针对上肢周围神经沙漏样收缩的早期积极收缩切除术：一项回顾性研究。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2024-10-23 DOI:10.1016/j.neuchi.2024.101605

Dandan Yang, Yao Wu, Long Zheng, Zhenzhi Wu, Xing Rong, Buguo Chen

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引用次数: 0

摘要

目的：周围神经沙漏样收缩（HGC）是神经性肌营养不良症的特征性病理表现。一旦发现，必须尽早进行手术治疗。然而，手术方法仍存在争议，尤其是关于是否需要切除 HGC。本研究旨在探讨早期积极切除上肢神经HGC的疗效：本回顾性研究主要针对2019年6月至2023年7月期间在我院接受治疗的13例自发性上肢瘫痪神经，在手术过程中发现了HGC。在手术过程中，对收缩区域进行了上神经切除术和筋膜间神经切断术。神经切除术后，如果符合以下条件之一，则进行收缩物切除术：(1) 单一收缩且收缩≥75%。(2）收缩合并扭转。(3）存在≥2处收缩。术后定期进行面对面随访：结果：4 例单发收缩小于 75% 的病例接受了上神经切除术和筋膜间神经切断术；8 例接受了收缩切除术，其中 4 例单发收缩并伴有扭转的病例在切除术后直接进行了端对端缝合，4 例收缩超过 2 处的病例接受了自体鞍神经移植术。术后随访显示，除一例病例恢复良好外，其他病例均恢复良好：结论：对于上肢周围神经 HGCs 的早期手术治疗，如果在手术中发现严重收缩、收缩合并扭转或存在两个以上收缩，积极的收缩切除术可能是更好的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Early aggressive constriction resection for hourglass-like constriction of peripheral nerve in the upper extremity: a retrospective study

Objectives

The hourglass like constriction (HGC) of peripheral nerves is a characteristic pathological manifestation of Neuralgic Amyotrophy. Once identified, early surgical intervention is essential. However, the method of surgery is controversial, particularly regarding whether HGC needs to be excised. This study aims to explore the efficacy of early aggressive resection of HGC in the upper limb nerves.

Materials and methods

This retrospective study focuses on 13 nerves of spontaneous upper limb paralysis treated at our hospital from June 2019 to July 2023, in which HGC was identified during surgery. During surgery, epineurectomy and interfascicular neurolysis were performed on the constricted areas. Post-neurolysis, constriction excision was carried out if any of the following conditions were met: (1) A single constriction with constriction ≥75%. (2) Constriction combined with torsion. (3) The presence of ≥2 constrictions. Regular face-to-face follow-ups were conducted postoperatively.

Results

Four cases with a single constriction of less than 75% underwent epineurotomy and interfascicular neurolysis; eight underwent constriction excision, of which four cases with a single constriction and associated torsion had direct end-to-end suturing after excision, and four had more than two constrictions treated with autologous sural nerve grafts. Postoperative follow-ups showed good recovery in all but one case, which had unique pathological features and had underwent only epineurectomy, showing moderate recovery.

Conclusions

For early surgical treatment of HGCs in peripheral nerves of the upper limbs, if severe constriction, constriction combined with torsion, or the presence of more than two constrictions are identified during surgery, aggressive constriction resection may be a better option.

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.