| Autor: |
Hurtado-Olmo P; Upper Limb Surgery Unit, Orthopedic Surgery Department, San Cecilio University Hospital of Granada, 18016 Granada, Spain., González-Santos Á; BIO 277 Group, Department of Physical Therapy, Faculty of Health Science, University of Granada, 18012 Granada, Spain.; A02-Cuídate, Instituto de Investigación Biosanitaria, 18012 Granada, Spain., Pérez de Rojas J; Department of Preventive Medicine and Public Health, San Cecilio University Hospital of Granada, 18016 Granada, Spain., Fernández-Martínez NF; Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain.; Instituto de Investigación Biosanitaria ibs, 18012 Granada, Spain.; CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain., Del Olmo L; Rehabilitation Department, San Cecilio University Hospital of Granada, 18016 Granada, Spain., Hernández-Cortés P; Upper Limb Surgery Unit, Orthopedic Surgery Department, San Cecilio University Hospital of Granada, 18016 Granada, Spain.; Instituto de Investigación Biosanitaria ibs, 18012 Granada, Spain.; Surgery Department, School of Medicine, Granada University, 18012 Granada, Spain. |
| Abstrakt: |
Background : For more than two decades, the surgical treatment of post-stroke spastic hands has been displaced by botulinum toxin therapy and is currently underutilized. Objectives : This article aimed to assess the potential of surgery for treating a post-stroke spastic upper extremity through a systematic review of the literature on surgical approaches that are adopted in different profiles of patients and on their outcomes and complications. Methods : Medline PubMed, Web of Science, SCOPUS, and Cochrane Library databases were searched for observational and experimental studies published in English up to November 2022. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) system. Results : The search retrieved 501 abstracts, and 22 articles were finally selected. The GRADE-assessed quality of evidence was low or very low. The results of the reviewed studies suggest that surgery is a useful, safe, and enduring treatment for post-stroke spastic upper extremities, although most studied patients were candidates for hygienic improvements alone. Patients usually require an individualized combination of techniques. Over the past ten years, interest has grown in procedures that act on the peripheral nerve. Conclusions : Despite the lack of comparative studies on the effectiveness, safety, and cost of the treatments, botulinum toxin has displaced surgery for these patients. Studies to date have found surgery to be an effective and safe approach, but their weak design yields only poor-quality evidence, and clinical trials are warranted to compare these treatment options. |
