复旦大学徐文东团队近日研究了椎间孔右侧C7神经切断加强化言语治疗与单纯强化言语治疗治疗慢性卒中后失语症的疗效与安全性。该项研究成果发表在2025年6月25日出版的《英国医学杂志》上。

为了评估在椎间孔处对第七颈神经（C7）进行右侧神经切断术加强化言语和语言治疗（SLT）是否能改善中风后慢性失语症患者的语言功能，研究组在中国设立四个中心，进行了一项多中心、评估者盲法、随机对照试验。

参与者为50名年龄在40-65岁之间的成年人，在单次左半球中风后失语症超过一年。参与者按1:1随机分组，接受C7神经切断术加三周强化SLT或仅接受三周强化SL T，按治疗中心分层。主要结局是60项波士顿命名测试（BNT，得分0-60，得分越高表示命名功能越好）的得分从基线到C7神经切断术加强化SLT三周或延期一周后强化SLT（对照组）三周的变化。次要结局包括使用西方失语症电池计算的失语症商数改变失语症的严重程度，以及患者报告的卒中后生活质量和抑郁的结局。

2022年7月25日到2023年7月31日，1086名患者中有322名被诊断为中风后失语症，并接受了资格筛查。50名符合条件的参与者被随机分配到治疗组（每组25人）。一个月时，神经切断加SLT组的BNT评分平均增加11.16分，对照组增加2.72分（差异8.51分，95%置信区间（CI）5.31至11.71，P<0.001）。BNT评分的组间差异在6个月时保持稳定（差异8.26分，4.16至12.35，P<0.001）。此外，与对照组相比，神经切断加SLT组的失语症商数显著改善（一个月时的差异为7.06分，4.41至9.72分，P<0.001），患者报告的日常生活活动和卒中后抑郁也有所改善。未报告与治疗相关的严重不良事件。

研究结果表明，C7神经切断术加三周强化SLT与六个月内单独进行三周强化SLT相比，语言功能有更大的改善。未报告严重不良事件或长期痛苦症状或功能丧失。

附：英文原文

Title: Right C7 neurotomy at the intervertebral foramen plus intensive speech and language therapy versus intensive speech and language therapy alone for chronic post-stroke aphasia: multicentre, randomised controlled trial

Author: Juntao Feng, Ruiping Hu, Minzhi Lyu, Xingyi Ma, Tie Li, Yuan Meng, Wenjun Qi, Haozheng Li, Ying Zhang, Shanshan Ding, Zhiyu Wang, Xiu’En Chen, Jiejiao Zheng, Yongqian Fan, Ling Ding, Lihui Wang, Zilong Wei, Xiaozhi Zhu, Mingxuan Guo, Kaixiang Yang, Wenshuo Chang, Jingrui Yang, Miaomiao Xu, Wen Fang, Ying Liu, Yanqun Qiu, Huawei Yin, Jie Jia, Yundong Shen, Yizheng Wang, Yudong Gu, Wendong Xu

Issue&Volume: 2025/06/25

Abstract:

Objective To evaluate whether right neurotomy of the seventh cervical nerve (C7) at the intervertebral foramen plus intensive speech and language therapy (SLT) improves language function compared intensive SLT alone in patients with chronic aphasia after stroke.

Design Multicentre, assessor blinded, randomised controlled trial.

Setting Four centres in mainland China.

Participants 50 adults aged 40-65 years with aphasia for more than one year after a single left hemispheric stroke.

Interventions Participants were randomised 1:1 to receive either C7 neurotomy plus three weeks of intensive SLT or three weeks of intensive SLT only, stratified by treatment centre.

Main outcome measures The primary outcome was change in score on the 60 item Boston naming test (BNT, scores 0-60, with higher scores indicating better naming function) from baseline to one week after C7 neurotomy plus intensive SLT for three weeks or intensive SLT for three weeks after deferral for one week (control group). Secondary outcomes included change in severity of aphasia using the aphasia quotient, calculated using the western aphasia battery, and patient reported outcomes on quality of life and depression after stroke.

Results From 25 July 2022 to 31 July 2023, 322 out of 1086 patients received a diagnosis of post-stroke aphasia and were screened for eligibility. 50 eligible participants were randomly assigned to treatment groups (25 in each). Mean increase in BNT score was 11.16 points in the neurotomy plus SLT group and 2.72 points in the control group at one month (difference 8.51 points, 95% confidence interval (CI) 5.31 to 11.71, P<0.001). The between group difference in BNT score remained stable at six months (difference 8.26 points, 4.16 to 12.35, P<0.001). In addition, the aphasia quotient improved significantly in the neurotomy plus SLT group versus control group (difference at one month 7.06 points, 4.41 to 9.72, P<0.001), as did patient reported activities of daily living and post-stroke depression. No treatment related severe adverse events were reported.

Conclusions C7 neurotomy plus three weeks of intensive SLT was associated with a greater improvement in language function compared with three weeks of intensive SLT alone over a period of six months. No severe adverse events or long term troublesome symptoms or functional loss were reported.

DOI: 10.1136/bmj-2024-083605

Source: https://www.bmj.com/content/389/bmj-2024-083605