上肢神经沙漏样狭窄的临床诊治  

Clinical diagnosis and treatment of hourglass-like constrictions of peripheral nerve in the upper extremity

作　　者：许娅莉[1] 白江博[1] 于亚东[1] 邵新中[1] Xu Yali;Bai Jiangbo;Yu Yadong;Shao Xinzhong(Department of Hand Surgery, the Third Hospital of Hebei Medical University,Shijiazhuang 050051, China)

机构地区：[1]河北医科大学第三医院手外科,石家庄050051

出　　处：《中华手外科杂志》2018年第3期202-205,共4页Chinese Journal of Hand Surgery

基　　金：2018年度河北省医学适用技术跟踪项目（G2018043）

摘　　要：目的探讨神经沙漏样狭窄的临床诊断和治疗。方法结合我科自2011年1月至2017年4月收治的9例上肢周围神经沙漏样狭窄患者，回顾性总结分析其临床特点、超声所见、治疗经过以及功能恢复情况。结果行超声检查的8例患者中有7例发现单处或多处沙漏样狭窄，其部位、数量、狭窄程度以及神经的形态变化与术中所见完全符合。根据狭窄程度、电生理结果和术中所见，积极手术后功能恢复良好。1例未行超声检查的患者3年后无恢复。结论超声可明确沙漏样狭窄的存在并确定其位置、数量和狭窄程度，为制定个体化的手术方案提供依据，防止病变遗漏，但与检查者的技术水平和经验有关。对狭窄严重的完全损伤进行积极的手术干预可促进神经的功能恢复。Objective To discuss the clinical diagnosis and treatment of hourglass-like peripheral nerve constriction. Methods From January 2011 to April 2017, 9 cases of hourglass-like constrictions of peripheral nerve in the upper extremity were treated in our department. The clinical characteristics, ultrasound findings, treatment course and functional recovery were retrospectively analyzed. Results Single or multiple hourglass-like constrictions were found in 7 cases from 8 cases who underwent ultrasound examination. Location, quantity, degree of constriction and morphological changes of the involved nerve were consistent with what were seen during the operation. According to the degree of constriction, electrophysiological results and intraoperative findings, functional recovery benefited from the positive surgical treatment. There was no recovery in 1 case without ultrasound examination even 3 years after the operation. Conclusion The presence, location, quantity and narrow degree of hourglass-like constriction can be identified by ultrasound, which provides the basis for the formulation of individual surgical procedures to prevent the omission of the disease. However, it is related to the technical level and experience of the examiners. Active surgical intervention for the cases with severe hourglass-like constriction can promote the recovery of nerve function.

关 键 词：超声检查 外科手术 沙漏样狭窄 自发性周围神经麻痹 

分 类 号：R651.3[医药卫生—外科学]