Institut de la Main - Clinique Bizet, Paris, France.
Service de Neurochirurgie fonctionnelle, Hôpital P.-Wertheimer, Hospices Civils de Lyon, Bron, France.
J Hand Surg Eur Vol. 2024 Jun;49(6):802-811. doi: 10.1177/17531934241238885. Epub 2024 Mar 27.
This article reviews the recent advances or nerve-oriented surgical procedures in the treatment of the spastic upper limb. The idea to intervene on the nerve is not recent, but new trends have developed in nerve surgery over the past few years, stimulating experiments and research. Specific surgical procedures involving the nerves have been described at different levels from proximal to distal: at the cervical spinal cord and the dorsal root entry zone (rhizotomy), at the level of the roots (contralateral C7 transfer) or in the peripheral nerve, within the motor trunk (selective neurectomy) or as its branches penetrate the muscles (hyperselective neurectomy). All of these neurosurgical procedures are only effective on spasticity but do not address the other deformities, such as contractures and motor deficit. Additional procedures may have to be planned in conjunction with nerve procedures to optimize outcomes.
本文回顾了神经导向手术治疗上肢痉挛的最新进展。干预神经的想法并不新鲜，但近年来神经外科出现了新的趋势，刺激了实验和研究。涉及神经的特定手术程序已在从近端到远端的不同水平上进行了描述：在颈脊髓和背根进入区（神经根切断术）、在神经根水平（对侧 C7 转移）或在周围神经内、在运动干内（选择性神经切除术）或在其分支穿透肌肉时（高选择性神经切除术）。所有这些神经外科手术仅对痉挛有效，但不能解决其他畸形，如挛缩和运动缺陷。可能需要与神经手术一起计划其他手术，以优化结果。
