Johannes Fabian Holle, Volker Limmroth, Wolfram Windisch, Maximilian Zimmerman
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引用次数: 0
Abstract
Background: Neuralgic amyotrophy (NA) is a multifactorial, monophasic neuritis that mainly affects the nerves of the shoulder girdle. It is characterized by very severe pain and by weakness that arises some time after the pain. Its reported incidence is high (100 cases per 100 000 persons per year), but our data suggest that many or most cases are diagnosed late or not at all.
Methods: This review of the epidemiology, pathophysiology, diagnosis, and treatment of NA is based on pertinent publications retrieved by a selective literature search, and on data provided by the scientific institute of AOK, a German statutory health-insurance carrier.
Results: It is currently thought that the combination of a genetic predisposition, an immunological trigger factor, and mechanical stress on the affected nerve segment(s) is pathophysiologically determinative. The prognosis of untreated NA is poor, with 25% of patients remaining unable to work at three years. The main form of treatment is with corticosteroids that are administered as early as possible. If there is evidence of nerve constriction or torsion, surgery may also help. There have only been six controlled cohort studies on the treatment of NA, and no randomized trials. It is not uncommon for the acute phase to develop into a chronic pain syndrome requiring multidimensional treatment.
Conclusion: Particularly in view of the high incidence and improved therapeutic options, NA should be included in the differential diagnosis of all patients with suggestive symptoms.
背景:神经性肌萎缩症(NA)是一种多因素单相神经炎,主要影响肩部神经。其特征是剧烈疼痛和疼痛后一段时间出现的无力。据报道,该病的发病率很高(每年每 10 万人中有 100 例),但我们的数据表明,许多或大多数病例诊断较晚或根本没有确诊:这篇关于 NA 的流行病学、病理生理学、诊断和治疗的综述是基于通过选择性文献检索检索到的相关出版物,以及德国法定医疗保险公司 AOK 的科学研究所提供的数据:目前认为,遗传易感性、免疫诱发因素和受累神经节段所受的机械应力是决定性的病理生理因素。未经治疗的 NA 预后很差,25% 的患者三年后仍无法工作。主要的治疗方法是尽早使用皮质类固醇。如果有神经收缩或扭转的迹象,手术也可能有所帮助。目前仅有六项治疗 NA 的对照队列研究,还没有随机试验。急性期发展为慢性疼痛综合征,需要多方面治疗的情况并不少见:特别是考虑到NA的高发病率和治疗方法的改进,应将NA纳入所有有提示症状患者的鉴别诊断中。
期刊介绍:
Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence.
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