PDF(Pubmed)
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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：这篇综述强调了神经转移手术在治疗中枢神经系统（CNS）损伤引起的功能障碍方面的最新进展和创新用途，特别关注脊髓损伤（SCI），中风,创伤性脑损伤,和脑瘫.
方法：对脊髓和脑损伤后恢复感觉运动功能和膀胱控制的神经转移进行了全面的文献检索，从1920年1月到2023年5月，跨越PubMed和WebofScience。两名独立审稿人进行了文章选择，数据提取,以及使用几种评估工具进行偏差风险评估，包括Cochrane偏差工具风险,JBI关键评估检查表，和SYRCLE的ROB工具。研究方案已按照PRISMA和AMSTAR指南进行注册和报告。
结果：共检索到九百六篇文章，其中包括35项研究(20项关于SCI，15项关于脑损伤)，手术组包括371名参与者,对照组包括192名参与者.这些文章大多是低风险的，与研究类型的方法论关注，强调复杂性和多样性。对于SCI，目标肌肉的力量增加了医学研究理事会等级的3.13，20例患者中有15例的残余尿量减少了100毫升以上。对于单侧脑损伤，与对照组的2.35-26相比，Fugl-Myer运动评估（FMA）改善了上肢15.14-26分。与对照组的0-1相比，改良Ashworth评分的总体降低为0.76-2。活动范围（ROM）增加18.4-80°的肘部，腕部20.4-110°,前臂18.8-130°,而ROM在弯头中改变了-4.03°-20°，腕部-2.08°-10°,对照组前臂-2.26°-20°。与术前相比，下肢FMA的改善分为9分。
结论：中枢神经系统损伤后，神经转移通常可改善瘫痪肢体的感觉运动功能和膀胱控制。该技术有效地为信号创建了一个“旁路”，并通过利用神经可塑性来促进功能恢复。它暗示了未来的手术，神经康复和机器人助手融合以改善中枢神经系统的预后。
方法：对脊髓和脑损伤后恢复感觉运动功能和膀胱控制的神经转移进行了全面的文献检索，从1920年1月到2023年5月，跨越PubMed和WebofScience。两名独立审稿人进行了文章选择，数据提取,以及使用几种评估工具进行偏差风险评估，包括Cochrane偏差工具风险,JBI关键评估检查表，和SYRCLE的ROB工具。研究方案已按照PRISMA和AMSTAR指南进行注册和报告。
结果：共检索到九百六篇文章，其中包括35项研究(20项关于SCI，15项关于脑损伤)，手术组包括371名参与者,对照组包括192名参与者.这些文章大多是低风险的，与研究类型的方法论关注，强调复杂性和多样性。对于SCI，目标肌肉的力量增加了医学研究理事会等级的3.13，20例患者中有15例的残余尿量减少了100毫升以上。对于单侧脑损伤，与对照组的2.35-26相比，Fugl-Myer运动评估（FMA）改善了上肢15.14-26分。与对照组的0-1相比，改良Ashworth评分的总体降低为0.76-2。活动范围（ROM）增加18.4-80°的肘部，腕部20.4-110°,前臂18.8-130°,而ROM在弯头中改变了-4.03°-20°，腕部-2.08°-10°,对照组前臂-2.26°-20°。与术前相比，下肢FMA的改善分为9分。
结论：中枢神经系统损伤后，神经转移通常可改善瘫痪肢体的感觉运动功能和膀胱控制。该技术有效地为信号创建了一个“旁路”，并通过利用神经可塑性来促进功能恢复。它暗示了未来的手术，神经康复和机器人助手融合以改善中枢神经系统的预后。
