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Zhao X, Ma X, Zhao H, Li T, Qiu Y, Shen Y, Feng J, Xu W. Unveiling the role of dorsal root ganglia in spasticity reduction: Insights from contralateral seventh cervical nerve cross transfer surgery. Brain Behav 2024; 14:e3613. [PMID: 38970224 PMCID: PMC11226549 DOI: 10.1002/brb3.3613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Central 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. METHODS This 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. RESULTS In 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. CONCLUSION This 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.
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Affiliation(s)
- Xuanyu Zhao
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
| | - Xingyi Ma
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
| | - Huali Zhao
- Department of Radiology, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
| | - Tie Li
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
| | - Yanqun Qiu
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
| | - Yundong Shen
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
| | - Juntao Feng
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
| | - Wendong Xu
- Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Branch of Huashan Hospital, the National Clinical Research Center for Aging and MedicineFudan UniversityShanghaiChina
- Institute of Brain Science, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain ScienceFudan UniversityShanghaiChina
- Research Unit of Synergistic Reconstruction of Upper and Lower Limbs after Brain InjuryChinese Academy of Medical SciencesShanghaiChina
- Co‐innovation Center of NeuroregenerationNantong UniversityNantongChina
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Xiang YT, Wu JJ, Ma J, Xing XX, Zhang JP, Hua XY, Zheng MX, Xu JG. Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review. Int J Surg 2024; 110:3814-3826. [PMID: 38935818 PMCID: PMC11175768 DOI: 10.1097/js9.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. METHODS A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE's ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. RESULTS Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14-26 score in upper extremity compared to 2.35-26 in the control group. The overall reduction in Modified Ashworth score was 0.76-2 compared to 0-1 in the control group. Range of motion (ROM) increased 18.4-80° in elbow, 20.4-110° in wrist and 18.8-130° in forearm, while ROM changed -4.03°-20° in elbow, -2.08°-10° in wrist, -2.26°-20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. CONCLUSION Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a 'bypass' for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.
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Affiliation(s)
- Yun-Ting Xiang
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
| | - Jia-Jia Wu
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jun-Peng Zhang
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
| | - Xu-Yun Hua
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Mou-Xiong Zheng
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Jian-Guang Xu
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Jiang L, Yang W, Chen H, Song H, Zhang S. Diagnosis and therapies for patients with cerebral palsy over the past 30 years: a bibliometric analysis. Front Neurol 2024; 15:1354311. [PMID: 38694779 PMCID: PMC11061478 DOI: 10.3389/fneur.2024.1354311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/20/2024] [Indexed: 05/04/2024] Open
Abstract
Background Currently, the incidence of cerebral palsy is high in newborns. However, the current methods for diagnosing and treating patients with cerebral palsy are complex and poorly targeted. Moreover, these studies lack the support of bibliometric analysis results. Objective Our study focused on a bibliometric analysis of published papers on the diagnosis and treatment of patients with cerebral palsy. This study identified the primary authors, institutions, and countries involved in analyzing the status and trends of research on the diagnosis and treatment of patients with cerebral palsy. Additionally, the study also involved screening pathways related to cerebral palsy. Methods The PubMed database was searched for publications on the diagnosis and treatment of patients with cerebral palsy between 1990 and 2023. R v4.2.2 and VOSviewer v1.6.18 software tools were utilized to perform bibliometric analysis and visualization. Results There were 1,965 publications on cerebral palsy diagnosis and 5,418 articles on the qualified treatment strategies, and the annual number of publications also increased. The United States dominated in this field of research. Gregory Y.H. Lip and Patrizio Lancellotti published the most number of papers. The Cleveland Clinic published the most number of papers in the field. According to the analysis of the co-occurrence of keywords, we found that the main research directions were age, sex, disease diagnosis, and treatment. Newly emerging research has focused mainly on heart failure, which is related to valvular heart disease. Conclusion The findings presented in this study offer valuable insights into ongoing research and potential future directions pertaining to cerebral palsy. These insights can assist researchers in identifying suitable collaborators and enhancing their investigations aimed at identifying the underlying molecular mechanisms associated with cerebral palsy, encompassing its etiology, preventive measures, and therapeutic interventions.
