周围神经沙漏样改变

zhangwenlong

这期美国手外科杂志，北京积水潭医院的潘永伟发表论文：Typical Brachial Neuritis (Parsonage-Turner Syndrome) With Hourglass-Like Constrictions in the Affected Nerves

Purpose
To report on 5 patients who had acute brachial neuritis (Parsonage-Turner syndrome) with hourglass-like constriction in the affected nerves.

Methods
We retrospectively reviewed 5 patients who were treated in our department from December 2003 to December 2008. Acute, intense pain around the shoulder girdle and upper arm was the first symptom and was followed by muscle weakness and atrophy. Clinical and EMG examinations showed involvement of 2 or more nerves in the affected extremity. Those severely affected nerves that had no response to conservative treatment were explored, and an hourglass-like constriction was identified. Neurolysis was performed at the sites of constrictions in 2 radial nerves and 1 median nerve. The constricted portion was resected, and direct coaptation was performed in 1 radial nerve and 1 musculocutaneous nerve. The constricted portion was resected, and nerve graft was performed in 2 radial nerves and 1 median nerve.

Results
All patients were followed up for 24 to 84 months after surgery. Of 3 nerves treated with external neurolysis, all attained full recovery. Of 2 nerves treated with resection and neurorrhaphy, 1 attained full recovery, and the other had an incomplete recovery. Of 3 nerves treated with resection and nerve graft, 1 (4-cm nerve graft) attained full recovery, and 2 (4-cm and 13-cm nerve graft, respectively) had incomplete recovery.

Conclusions
The site of nerve lesion of brachial neuritis was not necessarily within the brachial plexus. Our finding of hourglass-like constrictions in individual peripheral nerves suggest that multifocal involvement of terminal branch lesions may underlie the complex patterns of paralysis often encountered clinically.

郑昊

我的英语不行啊，呜呜  。。。。。

kk8217

发个沙漏样改变图片，一般是束带卡压或神经束扭转所致，轴索断裂仅剩外膜相连，诊断常是在术中才发现。

zhangwenlong

：）好东西。谢谢

zuoluoyang

蛮好

liu-yingliang

上次开会听积水潭的讲了这东西，听说简单松解、手术效果特好！