Effectiveness of T<sub>1</sub> rhizotomy combined with flexor origin slide for central hand flexion spasticity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Chen ¹ , XU Ke ¹ ^{共同第一作者} , LI Feng ¹ , YIN Yaobin ¹ , CHEN Xingyu ¹ , SUN Nan ¹ , CAO Qige ¹ , MA Ke ² ,  WANG Shufeng ¹ ,  LI Wenjun ^1,3,4

1. Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, P. R. China;
2. Department of Orthopedics and Spine Surgery, Binzhou Central Hospital, Binzhou Shandong, 256623, P. R. China;
3. Department of Neuroelectrophysiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, P. R. China;
4. Beijing Quality Control and Improvement Centre of Orthopedics, Beijing, 100035, P. R. China;

Corresponding?author：

WANG Shufeng, Email: wangshufeng1964@aliyun.com; LI Wenjun, Email: dcliwenjun@163.com

Keywords：

Central hand flexion spasticity; T₁ rhizotomy; flexor origin slide; hand function reconstruction

DOI：

10.7507/1002-1892.202602003

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Objective To investigate the effectiveness of T₁ rhizotomy combined with flexor origin slide for central hand flexion spasticity. Methods Between July 2023 and June 2025, 10 patients with central spastic flexion deformity and concomitant flexor tendon contracture due to traumatic brain injury, cerebral palsy, or other causes were admitted. All patients were treated with T₁ rhizotomy combined with flexor origin slide. Postoperative assessments included the Modified Ashworth Scale (MAS) for muscle tone, Medical Research Council (MRC) scale for muscle strength, Fugl-Meyer score for upper extremity motor function, and House Functional Classification (HFC) for hand function. Results All patients successfully completed the operations and were followed up 6-19 months (median, 13 months). During follow-up, patients showed significant relief of hand spasticity and improvement in hand function. At last follow-up, the MAS grade for muscle tone, Fugl-Meyer score for upper extremity motor function, and HFC grade for hand function showed significant improvement compared to preoperative levels (P<0.05); but there was no significant difference in MRC grade for muscle strength or PRWE score between pre- and post-operation (P>0.05). Conclusion T₁ rhizotomy combined with flexor origin slide effectively reduces muscle tone, corrects flexion deformity, and improves hand function, representing an effective surgical strategy for central spastic flexion deformity of the hand.

Citation： YANG Chen, XU Ke, LI Feng, YIN Yaobin, CHEN Xingyu, SUN Nan, CAO Qige, MA Ke, WANG Shufeng, LI Wenjun. Effectiveness of T₁ rhizotomy combined with flexor origin slide for central hand flexion spasticity. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(7): 1069-1074. doi: 10.7507/1002-1892.202602003 Copy

