臂丛神经炎的临床观察和分析

Clinical observation and analysis of brachial plexus neuritis

目的观察总结臂丛神经炎的临床诊疗,分析诊疗过程中的问题,为临床诊疗提供参考。方法回顾自2014年11月至2022年2月,我们诊治并得到随访的臂丛神经炎患者23例23侧,分别记录患者的病史、病程发展、详细治疗经过、辅助检查结果,并随访评估患者治疗前后的患肢疼痛、感觉、肌力变化情况。结果本组中,损伤累及上干患者20例,累及下干患者2例,全臂丛受累患者1例。所有患者均获得6个月以上的随访,平均(12.43±17.89)个月。末次随访中,16例患肢疼痛严重患者起病后2周至3个月症状均明显减轻或消失。7例患肢麻木明显患者均获得不同程度改善;15例通过保守治疗或药物治疗得到良好的上肢功能恢复;8例进行了手术治疗,其中神经转位7例,功能重建4例(有神经手术后恢复不佳患者),最终均获得良好的恢复。另有1例合并脑瘫患者手术后上肢功能恢复欠佳。结论臂丛神经炎有明显的临床特点,详细的病史了解是诊断的关键;保守治疗对大部分臂丛神经炎有效,当确认恢复不佳时,外科手术的介入是必要的。

Objective To observe and summarize the clinical diagnosis and treatment of brachial plexus neuritis,analyze the problems in the process of diagnosis and treatment,and provide reference for clinical diagnosis and treatment.Methods From November 2014 to February 2022,23 patients with brachial plexus neuritis who were treated and followed up were reviewed.The medical history,course and development,detailed treatment and auxiliary examination results of the patients were recorded respectively.The changes in pain,sensation and muscle strength of the affected limb were evaluated before and after treatment.Results Among the 23 patients,20patients were involved in the upper trunk,2 patients were involved in the lower trunk,and 1 patient was involved in the total brachial plexus.All patients were follow-up for more than 6 months,with an average of(12.43±17.89)months.At the last follow-up,the symptoms of 16 patients with severe limb pain were significantly relieved or disappeared 2 weeks to 3 months after onset.All 7 patients with significant limb numbness achieved varying degrees of improvement.15 patients achieved good upper limb function recovery through conservative or drug treatment.8 patients underwent surgical treatment,including 7 cases of nerve transposition and 4 cases of functional reconstruction(including patients with poor recovery after nerve surgery),all of which ultimately achieved good recovery.Another patient with cerebral palsy had poor recovery of upper limb function after surgery.Conclusion Brachial plexus neuritis has obvious clinical characteristics,and a detailed medical history is the key to diagnosis.Conservative treatment is effective for most cases of brachial plexus neuritis,and surgical intervention is necessary when poor recovery is confirmed.