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Affiliation(s)
- Lili Jiang
- Department of Outpatient, Hangzhou Children's Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Weifang Yang
- Department of Radiology, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Huai Chen
- Department of Neurosurgery, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Huangcheng Song
- Department of Neurosurgery, People's Hospital of Haimen District, Nantong, Jiangsu, China
| | - Song Zhang
- Department of Neurosurgery, Hangzhou Children's Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Zhang Q, Guo Y, Zhang Y. Contralateral C7 nerve transfer in the treatment of central hemiplegia after stroke under general anesthesia: A case report. IBRAIN 2022; 10:106-110. [PMID: 38682014 PMCID: PMC11045184 DOI: 10.1002/ibra.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 05/01/2024]
Abstract
Similar reports in the past pay less attention to the anesthetic management of these patients. We reported a 46-year-old man who suffered from hypertensive cerebral apoplexy 5 months ago and accepted C7 nerve transfer to improve the central spastic paralysis in the right upper limb. After careful evaluation and anesthesia management before anesthesia, the operation was successfully completed under general anesthesia. The patient was cured and discharged without complications. The anesthesia management of C7 nerve transfer should choose appropriate operation opportunities for patients according to the type of stroke, improve the preoperative preparation, and form a multidisciplinary diagnosis and treatment.
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Affiliation(s)
- Qiu‐Ying Zhang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yi Guo
- Department of Hepatological SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yi‐Nan Zhang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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Zhao HL, Gao Y, Yu AP, Wei YM, Shen YD, Jiang S, Qiu YQ, Yu J, Liang ZH. MRI-Based Optimization Design of the Pre-Spinal Route of Contralateral C7 Nerve Transfer for Spastic Arm Paralysis. Front Surg 2022; 9:837872. [PMID: 35846970 PMCID: PMC9276985 DOI: 10.3389/fsurg.2022.837872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The prespinal route of contralateral cervical 7 nerve transfer developed by Prof. Wendong Xu helps realize the direct anastomosis of the bilateral cervical 7 nerves. However, 20% of operations still require a nerve graft, which leads to an unfavorable prognosis. This study aims to explore the optimized prespinal route with MRI to further improve the prognosis. Methods The current study enrolled 30 patients who suffered from central spastic paralysis of an upper limb and who underwent contralateral cervical 7 nerve transfer via Prof. Xu’s prespinal route through the anterior edge of the contralateral longus colli. MRI images were used to analyze the route length, vertebral artery exposure, and contralateral cervical 7 nerve included angle. Three prespinal routes were virtually designed and analyzed. The selected optimal route was applied to another 50 patients with central spastic paralysis of an upper limb for contralateral cervical 7 nerve transfer. Results By the interventions on the 30 patients, the middle and posterior routes were shorter than the anterior route in length, but with no statistical difference between the two routes. Of 30 contralateral vertebral arteries, 26 were located at the posterior medial edge of the longus colli. The average included angles of the anterior, middle, and posterior routes were 108.02 ± 7.89°, 95.51 ± 6.52°, and 72.48 ± 4.65°, respectively. According to these data, the middle route was optimally applied to 50 patients, in whom the rate of nerve transplantation was only 4%, and no serious complications such as vertebral artery or brachial plexus injury occurred. Conclusion The low rate of nerve transplantation in 50 patients and the absence of any serious complications in these cases suggests that the middle route is the optimal one.
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Affiliation(s)
- Hua-Li Zhao
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Yun Gao
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Ai-Ping Yu
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Min Wei
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Yun-Dong Shen
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Su Jiang
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan-Qun Qiu
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
| | - Jing Yu
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
| | - Zong-Hui Liang
- Department of Radiology, Jing’an District Central Hospital, Shanghai, China
- Correspondence: Zong-Hui Liang
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Yu B, Xie Q, Xu J, Chen L, Zhang J, Yin H, Jia J, Qiu Y, Xu W. Impairments and Compensations of Static Balance and Plantar Load Distribution in Patients With Chronic Stroke: An Observational Study. J Manipulative Physiol Ther 2022; 44:734-742. [PMID: 35752501 DOI: 10.1016/j.jmpt.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to explore impairment and compensation characteristics of static balance and plantar load distribution in patients with chronic stroke. METHODS We recruited 68 patients who had chronic stroke who could stand independently (stroke group) and 30 healthy individuals (control group) with the Zebris FDM platform. Static balance parameters, including center of pressure (COP) ellipse sway area, COP path length, and angle-θ between y and major axis, were compared between 2 groups under standard standing posture. In the stroke group, balance parameters were re-tested under their preferring standing posture. Plantar load distribution was also assessed. Another 8 patients with chronic stroke who could not stand independently and had to rely on a crutch were enrolled to analyze the characteristics of balance compensation. RESULTS In the stroke group, the ellipse sway area, COP path length, and angle-θ were significantly larger than those of the control group. Sixty-one (89.7%) patients preferred standing with the affected foot outward-forward supporting, and their preferring standing balance was better than that of standard standing. All patients who could not stand independently tended to compensate for balance with a crutch supporting laterally and also preferred standing with a typical posture- the affected foot was outward-forward. CONCLUSIONS In patients post stroke, static balance is impaired mainly at the lateral direction, and patients commonly locate the crutch laterally for compensation of lateral balance. Patients preferred standing with the affected foot outward-forward supporting, and their preferring standing balance was better than that of standard standing, which challenged the necessity of training standing symmetrically.