1.	Nielsen JB, Crone C, Hultborn H. The spinal pathophysiology of spasticity—from a basic science point of view. Acta Physiol (Oxf), 2007, 189(2): 171-180.
2.	Gracies JM, Alter KE, Biering-S?rensen B, et al. Spastic paresis: a treatable movement disorder. Mov Disord, 2025, 40(1): 44-50.
3.	Otero-Romero S, Sastre-Garriga J, Comi G, et al. Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Mult Scler, 2016, 22(11): 1386-1396.
4.	Xu Q, Xiao H, Zhu Z, et al. Research progress in the use of botulinum toxin type a for post-stroke spasticity rehabilitation: a narrative review. Ann Med, 2025, 57(1): 2521427. doi: 10.1080/07853890.2025.2521427.
5.	楊辰, 李文軍, 李峰, 等. 胸₁脊神經根切斷治療手痙攣性癱瘓的臨床效果觀察. 中國醫刊, 2023, 58(1): 59-62.
6.	Bakheit AM, Fheodoroff K, Molteni F. Spasticity or reversible muscle hypertonia? J Rehabil Med, 2011, 43(6): 556-557.
7.	Lieber RL, Fridén J. Muscle contracture and passive mechanics in cerebral palsy. J Appl Physiol (1985), 2019, 126(5): 1492-1501.
8.	Stevanovic M, Sharpe FE. Refinements in the treatment of Volkmann ischemic contracture of the forearm: a thematic review. Plast Reconstr Surg Glob Open, 2024, 12(2): e5532. doi: 10.1097/GOX.0000000000005532.
9.	中華醫學會超聲醫學分會婦產超聲學組, 中國醫師協會醫學遺傳醫師分會臨床遺傳學組, 中華預防醫學會出生缺陷預防與控制專業委員會遺傳病防控學組. 先天性多發性關節攣縮臨床診療專家共識(2025年版). 中華醫學遺傳學雜志, 2025, 42(7): 820-829.
10.	李樺, 陳浩杰, 陳國華, 等. 電燒傷后肘關節纖維性強直的解剖學基礎與臨床治療. 中華燒傷雜志, 2005, 21(3): 207-209.
11.	戴北辰, 何旭宸, 施海峰, 等. 先天性指深屈肌腱起點異常的診斷及治療. 中華手外科雜志, 2023, 39(6): 562-565.
12.	de Blas-Zamorano P, Montagut-Martínez P, Pérez-Cruzado D, et al. Fugl-Meyer Assessment for upper extremity in stroke: A pyschometric systematic review. J Hand Ther, 2026, 39(1): 22-51.
13.	Bukowiec LG, Wu KY, Brandenburg JE, et al. Hyperselective neurectomy for spastic equinovarus in pediatric patients with hypertonia. J Pediatr Rehabil Med, 2025, 18(4): 295-303.
14.	MacDermid JC, Turgeon T, Richards RS, et al. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma, 1998, 12(8): 577-586.
15.	T₁神經根切斷術治療中樞性手屈曲痙攣專家共識制定小組. T₁神經根切斷術治療中樞性手屈曲痙攣專家共識(2024). 中國修復重建外科雜志, 2025, 39(3): 259-263. doi: 10.7507/1002-1892.202501021.
16.	Thevenin-Lemoine C, Denormandie P, Schnitzler A, et al. Flexor origin slide for contracture of spastic finger flexor muscles: a retrospective study. J Bone Joint Surg (Am), 2013, 95(5): 446-453.
17.	Gowda TB, Sharma A, Nandeesh S, et al. A case of Volkmann’s ischemic contracture—a case report. J Orthop Case Rep, 2025, 15(9): 138-142.
18.	Agarwal P, Jana S, Sharma D, et al. Seventh cervical nerve (C₇) transection for spastic arm paralysis after cerebral injury. Oper Neurosurg, 2023, 24(3): 256-261.
19.	李炳萬, 李大村, 李中檀. 前臂屈肌群起點下移治療前臂缺血性肌攣縮. 中華手外科雜志, 1996, 12(2): 86-88.
20.	Gordon T, English AW. Strategies to promote peripheral nerve regeneration: electrical stimulation and/or exercise. Eur J Neurosci, 2016, 43(3): 336-350.
21.	顧玉東, 陳亮, 王濤, 等. C₈神經根切斷治療上肢腦癱的重新評價. 中華手外科雜志, 2005, 21(6): 350-352.
22.	顧玉東, 蔡佩琴, 王濤, 等. C₈神經根切斷治療上肢腦癱. 中華手外科雜志, 1997, 13(3): 130-132.
23.	Leclercq C, Perruisseau-Carrier A, Gras M, et al. Hyperselective neurectomy for the treatment of upper limb spasticity in adults and children: a prospective study. J Hand Surg (Eur Vol), 2021, 46(7): 708-716.
24.	Kim IK, Kim PT, Park BC, et al. Flexor sliding operation for established Volkmann’s ischemic contracture. J Korean Orthop Assoc, 1993, 28(3): 1199-1206.
25.	Handsfield GG, Williams S, Khuu S, et al. Muscle architecture, growth, and biological remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord, 2022, 23(1): 233. doi: 10.1186/s12891-022-05110-5.
26.	Bandela S, McPherson L, Harvey RL, et al. Early recognition and intervention for poststroke spasticity: a scientific statement from the american heart association. Stroke, 2026, 57(4): e146-e159.

