Yan Zhengcun, Luo Wenmiao, Gu Jiaxiang, Liu Hongjun, Meng Zhaoxiang, Wang Xiaodong, Wei Min, Wang Xingdong, Wang Yongxiang, Zhang Hengzhu
Department of Neurosurgery, Northern Jiangsu People's Hospital, Northern Jiangsu People's Hospital affiliated Yangzhou University.
Department of Hand Surgery, Northern Jiangsu People's Hospital, Northern Jiangsu People's Hospital affiliated Yangzhou University.
J Craniofac Surg. 2025;36(1):309-313. doi: 10.1097/SCS.0000000000010764. Epub 2024 Oct 14.
To explore the anatomic characteristics of C7 nerve localization, course, and length during cross-transfer surgery of the C7 nerve through the anterior vertebral approach and investigate the feasibility, safety, and clinical efficacy of C7 nerve transfer surgery through the anterior vertebral approach for the treatment of central upper limb spastic paralysis.
Four fresh-frozen adult head and neck samples were selected. C7 nerve transfer surgery was simulated through the anterior vertebral approach. The vertical distance between the C7 nerve and the medial edge of the clavicle, the length of the C7 nerve, and the shortest distance of C7 nerve transfer required through the anterior vertebral approach were measured. This was a retrospective analysis of the clinical data of 2 patients with central upper limb spastic paralysis after C7 nerve transfer surgery at Northern Jiangsu People's Hospital affiliated with Yangzhou University. The patients were all female, aged 50 to 51 years, with upper limb paralysis on the affected side. The muscle strength was grade 0 or grade 1, and the muscle tension was relatively high. Both patients underwent C7 nerve transfer surgery through the anterior vertebral approach. Upper limb sensation and motor function were observed.
Bilateral C7 nerves can be fully exposed and located through the anterior vertebral approach. The C7 nerve runs between the anterior and middle scalene muscles, with a vertical distance of 1.7 to 2.5 (2.1±0.3) cm from the inner edge of the clavicle. The length of the C7 nerve is 5.6 to 6.8 (6.4±0.5) cm, and the shortest distance of C7 nerve transfer through the anterior vertebral approach is 4.8 to 5.7 (5.3±0.4 cm). Two patients with central upper limb paralysis successfully underwent C7 nerve transfer surgery using the anterior vertebral approach. Two patients had normal motor function in the healthy upper limb after surgery but experienced pain and numbness in the healthy upper limb. Both patients recovered within 1 month. Two patients experienced significant relief of spasticity symptoms in the affected upper limb. One patient was followed up for 15 months, and, at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 3 and distal muscle strength at level 2. Another patient was followed up for 11 months, and at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 1+ and distal muscle strength at level 1.
For central upper limb spastic paralysis, C7 nerve transfer surgery through the anterior vertebral approach is safe and feasible and is a good treatment option. Related anatomic research can effectively guide clinical surgery and assist in locating the C7 nerve, and incising the musculus longus colli can shorten the distance of C7 nerve transfer.
探讨经前路椎体入路行C7神经交叉移位手术时C7神经的解剖特点、走行及长度，研究经前路椎体入路行C7神经移位手术治疗上肢中枢性痉挛性瘫痪的可行性、安全性及临床疗效。
选取4例新鲜冷冻的成人头颈部标本，经前路椎体入路模拟C7神经移位手术，测量C7神经与锁骨内侧缘的垂直距离、C7神经长度及经前路椎体入路所需C7神经移位的最短距离。对扬州大学附属苏北人民医院2例上肢中枢性痉挛性瘫痪患者行C7神经移位手术后的临床资料进行回顾性分析。患者均为女性，年龄50～51岁，患侧上肢瘫痪，肌力为0级或1级，肌张力较高。2例患者均行经前路椎体入路C7神经移位手术，观察上肢感觉及运动功能。
经前路椎体入路可充分暴露并定位双侧C7神经。C7神经走行于前、中斜角肌之间，与锁骨内缘垂直距离为1.7～2.5（2.1±0.3）cm。C7神经长度为5.6～6.8（6.4±0.5）cm，经前路椎体入路C7神经移位最短距离为4.8～5.7（5.3±0.4）cm。2例上肢中枢性瘫痪患者成功行经前路椎体入路C7神经移位手术。2例患者术后健侧上肢运动功能正常，但出现健侧上肢疼痛、麻木，均于1个月内恢复。2例患者患侧上肢痉挛症状均明显缓解。1例患者随访15个月，末次随访时患侧上肢感觉正常，近端肌力3级，远端肌力2级。另1例患者随访11个月，末次随访时患侧上肢感觉正常，近端肌力1+级，远端肌力1级。
对于上肢中枢性痉挛性瘫痪，经前路椎体入路行C7神经移位手术安全可行，是一种较好的治疗选择。相关解剖学研究可有效指导临床手术，辅助定位C7神经，切开颈长肌可缩短C7神经移位距离。
