臂丛上干卡压症的临床特点

Clinical characteristics of compression of upper trunk brachial plexus

目的探讨臂丛上干卡压症的临床特点。方法回顾性分析27例臂丛上干卡压症患者的临床资料。结果27例均表现为一侧上肢桡侧感觉障碍,13例合并同侧肩背部或胸部感觉异常;所有患者病侧胸锁乳突肌后缘中点或中下1/3处均有明显压痛,并放散到患侧上肢、肩背或胸部;55.6%(15/27)患者患肢处于外展外旋位时疼痛加重。25.9%(7/27)患者神经传导速度轻度减低,7.4%(2/27)患者大鱼际肌运动单位电位异常。27例患者颈椎X线片检查未见相关的责任病灶。局部封闭并理疗4周后总有效率为85.2%(23/27),4例(14.8%)无效的患者病程较长。结论胸锁乳突肌后缘中点或中下1/3交界点压痛并放散到受累的上肢、背部或胸部是臂丛上干卡压症的临床特征;压痛点局部封闭不仅是有效的治疗方法,也是鉴别诊断的手段之一。

Objective To investigate the clinical characteristics of compression of upper trunk brachial plexus. Methods Clinical data of 27 patient with compression of upper trunk brachial plexus were retrospective analyzed. Results All cases showed sensory disturbance in radialis sides of upper extremities. 13 cases accompanied by ipsilateral breast or mid-back pain. All cases showed severe tenderness at the middle point or at the juncture between center and lower third part of posterior edge of the ipsilateral steruocleidomastoid muscle. The tenderness always radiated to the involvement limb, the affected breast or the mid-back areas. Symptoms aggravated in 55.6% （15/27） cases when the suffering limbs were set in abducens and rotated externally position. 25.9% （ 7/27 ） cases showed decreased nerve conduction velocities and 7.4% （2/27） showed abnormal motor unit potential. Radioactive ray studies found no abnormalities corresponding to the symptoms. Nerve blockade at the tenderness point together with physiotherapy were effective. 4 weeks after treatment the total effective rate was 82.5% （23/27） , ineffective rate was 14.8% （4/27）. Conclusions The features of upper trunk brachial plexus entrapment neuropathy including： paraesthesia in radialis side of upper extremities and severe tenderness at the middle or center-lower part third of posterior edge of ipsilateral sternocleidomastoid muscle which radiates to the involvement limb, mid-back or breast. Local nerve blockade combined with physiotherapy was effective, and also one of the way for differential diagnosis.