1. Nielsen JB, Crone C, Hultborn H. The spinal pathophysiology of spasticity—from a basic science point of view. Acta Physiol (Oxf), 2007, 189(2): 171-180.
2. Gracies JM, Alter KE, Biering-S?rensen B, et al. Spastic paresis: a treatable movement disorder. Mov Disord, 2025, 40(1): 44-50.
3. Otero-Romero S, Sastre-Garriga J, Comi G, et al. Pharmacological management of spasticity in multiple sclerosis: Systematic review and consensus paper. Mult Scler, 2016, 22(11): 1386-1396.
4. Xu Q, Xiao H, Zhu Z, et al. Research progress in the use of botulinum toxin type a for post-stroke spasticity rehabilitation: a narrative review. Ann Med, 2025, 57(1): 2521427. doi: 10.1080/07853890.2025.2521427.
5. 楊辰, 李文軍, 李峰, 等. 胸₁脊神經根切斷治療手痙攣性癱瘓的臨床效果觀察. 中國醫刊, 2023, 58(1): 59-62.
6. Bakheit AM, Fheodoroff K, Molteni F. Spasticity or reversible muscle hypertonia? J Rehabil Med, 2011, 43(6): 556-557.
7. Lieber RL, Fridén J. Muscle contracture and passive mechanics in cerebral palsy. J Appl Physiol (1985), 2019, 126(5): 1492-1501.
8. Stevanovic M, Sharpe FE. Refinements in the treatment of Volkmann ischemic contracture of the forearm: a thematic review. Plast Reconstr Surg Glob Open, 2024, 12(2): e5532. doi: 10.1097/GOX.0000000000005532.
9. 中華醫學會超聲醫學分會婦產超聲學組, 中國醫師協會醫學遺傳醫師分會臨床遺傳學組, 中華預防醫學會出生缺陷預防與控制專業委員會遺傳病防控學組. 先天性多發性關節攣縮臨床診療專家共識(2025年版). 中華醫學遺傳學雜志, 2025, 42(7): 820-829.
10. 李樺, 陳浩杰, 陳國華, 等. 電燒傷后肘關節纖維性強直的解剖學基礎與臨床治療. 中華燒傷雜志, 2005, 21(3): 207-209.
11. 戴北辰, 何旭宸, 施海峰, 等. 先天性指深屈肌腱起點異常的診斷及治療. 中華手外科雜志, 2023, 39(6): 562-565.
12. de Blas-Zamorano P, Montagut-Martínez P, Pérez-Cruzado D, et al. Fugl-Meyer Assessment for upper extremity in stroke: A pyschometric systematic review. J Hand Ther, 2026, 39(1): 22-51.
13. Bukowiec LG, Wu KY, Brandenburg JE, et al. Hyperselective neurectomy for spastic equinovarus in pediatric patients with hypertonia. J Pediatr Rehabil Med, 2025, 18(4): 295-303.
14. MacDermid JC, Turgeon T, Richards RS, et al. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma, 1998, 12(8): 577-586.
15. T₁神經根切斷術治療中樞性手屈曲痙攣專家共識制定小組. T₁神經根切斷術治療中樞性手屈曲痙攣專家共識(2024). 中國修復重建外科雜志, 2025, 39(3): 259-263. doi: 10.7507/1002-1892.202501021.
16. Thevenin-Lemoine C, Denormandie P, Schnitzler A, et al. Flexor origin slide for contracture of spastic finger flexor muscles: a retrospective study. J Bone Joint Surg (Am), 2013, 95(5): 446-453.
17. Gowda TB, Sharma A, Nandeesh S, et al. A case of Volkmann’s ischemic contracture—a case report. J Orthop Case Rep, 2025, 15(9): 138-142.
18. Agarwal P, Jana S, Sharma D, et al. Seventh cervical nerve (C₇) transection for spastic arm paralysis after cerebral injury. Oper Neurosurg, 2023, 24(3): 256-261.
19. 李炳萬, 李大村, 李中檀. 前臂屈肌群起點下移治療前臂缺血性肌攣縮. 中華手外科雜志, 1996, 12(2): 86-88.
20. Gordon T, English AW. Strategies to promote peripheral nerve regeneration: electrical stimulation and/or exercise. Eur J Neurosci, 2016, 43(3): 336-350.
21. 顧玉東, 陳亮, 王濤, 等. C₈神經根切斷治療上肢腦癱的重新評價. 中華手外科雜志, 2005, 21(6): 350-352.
22. 顧玉東, 蔡佩琴, 王濤, 等. C₈神經根切斷治療上肢腦癱. 中華手外科雜志, 1997, 13(3): 130-132.
23. Leclercq C, Perruisseau-Carrier A, Gras M, et al. Hyperselective neurectomy for the treatment of upper limb spasticity in adults and children: a prospective study. J Hand Surg (Eur Vol), 2021, 46(7): 708-716.
24. Kim IK, Kim PT, Park BC, et al. Flexor sliding operation for established Volkmann’s ischemic contracture. J Korean Orthop Assoc, 1993, 28(3): 1199-1206.
25. Handsfield GG, Williams S, Khuu S, et al. Muscle architecture, growth, and biological remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord, 2022, 23(1): 233. doi: 10.1186/s12891-022-05110-5.
26. Bandela S, McPherson L, Harvey RL, et al. Early recognition and intervention for poststroke spasticity: a scientific statement from the american heart association. Stroke, 2026, 57(4): e146-e159.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of T₁ rhizotomy combined with flexor origin slide for central hand flexion spasticity

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Chinese Journal of Reparative and Reconstructive Surgery

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Effectiveness of T₁ rhizotomy combined with flexor origin slide for central hand flexion spasticity