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Affiliation(s)
- Baofu Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; The Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian Xie
- Department of Radiology, Jing'an District Center Hospital, Fudan University, Shanghai, China
| | - Jing Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Liwen Chen
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Jionghao Zhang
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Department of Orthopaedic Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China
| | - Huawei Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Jie Jia
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China
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Fan ZQ, Liu DW. Impairment characteristics of static balance and plantar load distribution of patients undergoing tibial cortex transverse distraction for diabetic foot ulcers. J Orthop Surg Res 2022; 17:171. [PMID: 35303911 PMCID: PMC8932111 DOI: 10.1186/s13018-022-03042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Tibial cortex transverse distraction (TCTD) has been recently reported for the treatment of diabetic foot ulcers. Herein, we explored the characteristics of the impairments in static balance and plantar load distribution in patients. Methods We performed a retrospective study of 21 patients with diabetic foot ulcers who underwent TCTD, who were regularly followed up for > 1 year after surgery, and 20 healthy individuals (control group). A pressure platform was used to assess the standing balance functions of the lower extremities and the plantar load distribution. Results One patient underwent amputation because of severe infection. In patient group, center of pressure (COP) ellipse sway area, COP path length and angle θ were all larger, compared with those of control group (250.15 ± 98.36 mm2 vs. 135.67 ± 53.21 mm2, 145.15 ± 67.43 mm vs. 78.47 ± 34.15 mm, 39.75 ± 17.61° vs. 22.17 ± 14.15°), with statistically significant differences (P < 0.01). The average plantar load and backfoot load of the unaffected side was significantly larger than that of the affected side (58.4 ± 5.5% vs. 41.6 ± 5.5%, 45.3 ± 6.4% vs. 36.5 ± 5.6%), but they were similar for the two feet of members of the control group. Conclusions Although TCTD may represent an appropriate method for the treatment of diabetic foot ulcers, postoperative impairments in static balance and plantar load distribution remain in the long term. These potential long-term problems should be taken into account in further rehabilitation planning. Type of study/level of evidence: Therapeutic III.
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Affiliation(s)
- Zhi-Qiang Fan
- Department of Orthopaedic Surgery, Jiangxi Provincial People's Hospital Affiliated To Nanchang University, 152 Ai Guo Road, Nanchang, 330006, Jiangxi, People's Republic of China. .,Institute of Burn, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - De-Wu Liu
- Institute of Burn, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Qian TD, Zheng XF, Shi J, Ma T, You WY, Wu JH, Huang BS, Tao Y, Wang X, Song ZW, Li LX. L4-to-L4 nerve root transfer for hindlimb hemiplegia after hypertensive intracerebral hemorrhage. Neural Regen Res 2021; 17:1278-1285. [PMID: 34782572 PMCID: PMC8643034 DOI: 10.4103/1673-5374.327359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage. Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles, we investigated a potential method of nerve repair using the L4 nerve roots. Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule. The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs. We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage. In a beam-walking test and ladder rung walking task, model rats exhibited an initial high number of slips, but improved in accuracy on the paretic side over time. At 17 weeks after surgery, rats gained approximately 58.2% accuracy from baseline performance and performed ankle motions on the paretic side. At 9 weeks after surgery, a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots. In addition, histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord. Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved. These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints, particularly of the distal ankle. Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage. All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (No. IACUC-1906009) in June 2019.
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Affiliation(s)
- Teng-Da Qian
- Department of Neurosurgery, Jintan Hospital, Affiliated Hospital of Jiangsu Vocational College of Medicine, Jintan, Jiangsu Province, China
| | - Xi-Feng Zheng
- Department of Gastroenterology, Jintan Hospital, Affiliated Hospital of Jiangsu Vocational College of Medicine, Jintan, Jiangsu Province, China
| | - Jing Shi
- Department of Neurosurgery, Changzhou First People's Hospital, Suzhou University, Changzhou, Jiangsu Province, China
| | - Tao Ma
- Department of Neurosurgery, Changzhou First People's Hospital, Suzhou University, Changzhou, Jiangsu Province, China
| | - Wei-Yan You
- Deparment of Neurobiology, Basic Medical College, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jia-Huan Wu
- Deparment of Neurobiology, Basic Medical College, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Bao-Sheng Huang
- Department of Neurosurgery, Sir Run Run Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yi Tao
- Department of Neurosurgery, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xi Wang
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ze-Wu Song
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Li-Xin Li
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery. J Clin Med 2021; 10:jcm10153344. [PMID: 34362127 PMCID: PMC8347887 DOI: 10.3390/jcm10153344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/19/2021] [Accepted: 07/11/2021] [Indexed: 11/22/2022] Open
Abstract
Ischemic stroke remains a major cause of disability in the United States and worldwide. Following the large-scale implementation of stroke thrombectomy and the optimization of treatment protocols for acute stroke, the reduction in stroke-associated mortality has resulted in an increased proportion of stroke survivors, many of whom have moderate to severe disability. To date, the treatment of subacute and chronic stroke has remained a challenge. Several approaches, involving pharmacological interventions to promote neuroplasticity, brain stimulation strategies and rehabilitative interventions, are currently being explored at different stages of the translational spectrum, yet level 1 evidence is still limited. In a recent landmark study, surgical intervention using contralateral C7 nerve transfer, an approach used to treat brachial plexus injury, was implemented in patients with chronic stroke, demonstrating an added benefit to standard rehabilitation strategies, leading to improved motor performance and reduced spasticity. The procedure involved the transfer of the C7 nerve root and middle trunk from the uninjured extremity to the injured extremity using a short conduit that allows for faster regeneration and innervation of the injured upper extremity via the ipsilateral (contralesional) hemisphere. In this work, we review the rationale for using contralateral C7 nerve transfer in stroke, describe the surgical intervention with associated variations and limitations, and discuss the current evidence for the efficacy of this technique in ischemic stroke research.
