非创伤性桡神经麻痹伴神经多段束带样病变

Non-traumatic paralysis of the radial nerve with multiple constrictions

目的 报告罕见的非创伤性桡神经麻痹伴神经多段束带样病变。 方法 对 1994年 1月～ 1999年 8月收治的 5例患者的诊断和治疗情况进行回顾性总结。男 2例 ,女 3例 ,年龄 10～ 43岁 ,平均 2 8岁。自发病到手术时间 1 5～ 3 5个月 ,平均 2 4个月。手术探查桡神经 ,发现桡神经主干及其深支上有 1～ 5处束带样病变 ,3例在最严重的束带样病变处神经有扭转 ,无任何外在卡压。 3例行组织学检查 ,发现神经外膜及束膜内滋养血管周围有淋巴细胞浸润。 1例行神经外膜松解术 ,4例将病变切除 ,其中 1例直接吻合神经 ,3例有神经缺损行神经移植。 结果 术后随访 8个月～ 4年 ,4例伸腕、伸指、伸拇肌力恢复在 4级以上 ,1例神经移植患者随访 14个月 ,伸腕肌、指总伸肌肌力 4级 ,拇长伸肌肌力 3级。 结论 非创伤性桡神经麻痹伴神经多段束带样病变临床罕见 ,其病因可能是神经外膜、束膜内的血管炎 ;

Objective [WT5”BZ]To report uncommon lesion of radial nerve paralysis with multiple constrictions. Methods Five patients were treated in our department from January 1994 to August 1999. There were 2 men and 3 women, with a mean age of 28 years (10 to 43 years). All patients were treated surgically. Periods from paralysis to surgery were 1 5 to 3 5 months(mean 2 4 months). The radial nerves were explored. There were 1 to 5 segmental constrictive lesions at the main trunks of radial nerves and the posterior interosseous nerves; no obvious extrinsic compression was noted. The nerves were twisted at the site of the most severe constrictions in 3 patients. One underwent epineurolysis. In the other patients the constricted portions of the nerves were resected, and the ends were sutured in one patient,nerve grafting in three. Histological examination of the resected portions showed concentration of inflammatory cells around the vessels in the perineurium. [WT5”HZ]Results [WT5”BZ]The patients were followed up for 8 months to 4 years after operation. Four patients regained at least grade 4 muscle power in the involved muscles. One patient who had been treated by nerve grafting regained grade 4 muscle power in the extensor digitorum communis, and grade 3 in the extensor pollicis longus 14 months after operation. [WT5”HZ]Conclusions [WT5”BZ]The lesion was very uncommon. The etiology may be a focal inflammatory response around the feeding arteries in the perineurium. The results of surgical treatment were good.