Analysis of factors affecting the efficacy of contralateral seventh cervical nerve transfer for central upper limb paralysis and prediction model for efficacy evaluation
Year: 2025
Type: article
Abstract: This study aims to evaluate the efficacy, safety, and predictors of contralateral C7 nerve transfer (CC7) for central upper limb spastic hemiplegia and develop a preoperative prediction model. A retrospective analysis included 58 stroke patients with spastic hemiplegia undergoing CC7 surgery. Composite efficacy endpoints assessed efficacy. Univariate and multivariate logistic regression identified predictive factors. A nomogram prediction model was built and validated using receiver operating characteristic curves, calibration curves, and decision curve analysis. CC7 significantly improved affected upper limb function. The Fugl-Meyer Assessment for upper extremity (FMA-UE) score increased from 25.9 ± 3.6 preoperatively to 37.6 ± 3.4 at final follow-up (P < .001). Based on composite endpoints, the overall efficacy rate was 60.3% (35/58). Analysis of 15 potential factors identified 2 significant independent predictors of efficacy: younger age (odds ratio = 0.86, 95% confidence interval [CI]: 0.77-0.96, P = .006) and higher baseline FMA-UE score (odds ratio = 1.45, 95% CI: 1.12-1.89, P = .005). A nomogram incorporating these factors demonstrated strong diagnostic performance (area under the curve = 0.898, 95% CI: 0.820-0.976, P < .05). Bootstrap validation (area under the curve = 0.884), calibration curves, and decision curve analysis confirmed the model's robustness and clinical utility. CC7 showed good safety; postoperative adverse reactions (transient contralateral limb numbness/pain) were mild and resolved without long-term issues. CC7 is a safe and effective treatment for central hemiplegia, significantly improving upper limb function. The developed nomogram, using age and baseline FMA-UE score, provides an accurate tool for predicting CC7 efficacy and aiding patient selection.
Source: Medicine
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W7117324115