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陈 涛, 高 绍, 魏 在. [Research progress of contralateral C 7 nerve root transfer via prevertebral pathway]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:265-268. [PMID: 33624485 PMCID: PMC8171680 DOI: 10.7507/1002-1892.202006088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/19/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review the research progress on the establishment of prevertebral pathway in the treatment of unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury by contralateral C 7 nerve root transfer. METHODS The literature about contralateral C 7 nerve root transfer via prevertebral pathway at home and abroad was extensively reviewed, and the development, changes, advantages and disadvantages of various operation methods were analyzed and summarized. RESULTS After unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury, it can be repaired by a variety of surgical methods of the contralateral C 7 nerve root transfer via prevertebral pathway, which include the anterior subcutaneous tissue tunnel of the vertebral body, the passage under the sternocleidomastoid muscle, the posterior pharyngeal space and the anterior vertebral fascia passage, the modified posterior esophageal anterior vertebral passage, the anterior vertebral passage that cuts off the bilateral anterior scalene, and Huashan anterior pathway, etc. Among them, how to establish the shortest, safe, and effective way of anterior vertebral canal has been paid more attention and discussed by peripheral nerve repair doctors. CONCLUSION It is a safe and effective surgical method to repair unilateral total brachial plexus injury, cerebral palsy, stroke, and traumatic brain injury patients with contralateral C 7 nerve root transfer via prevertebral pathway.
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Affiliation(s)
- 涛 陈
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 绍莹 高
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
| | - 在荣 魏
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China
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Yu BF, Chen LW, Qiu YQ, Xu J, Yin HW, Li QY, Xu WD. Contralateral seventh cervical nerve transfer can affect the pennation angle of the lower limb in spastic hemiplegia patients: An observational case series study. Brain Behav 2019; 9:e01460. [PMID: 31721481 PMCID: PMC6908868 DOI: 10.1002/brb3.1460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/14/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION We previously reported transferring seventh cervical (C7) nerve from unaffected side to affected side in patients with spastic hemiplegia due to chronic cerebral injury, to improve function and reduce spasticity of paralyzed upper limb. In the clinics, some patients also reported changes of spasticity in their lower limb, which could not be detected by routine physical examinations. Pennation angle of muscle can indirectly reflect the condition of spasticity. The purpose of this study was to evaluate whether this upper limb procedure may affect spasticity of lower limb, using ultrasonography to detect changes of muscle pennation angle (PA). METHODS Twelve spastic hemiplegia patients due to cerebral injury including stroke, cerebral palsy, and traumatic brain injury, who underwent C7 nerve transfer procedure, participated in this study. B-mode ultrasonography was used to measure PA of the gastrocnemius medialis (GM) muscle at rest preoperatively and postoperatively. The plantar load distribution of the lower limbs was evaluated using a Zebris FDM platform preoperatively and postoperatively. RESULTS The PA of the GM was significantly smaller on the affected side than that of unaffected side before surgery. On the affected side, the postoperative PA was significantly larger than preoperative PA. On the unaffected side, the postoperative PA was not significantly different compared to preoperative PA. The postoperative plantar load distribution of the affected forefoot was significantly smaller than preoperative load distribution, which was consistent with ultrasonography results. CONCLUSIONS This study indicates that C7 nerve transfer surgery for improving upper limb function can also affect muscle properties of lower limb in spastic hemiplegia patients, which reveals a link between the upper and lower limbs. The interlimb interactions should be considered in rehabilitation physiotherapy, and the regular pattern and mechanism need to be further studied.
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Affiliation(s)
- Bao-Fu Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Li-Wen Chen
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Yan-Qun Qiu
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Jing Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua-Wei Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qin-Ying Li
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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