[Research advances in nerve transfer for upper limb function restoration: applications from peripheral nerve injury to central nervous system injury].

内容摘要

To review recent research progress on nerve transfer for the reconstruction of upper limb function following peripheral nerve injury and central nervous system injury. A retrospective analysis of recent domestic and international literature on nerve transfer was conducted. The evolution of nerve transfer surgery from its application in peripheral nerve injuries to its extension to central nervous system injuries was described. The current therapeutic status of nerve transfer in upper limb hemiplegia resulting from spinal cord injury and brain injury was discussed, and the central role of central nervous system plasticity in postoperative functional recovery was analyzed. Nerve transfer is a crucial technique for upper limb function reconstruction, initially used to treat peripheral nerve injuries such as brachial plexus injuries. In recent years, this technique has gradually expanded into the field of central nervous system injuries. In cervical spinal cord injuries, various nerve transfer procedures can restore elbow flexion, wrist extension, and hand grasping functions, with efficacy correlated with the activation of plasticity in the spinal cord distal to the injury site. In cases of upper limb hemiplegia following brain injury, contralateral C 7 nerve transfer is the primary procedure, which can significantly reduce muscle tone and improve partial motor function; however, its ability to enhance fine motor skills and key muscle strength remains limited, and challenges such as maladaptive plasticity and co-activatory patterns persist. Mechanisms of central plasticity involve interhemispheric reorganization, activation of cortico-red nucleus-spinal pathways, and the remodeling of sensorimotor networks. The expansion of nerve transfer techniques from "peripheral repair" to "induction of central plasticity" offers a new strategy for treating central upper limb paralysis. However, current applications in brain injury are limited by a lack of surgical diversity and restricted central plasticity. Future efforts should integrate cell/gene therapy, electrical stimulation, novel transfer techniques, and systematic rehabilitation training to enhance neural regeneration and central plasticity, thereby further improving therapeutic outcomes. 综述神经移位术重建周围神经损伤及中枢神经系统损伤患者上肢功能的研究进展。. 回顾分析近年国内外有关神经移位术文献，阐述神经移位术从周围神经损伤拓展至中枢神经系统损伤的演变历程，重点探讨其在脊髓损伤和脑损伤偏瘫上肢中的治疗现状，并分析中枢可塑性在术后功能恢复中的核心作用。. 神经移位术是上肢功能重建的重要技术，最初用于臂丛损伤等周围神经损伤治疗，近年来已逐步拓展至中枢神经系统损伤领域。在颈髓损伤中，多种神经移位术可重建屈肘、伸腕及手部抓握功能，其疗效与激活损伤远端脊髓可塑性相关；在脑损伤偏瘫上肢中，以健侧C 7神经移位术为主，可显著降低肌张力、改善部分运动功能，但其对手部精细动作及关键肌力的提升仍有限，且存在适应不良性重塑、联合运动模式等挑战。中枢可塑性机制涉及半球间重组、皮质-红核-脊髓通路激活及感觉运动网络重塑等。. 神经移位术从“外周修复”向“诱导中枢重塑”的拓展为中枢性上肢瘫提供了新策略，但当前在脑损伤中的应用术式单一、中枢重塑受限。未来需结合细胞/基因治疗、电刺激、新型移位术式及系统性康复训练，以增强神经再生与中枢可塑性，进一步提升疗效。.