移位术，涉及15例上肢。研究纳入12名创伤性脊髓损伤患者，均为AIS A级或B级，神经损伤平面位于C4至C7节段；其中11名患者完成了24个月的随访并获得有效数据。本研究采用医学研究理事会（Medical Research Council, MRC）肌力分级量表评估受区肌肉的力量恢复情况；采用1版肌力、感觉与抓握功能分级重新定义评估量表（Graded Redefined Assessment of Strength Sensibility and Prehension, GRASSP）以及脊髓独立性评定量表第三版（Spinal Cord Independent Measure III, SCIM III）评估上肢功能与日常活动独立程度；同时对患者的手术满意度进行了评价。术后24个月随访时，各受检肌肉的MRC评分中位数（范围）如下：肱三头肌2分（1~2分）；指总伸肌3分（1~4分）；拇长伸肌2.5分（1~4分）；指深屈肌2分（0~4分）；拇长屈肌2分（0~4分）。本研究未出现手术相关并发症。GRASSP量表的抓握能力总分及抓握表现总分均在术后24个月时出现显著改善，分别从基线的1分（0~4分）提升至2分（0~7分），以及从1分（0~8分）提升至5分（0~22分）。SCIM III自理亚量表评分在24个月随访时得到显著提升（p=0.009）。本研究存在重要局限性，包括研究结果的外推性有限，且样本量较小，无法得出确定性结论，未来需开展大型多中心前瞻性研究以验证本研究结果。神经移位术是四肢瘫痪患者上肢功能重建的一种并发症发生率较低的有效手术方案。