Object: To analyze the recovery of peripheral nerve rewiring (PNR) surgery in the treatment of hemiplegic upper extremity and evaluate its relevant clinical features, efficiency, and optimal indications. Methods: Prospective follow-up were carried out in patients with hemiplegic upper extremity following stroke, traumatic brain injury, and cerebral palsy. Patients underwent PNR surgery and were followed-up every 3 months after surgery. Measurements included Fugl-Meyer scale, sensorimotor functions, range of motion, and muscle strength. Primary outcomes were assessed and influencing factors such as etiology, disease course, age at surgery, and injured side were also evaluated. Results: A total of 67 patients underwent PNR surgery between April 2007 and December 2015. Fifty-one patients had been followed-up for more than 1 year and the Fugl-Meyer score were 47.52 ± 6.94 at 12 months, compared with 28.31 ± 3.15 before surgery. Patients showed improvements in wrist stability, motor control of the paralyzed hand, and the grasping function. The items that reflect fine motor functions of wrist and fingers increased from 8.65 ± 1.61 to 18.91 ± 4.16. The range of motion increased from 98.35 ± 29.67 to 123.12 ± 19.46 in the elbow and from 34.81 ± 29.20 to 79.55 ± 23.68 in the wrist at 12 months after surgery. And the strength improved from 3.4 ± 1.0 to 4.4 ± 0.5 in elbow extension and from 1.3 ± 1.3 to 3.7 ± 0.6 in wrist extension according to British Medical Council grading system. The patients of cerebral palsy obtained more satisfactory outcomes than those of other causes such as stroke, traumatic brain injury, and encephalitis, that was from 27.6 ± 1.18 preoperation to 47.5 ± 5.54 at 12 months postoperation. Patients who were under 25 years old presented best improvements in the Fugl-Meyer score, from 28.16 ± 1.24 to 47.3 ± 4.56. Patients between 25 and 45 years took the second place while those more than 45 years obtained the third favorable results. However, patients who were older than 45 years still significantly recovered, with Fugl-Meyer score improving from 31.5 ± 2.97 to 43.6 ± 1.97. No significant differences were found when either side was involved or between different sexes. Conclusion: PNR surgery is an effective procedure in treating hemiplegic upper extremity following central neurologic injury. The range of motion and extension strength of paralyzed, wrist and elbow significantly improved. The patients especially reported obvious improvements in wrist stability and hand grasping function. The surgery was effective for all the etiologies including cerebral palsy, traumatic brain injury, stroke, and encephalitis, and cerebral palsy patients obtained most favorable recovery. Patients at lower ages showed better results than other age groups. However, it is still effective in older patients over 45 years. Side of injury and sex do not influence the results.
