Hurtado-Olmo Patricia, González-Santos Ángela, Pérez de Rojas Javier, Fernández-Martínez Nicolás Francisco, Del Olmo Laura, Hernández-Cortés Pedro
Upper Limb Surgery Unit, Orthopedic Surgery Department, San Cecilio University Hospital of Granada, 18016 Granada, Spain.
BIO 277 Group, Department of Physical Therapy, Faculty of Health Science, University of Granada, 18012 Granada, Spain.
J Clin Med. 2024 Feb 7;13(4):945. doi: 10.3390/jcm13040945.
: For more than two decades, the surgical treatment of post-stroke spastic hands has been displaced by botulinum toxin therapy and is currently underutilized. : This article aimed to assess the potential of surgery for treating a post-stroke spastic upper extremity through a systematic review of the literature on surgical approaches that are adopted in different profiles of patients and on their outcomes and complications. : Medline PubMed, Web of Science, SCOPUS, and Cochrane Library databases were searched for observational and experimental studies published in English up to November 2022. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) system. : The search retrieved 501 abstracts, and 22 articles were finally selected. The GRADE-assessed quality of evidence was low or very low. The results of the reviewed studies suggest that surgery is a useful, safe, and enduring treatment for post-stroke spastic upper extremities, although most studied patients were candidates for hygienic improvements alone. Patients usually require an individualized combination of techniques. Over the past ten years, interest has grown in procedures that act on the peripheral nerve. : Despite the lack of comparative studies on the effectiveness, safety, and cost of the treatments, botulinum toxin has displaced surgery for these patients. Studies to date have found surgery to be an effective and safe approach, but their weak design yields only poor-quality evidence, and clinical trials are warranted to compare these treatment options.
二十多年来，肉毒杆菌毒素疗法已取代了中风后痉挛性手部的外科治疗，目前该疗法未得到充分利用。本文旨在通过系统回顾有关不同患者情况所采用的手术方法及其结果和并发症的文献，评估手术治疗中风后痉挛性上肢的潜力。检索了Medline PubMed、科学网、Scopus和考科蓝图书馆数据库，查找截至2022年11月以英文发表的观察性和实验性研究。使用推荐分级评估、制定和评价（GRADE）系统评估证据质量。检索到501篇摘要，最终选定22篇文章。经GRADE评估的证据质量为低或极低。综述研究结果表明，手术是治疗中风后痉挛性上肢的一种有用、安全且持久的治疗方法，尽管大多数研究患者仅适合改善卫生状况。患者通常需要个性化的技术组合。在过去十年中，对外周神经作用的手术方法的兴趣有所增加。尽管缺乏关于这些治疗方法的有效性、安全性和成本的比较研究，但肉毒杆菌毒素已取代了针对这些患者的手术治疗。迄今为止的研究发现手术是一种有效且安全的方法，但其设计薄弱，仅产生低质量的证据，因此有必要进行临床试验以比较这些治疗选择。
