上肢神经沙漏样病变的早期超声诊断及手术治疗策略分析  

Early ultrasound diagnosis and surgical treatment strategy analysis of upper limb nerve hourglass-like constrictions

作　　者：蒋炜 俞淼 李学渊[1] 李苗钟 周晓玲[1] 丁文全[1] 陈宏[1] Jiang Wei;Yu Miao;Li Xueyuan;Li Miaozhong;Zhou Xiaoling;Ding Wenquan;Chen Hong(Department of Hand Surgery,Ningbo Sixth Hospital,Ningbo 315042,China)

机构地区：[1]宁波市第六医院手外科,宁波315042

出　　处：《中华手外科杂志》2024年第5期422-425,共4页Chinese Journal of Hand Surgery

摘　　要：目的 探讨臂丛神经炎神经沙漏样变的早期诊断及不同手术治疗策略的分析.方法 自2018年1月至2022年6月,我们收治的65例急性臂丛神经炎患者中,常规B超检测后发现神经沙漏样变12例,均在发病3个月内行手术探查.不全缩窄的神经予外膜束膜松解,完全缩窄的神经直接切断重新显微缝合.记录术中所见并密切随访预后.结果 12例患者中男5例,女7例;年龄20~49岁.累及桡神经3例,骨间后神经4例,骨间前神经5例,腋神经1例.术前B超提示受累神经除了在特定部位发生缩窄,局部神经较健侧明显肿胀,累及长度5~15 cm.其中单根神经2处缩窄5例,3处缩窄4例,1处缩窄2例,7处缩窄1例.术中发现病变部位与B超提示高度吻合,但有4例B超显示部分缩窄,实际上为完全缩窄.急性期受累神经外膜充血增厚.病理结果提示炎性细胞浸润.术后随访8例患者在4~6个月内肌力恢复至S4及以上,4例高位缩窄在10个月后肌力恢复至S4.结论 B超辅助下早期确诊沙漏样变性,并根据狭窄情况行手术松解或切断修复,能够较大程度促进恢复.Objective To investigate the early diagnosis of hourglass-like constrictions in brachial plexus neuritis and analyze different surgical treatment strategies.Methods From January 2018 to June 2022,among the 65 patients with acute brachial plexus neuritis treated by us,12 cases were found to have hourglass-like constrictions after routine ultrasound examination,all of whom underwent surgical exploration within 3 months of onset.Incomplete constricted nerves were released from the outer membrane and fasciculus,while completely constricted nerves were directly cut off and microsurgical sutured again.The intraoperative findings were recorded and prognosis was closely followed up.Results Among the 12 patients,there were 5 males and 7 females.The age ranged from 20 to 49 years old.There were 3 cases involving the radial nerve,4 cases involving the posterior interosseous nerve,5 cases involving the anterior interosseous nerve,and 1 case involving the axillary nerve.The preoperative ultrasound showed that the affected nerves underwent narrowing in specific areas,and the local nerves were significantly swollen compared to the healthy side,with an affected length ranging from 5 to 15 cm.Among them,there were 5 cases of single nerve constriction at 2 locations,4 cases of nerve constriction at 3 locations,2 cases of nerve constriction at 1 location,and 1 case of nerve constriction at 7 locations.During the operation,it was found that the lesion site was highly consistent with the ultrasound indication,but in 4 cases,the ultrasound showed partial narrowing,which was actually complete narrowing.During the acute phase,the affected nerve outer membrane became congested and thickened.The pathological results indicated inflammatory cell infiltration.Eight patients were follow-up after surgery,and their muscle strength recovered to S4 or above within 4 to 6 months.Four patients with upper arm level nerve constriction recovered to S4 after 10 months.Conclusion Early diagnosis of hourglass-like constriction with B-ultrasound assistanc

关 键 词：臂丛神经炎 超声检查 沙漏样变 早期 

分 类 号：R658.2[医药卫生—外科学]