股动脉穿刺并发股神经损伤相关因素分析  

Femoral nerve injuries caused by femoral artery puncturing: analysis of related factors

作　　者：郑波 李兆南 袁罡 徐燕能 胡伟 张向琼 马小燕 斯光晏 ZHENG Bo;LI Zhaonan;YUAN Gang;XU Yanneng;HU Wei;ZHANG Xiangqiong;MA Xiaoyan;SI Guangyan(Department of Interventional Radiology,Affiliated Hospital of Traditional Chinese Medicine,Southwest Medical University,Luzhou,Sichuan Province 646000,China)

机构地区：[1]四川泸州西南医科大学附属中医医院介入诊疗科,646000

出　　处：《介入放射学杂志》2018年第10期963-965,共3页Journal of Interventional Radiology

摘　　要：目的分析股动脉穿刺并发股神经损伤的原因,以期提高临床诊治水平。方法回顾性分析2012年1月至2016年12月股动脉穿刺置管4 673例,其中6例根据临床表现及神经肌电图检查确诊为股神经损伤(2例直接穿刺伤,1例穿刺点血肿压迫继发伤,3例止血带压迫伤)。4例接受神经松解、神经阻滞治疗结合药物治疗(扩血管改善微循环及维生素B1营养神经等);2例接受单纯药物治疗。结合临床表现和文献分析股神经损伤原因。结果术后平均随访3个月(1～6个月),所有患者股四头肌肌力由治疗前3～4级恢复至4～5级,伸膝功能及步态正常;4例感觉功能完全恢复,1例随访3个月后仍有大腿下2/3前下及小腿内侧感觉减退,1例止血带压迫损伤患者肌力恢复正常,但随访4个月后仍有感觉障碍。结论股神经损伤是一种临床少见的经皮穿刺置管并发症,医源性损伤不容忽视,患肢肌力下降、大腿感觉异常应引起重视,早期诊断及及时、适当治疗是预后良好的关键。Objective To analyze the causes of femoral nerve injuries caused by femoral artery puncturing in order to improve clinical diagnosis and treatment level. Methods The clinical data of 4 673 patients, who received femoral artery catheterization during the period from January 2012 to December 2016, were retrospectively analyzed. Among the 4 673 patients, 6 patients were diagnosed as femoral nerve injury, which was confirmed by clinical manifestations and nerve electromyography; the injuries resulted from direct puncture injury （n=2）, secondary injury of puncture point hematoma compression （n=l） and tourniquet compression injury （n=3）. Of the 6 patients with nerve injury, neurolysis and nerve block combined with medication （vasodilatation drug to improve microcireulation and vitamin B1 to give nerve nutrition） were employed in 4 and pure medication was adopted in 2. Combined with clinical manifestations and medical literature the causes of femoral nerve injuries were analyzed. Results The patients were followed up for a mean period of 3 months （1-6 months）. In all patients, the muscle force of quadriceps femoris recovered from preoperative grade Ⅲ -Ⅳ to postoperative grade Ⅳ- Ⅴ. The function of extension of knee joint and walking gait were normal. The sensory function recovered completely in 4 patients. One patient was followed up for 3 months, who still suffered from hypoesthesia at the anterior-lower area of lower two thirds of thigh and at the medial side of calf. In one patient with tourniquet compression injury, his muscle strength returned to normal, but he still had sensory disorder in the following-up period of 4 months. Conclusion Clinically, femoral nerve injury is a rare complication of percutaneous catheterization. It is an iatrogenic injury that should not be ignored. The occurrence of femoral nerve damage should be thought of when the patient complains of muscle weakness and abnormal thigh sensation. Proper and timely diagnosis and treatment are the key to ensure a good progn

关 键 词：股动脉穿刺 股神经 股神经损伤 

分 类 号：R741[医药卫生—神经病学与精神病学]