电生理监测^(125)I粒子治疗癌性臂丛神经损伤临床疗效的价值

Clinical efficacy of electrophysiological monitoring for patients with cancer-induced brachial plexus injury treated with ^(125)I seeds therapy

目的通过神经电生理监测来探讨^(125)I粒子植入术对癌性臂丛神经压迫所致疼痛及运动障碍的临床疗效。方法回顾性选择2021年1月至2023年8月河北省人民医院肿瘤科行^(125)I粒子治疗癌性臂丛神经损伤的8例患者(男女各4例, 年龄58~63岁), 采用疼痛数字评价(NRS)量表及运动功能评定(F-M)量表评估患者的患肢疼痛及运动障碍情况, 应用电生理监测肌皮神经、腋神经、正中神经、尺神经、桡神经感觉及运动支于治疗前及治疗后3个月的传导速度。采用配对样本t检验分析数据。结果 8例患者均为中重度疼痛(6例伴运动功能障碍), 术前及术后3个月NRS评分分别为(5.9±1.0)和(3.3±1.7)分(t=4.93, P=0.002), F-M评分分别为(44.8±7.6)和(54.8±5.7)分(t=-3.52, P=0.017)。电生理结果显示, 7例患者病灶累及臂丛下干, 1例患者累及臂丛上干。术前及术后3个月尺神经运动支传导速度分别为(47.2±2.6)和(59.7±8.2) m/s(t=-3.17, P=0.034), 感觉支传导速度为(41.8±1.2)和(56.0±5.7) m/s(t=-5.82, P=0.001), 神经传导速度较术前升高。结论 ^(125)I粒子植入术对因臂丛神经受压导致的癌性疼痛及运动障碍具有良好临床疗效, 电生理前后变化可定量监测臂丛神经的感觉及运动功能恢复。

ObjectiveTo explore the clinical efficacy of ^(125)I seeds implantation in treating cancer-induced pain and motor dysfunction caused by brachial plexus compression through neurophysiological monitoring.MethodsA retrospective study was conducted on 8 patients(4 males,4 females;age 58-63 years)who underwent ^(125)I seeds therapy for cancer-induced brachial plexus injury at Hebei Provincial People′s Hospital from January 2021 to August 2023.Pain severity was assessed by using the numerical rating scale(NRS)and motor function was evaluated by using the Fugl-Meyer(F-M)assessment.Electrophysiological monitoring was used to assess changes in sensory and motor branch conduction velocity(CV)of the musculocutaneous nerve,axillary nerve,median nerve,ulnar nerve,and radial nerve before and 3 months after treatment.Paired t-test was used for data analysis.ResultsAll 8 patients had moderate to severe pain(6 had motor dysfunction).The preoperative and postoperative NRS scores was 5.9±1.0 and 3.3±1.7,respectively(t=4.93,P=0.002),while F-M scores was 44.8±7.6 and 54.8±5.7,respectively(t=-3.52,P=0.017).Electrophysiological results showed that 7 patients had lesion involvement in the lower trunk of the brachial plexus,and 1 patient had involvement in the upper trunk.The preoperative and postoperative motor branch CV of the ulnar nerve was(47.2±2.6)and(59.7±8.2)m/s,respectively(t=-3.17,P=0.034),while the sensory branch CV was(41.8±1.2)and(56.0±5.7)m/s,respectively(t=-5.82,P=0.001).The nerve CV increased compared to the preoperative ones.Conclusions ^(125)I seeds implantation has good clinical efficacy in treating cancer-related pain and motor dysfunction caused by brachial plexus compression.Changes in electrophysiology can quantitatively monitor the recovery of sensory and motor functions of the brachial plexus.