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Journal of Neurorestoratology  2019, Vol. 7 Issue (3): 129-135    doi: 10.26599/JNR.2019.9040013
Research Article     
Hand function recovery using nerve segment insert grafting in patients with chronic incomplete lower cervical spinal cord injury: a preliminary clinical report
Wenbin Ding1(),Shaocheng Zhang1,(✉)(),Dajiang Wu1(),Yanpeng Zhang2(),Hualong Ye1()
1 Department of Orthopaedics, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China
2 Department of Orthopaedics, Baoshan Branch of Huashan Hospital, Shanghai 200431, China
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Abstract  Objective:

The objective of this study was to show that hand functions could be recovered using nerve segment insert grafting in quadriplegic patients with chronic incomplete lower cervical spinal cord injury (CSCI) (C5/6/7/8).

Methods:

A retrospective analysis was performed in 18 quadriplegic patients (12 male and 6 female patients; mean age, 27 years; age range, 17–55 years) with chronic incomplete lower CSCI who had undergone nerve segment insert grafting from January 2001 to June 2015. Among the 18 patients, the right upper limb was involved in 7, left upper limb in 4, and bilateral upper limbs in 7 patients.

Results:

The mean follow-up period was 16 months (range, 3 months–3 years), and all patients exhibited obvious relief of limb spasm. Among all patients, 15 patients experienced no obvious spasm attacks and exhibited recovery of living abilities, i.e., recovery of the hand functions of grasping, holding, and pinching, and recovery of pain and temperature sensation in the fingers and palms; furthermore, they were able to steer an ordinary wheelchair independently postoperatively. The remaining three patients exhibited a significant and continuous improvement in hand functions over time, without any significant donor nerve dysfunction.

Conclusions:

Nerve segment insert grafting is an effective method that helps recover hand functions in quadriplegic patients with chronic incomplete lower CSCI. Moreover, spasticity can be relieved and partial normal innervation can be obtained in the spastic muscles postoperatively.



Key wordschronic lower cervical spinal cord injury      functional recovery      nerve segment insert grafting     
Received: 19 March 2019      Published: 28 June 2019
Corresponding Authors: Shaocheng Zhang     E-mail: 4471396@qq.com;shczhang2003@163.com;dajiangdajiang@hotmail.com;ypzhang1027@163.com;1016839129@qq.com
About author: Wenbin Ding, MM, Department of Traumatic Orthopedics, Shanghai Changhai Hospital, China; Naval Military Medical University, Shanghai, China. He focuses on the treatment and experiment of microsurgery, spinal cord injury and cerebral palsy. E-mail address: 4471396@qq.com.|Shaocheng Zhang is a chief physician, professor, and doctoral supervisor. He has been engaged in orthopedic clinical work, teaching, and research studies at the Changhai Hospital for over 40 years and has vast clinical experience. He has rich experience in limb orthopedics, tissue repair, and hand/foot functional recovery. He is a leader in the field of microsurgical treatment of peripheral nerve injury and is an internationally recognized expert in the fields of functional recovery after spinal cord injury, pediatric cerebral palsy, cerebral trauma, and spastic paralysis after stroke. Many of the novel technologies that he pioneered have been affirmed and cited by internationally renowned textbooks and magazines. E-mail address: shczhang2003@163.com.|Dajiang Wu, MD, Department of Traumatic Orthopedics, Shanghai Changhai Hospital, China; Naval Military Medical University, Shanghai, China. He focuses on the treatment and experiment of minimally invasive spine surgery, surgical spinal fracture, lumbar disc herniation, cervical spondylosis, spinal cord injury and cerebral palsy. E-mail address: dajiangdajiang@hotmail.com.|Yanpeng Zhang, On-the-job postgraduate degree, Orthopedic attending physician in Renhe Hospital, Baoshan district, Shanghai. He is focused on Limb trauma. E-mail address: ypzhang1027@163.com.|Hualong Ye, MM, Department of Traumatic Orthopedics, Shanghai Changhai Hospital, China; Naval Military Medical University, Shanghai, China. E-mail address: 1016839129@qq.com.
Cite this article:

Wenbin Ding,Shaocheng Zhang,Dajiang Wu,Yanpeng Zhang,Hualong Ye. Hand function recovery using nerve segment insert grafting in patients with chronic incomplete lower cervical spinal cord injury: a preliminary clinical report. Journal of Neurorestoratology, 2019, 7: 129-135.

URL:

http://jnr.tsinghuajournals.com/10.26599/JNR.2019.9040013     OR     http://jnr.tsinghuajournals.com/Y2019/V7/I3/129

Age (years ± SD)27 ± 10.2
Sex, n (%)
Male12 (66.7)
Female6 (33.3)
AIS classification, n (%)
AIS-A0
AIS-B6 (33.3)
AIS-C9 (50.0)
AIS-D3 (16.7)
AIS-E0
Injury level, n (%)
C54 (22.2)
C63 (16.7)
C75 (27.8)
C86 (33.3)
Table 1 Demographic and clinical features of study patients.
Fig. 1 Illustration of nerve transfer: a part of the posterior bundle/radial nerve or medial bundle/ulnar nerve from the original site is grafted at the original site of the lateral bundle/musculocutaneous nerve.
Fig. 2 The medial cutaneous nerve of the arm.
Fig. 3 Nerve grafting.
Fig. 4 Grafted nerve segment.
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[1] Wenbin Ding , Shaocheng Zhang, Dajiang Wu , Yanpeng Zhang , Hualong Ye. Hand function reconstruction in patients with chronic incomplete lower cervical spinal cord injury by nerve segment insert grafting: a preliminary clinical report[J]. Journal of Neurorestoratology, 2019, 7(3): 129-135.