91例颈肩上肢痛临床特征与诊断分析  

Clinical features and diagnosis analysis of 91 cases of neck shoulder upper extremity pain syndrome

作　　者：罗文琪[1] 杨光[2] 崔树森[3] 朱庆三[1] 顾锐[1] 方乐[4] 张静菊[5] 郭嘉隆[6] 罗民[7] Luo Wenqi;Yang Guang;Cui Shusen;Zhu Qingsan;Gu Rui;Fang Le;Zhang Jingju;Guo Jialong;Luo Min(Department of Orthopedics, the Multi-disciplinary Consultation Platform of Neck Shoulder Upper Extremity, China-Japan Union Hospital of Jilin University, Changchun 130033, China;Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, China;Department of Hand Surgery, the Multi-disciplinary Consultation Platform of Neck Shoulder Upper Extremity, China-Japan Union Hospital of Jilin University, Changchun 130033, China;Department of Neurology, the Multi-disciplinary Consultation Platform of Neck Shoulder Upper Extremity, China-Japan Union Hospital of Jilin University, Changchun 130033, China;Department of Vascular Surgery, the Multi-disciplinary Consultation Platform of Neck Shoulder Upper Extremity, China-Japan Union Hospital of Jilin University, Changchun 130033, China;Department of Rheumatology and Immunology, the Multi-disciplinary Consultation Platform of Neck Shoulder Upper Extremity, China-Japan Union Hospital of Jilin University, Changchun 130033, China;Department of Pain, the Multi-disciplinary Consultation Platform of Neck Shoulder Upper Extremity, China-Japan Union Hospital of Jilin University, Changchun 130033, China)

机构地区：[1]吉林大学中日联谊医院骨科,颈肩上肢疼痛疑难病会诊中心,长春130033 [2]吉林大学中日联谊医院手外科,长春130033 [3]吉林大学中日联谊医院手外科,颈肩上肢疼痛疑难病会诊中心,长春130033 [4]吉林大学中日联谊医院神经内科,颈肩上肢疼痛疑难病会诊中心,长春130033 [5]吉林大学中日联谊医院血管外科,颈肩上肢疼痛疑难病会诊中心,长春130033 [6]吉林大学中日联谊医院风湿免疫科,颈肩上肢疼痛疑难病会诊中心,长春130033 [7]吉林大学中日联谊医院疼痛科,颈肩上肢疼痛疑难病会诊中心,长春130033

出　　处：《中华手外科杂志》2019年第2期118-122,共5页Chinese Journal of Hand Surgery

摘　　要：目的分析复杂性颈肩上肢痛病例临床特征,并对诊断结果进行归类、总结,旨在提高临床医师对颈肩上肢痛的认识,为临床工作提供有价值的参考。方法回顾性分析自2015年7月至2017年3月在我院颈肩上肢痛疑难病多学科会诊中心就诊的颈肩上肢痛患者临床资料。对患者的一般资料、症状、体征、辅助检查和诊断进行分类、总结。结果符合纳入标准共计91例患者,男41例,女50例。病史5 d至30年,平均25.4个月。47~67岁年龄段最多见(53例,58.2%)。除疼痛外,麻木(35%)、无力(13%)、肌肉萎缩(11%)、活动受限(7%)是常见的症状。24例Spurling征阳性患者中,有神经根型颈椎病17例(70.8%)。11例行前中斜角肌诊断性封闭,8例阳性中7例患者诊断为胸廓出口综合征。在48例单一诊断中,颈椎病类10例(21%)、胸廓出口综合征类9例(19%)、周围神经类9例(19%)、中枢神经系统类7例(15%)、肿瘤类4例(8%)、感染类3例(6%)、其他6例(12%)。在29例复合诊断中,胸廓出口综合征合并其他疾病16例(55.2%),其中包括胸廓出口综合征合并神经根型颈椎病8例。神经根型颈椎病合并其他疾病7例(24.1%)。结论复杂性颈肩上肢痛好发于中老年人,以女性多见。颈椎病是复杂性颈肩上肢痛最常见病因,胸廓出口综合征占到一定比例。部分复杂性颈肩上肢痛患者是以神经根型颈椎病或胸廓出口综合征为主的复合性诊断。Spurling征和前中斜角肌诊断性封闭有助于复杂性颈肩上肢痛疾病的诊断。Objective To analyze the clinical characteristics of complex neck shoulder upper extremity pain cases and to classify and summarize the diagnosis outcomes in order to improve the doctors' understanding of neck shoulder upper extremity pain and provide valuable reference for clinical work. Methods A retrospective analysis was performed on the clinical data of patients with neck, shoulder and upper extremity pain who were treated in the multidisciplinary consultation center of neck, shoulder and upper extremity pain in our hospital from July 2015 to March 2017. The general information, symptoms, signs, auxiliary examinations and diagnosis of the patients were classified and summarized. Results A total of 91 patients, 41 males and 50 females, met the inclusion criteria. The medical history ranged from 5 days to 30 years, with an average of 25.4 months. The most common age group was 47 to 67 years old (53 cases, 58.2%). Apart from pain, numbness (35%), weakness (13%), muscle atrophy (11%) and activity limitation (7%) were common symptoms. Of the 24 cases with positive Spurling's sign, 17 cases (70.8%) had cervical spondylotic radiculopathy. Diagnostic block of anterior and middle scalene muscles was performed in 11 cases, and thoracic outlet syndrome was diagnosed in 7 out of 8 positive cases. Among 48 cases of single diagnosis, 10 cases (21%) were cervical spondylosis, 9 cases (19%) were thoracic outlet syndrome, 9 cases (19%) were peripheral nerve disease, 7 cases (15%) were central nervous system disorder, 4 cases (8%) were tumors, 3 cases (6%) were infections and 6 cases (12%) were others. Among the other 29 cases of complex diagnosis, 16 cases (55.2%) had thoracic outlet syndrome with other diseases, including 8 cases of thoracic outlet syndrome with cervical spondylotic radiculopathy. 7 cases (24.1%) of cervical spondylotic radiculopathy combined with other diseases. Conclusion Complex neck, shoulder and upper extremity pain is more common in the middle-aged and elderly people, especially in women. Cervical spo

关 键 词：疼痛 诊断 临床特征 神经根型颈椎病 胸廓出口综合征 

分 类 号：R681.5[医药卫生—骨科学]