桡神经浅支卡压综合征的临床诊断及治疗

目的对收治的桡神经卡压综合征诊治病例进行分析,以提高临床诊断及治疗效果。方法 2013年12月-2016年6月,对收治的10例桡神经浅支卡压综合征患者,4例行保守治疗,6例行手术治疗。结果 10例桡神经浅支卡压综合征患者疼痛及麻木症状均明显缓解。结论桡神经浅支卡压综合征为慢性、反复性疾病,常见于体力劳动者,症状表现为手背疼痛、麻木,握拳或前臂旋前时可伴疼痛,前臂桡侧Tinel征(+),有上述症状的患者应考虑桡神经浅支卡压综合征的可能。     

桡神经浅支卡压征的治疗体会

本文报告用局封治疗１１例桡神经浅支卡压征。随访６个月-１年，疗效满意。其症状主要表现为：手背及前臂远段桡侧疼痛；手背桡测感觉减退；患手握力下降;Ｔｉｎｅｌ征阳性。桡神经浅支穿出点神经是固定的，进入浅部后有一定的滑动度，长期反复活动腕关节，使桡神经浅支反复牵拉、磨擦，以致水肿纤维化、结缔组织增生造成卡压是其发病的解剖因素。     

桡神经浅支卡压征的治疗体会

本文报告用局封治疗１１例桡神经浅支卡压征。随访６个月－１年，疗效满意。其症状主要表现为：手背及前臂远段桡侧疼痛；手背桡侧感觉减退；患手握力下降；Ｔｉｎｅｌ征阳性。桡神经浅支穿出点神经是固定的，进入浅部后有一定的滑动度，长期反复活动腕关节，使桡神经浅支反复牵拉、磨擦，以致水肿纤维化、结缔组织增生造成卡压是其发病的解剖因素。     

桡神经浅支卡压的治疗体会

桡神经在行程中,其主干与分支均可因受压而发生卡压综合征。但桡神经浅支在前臂的卡压较少见,多为慢性反复劳损所致。其临床表现又不尽相同,常被误诊为桡骨茎突狭窄性腱鞘炎,因此对桡神经浅支卡压征的诊断和治疗日益受到重视。我科自l994年7月起共收治15例,经保守治疗及手术治疗效果满意,报告如下:1 临床资料本组15例,男12例,女3例。年龄18~45岁,平均29岁。其中工人6名,农民4名,战土3名,干部1名,学生1名。发生于右侧10例,左     

正中神经返支卡压征

目的：介绍正中神经返支卡压征，由于国内未见报道，旨在引起同道们对该病的注意和认识。方法：本组３例，临床特征为拇指对掌功能受限，大鱼际肌萎缩，但手部感觉无障碍。均采用手术治疗。除作神经松解术外，在神经外膜下及周围软组织间注入醋酸泼尼松龙２５ｍｇ。结果：术后随访１～５个月，拇指对掌功能完全恢复。结论：正中神经返支卡压的病因与局部解剖有关，其诊断依据主要为拇指对掌、对指功能障碍，病程长时大鱼际肌可出现萎缩，但手部桡侧半无感觉障碍。     

手术致桡神经损伤的原因分析及防治

目的 :分析手术致桡神经损伤的原因并探讨其防治措施。方法 :对 1 987年以来收治的 2 2例手术致桡神经损伤的原因、治疗措施及预后进行回顾性总结。结果 :经 6个月～ 1 0年的随访 ,桡神经浅支损伤的 5例感觉功能完全恢复 ,桡神经干及深支损伤的 1 7例优良率为 94.1 %。结论 :手术致桡神经损伤的主要原因为 :局部解剖不熟悉 ,技术操作不规范 ,责任心不强 ;只要杜绝上述原因 ,桡神经损伤是可以避免的 ;桡神经损伤后应积极的采取相应的治疗措施 ,其预后多良好     

桡神经浅支卡压

桡神经浅支在前臂的卡压,临床上并不少见,容易被误诊为“桡骨茎突狭窄性腱鞘炎”、“网球肘”、“腕关节背侧韧带损伤”等等,为了解桡神经浅支在前臂的解剖特点及其可能的受压因素,加深对桡神经浅支卡压征的认识,作者作相应的解剖研究并随访华山医院自1988年至1996年20例病人,报告如下:     

尺神经手背支卡压所致腕尺侧痛的解剖和临床研究

目的 对尺神经手背支卡压引起腕尺侧痛的机理进行研究并探讨尺神经手背支卡压症的诊断和治疗。方法 对40侧福尔马林固定的成人尸体前臂部和腕部进行大体解剖和显微解剖。在临床上诊治了13例尺神经手背支卡压的病例并进行分析。结果 尺神经手背支在尺骨茎突以近5.6-6.8cm处尺侧腕屈肌（腱）深面内侧缘穿出,紧贴尺骨行走,在尺骨小头内侧分成2－3大支,其中的横支紧贴骨膜,横跨尺骨小头或绕经尺骨小头远端斜行向桡侧,腕关节活动和尺骨小头的位置改变极易对其造成损伤。临床发现患该症的患者尺骨小头远端或尺侧缘有一显著而局限的压痛点,其周围有局部的皮肤感觉改变。13个病例中,7例局部封闭,6例手术,其中9例随访4个月－1年,未见复发。结论 腕关节反复屈伸时尺神经手背支尤其是横支被牵拉和压迫是造成尺神经手背支卡压的解剖学基础。临床上对腕尺侧痛并有皮肤感觉改变的病例,应考虑尺神经手背支卡压的可能性。     

指神经卡压征

目的探讨指神经卡压征的诊断和治疗方法。方法对８例指神经卡压征分别采用神经卡压部周围纤维组织切除术、神经外膜切开减压术、解剖异常矫正术及局部封闭等方法治疗。结果手术治疗５例,术后指神经功能全部恢复正常;局部封闭治疗２例,１例因无效改作手术（算在手术５例内）,另１例症状略有缓解,疗效不理想;２例因拒绝治疗而失去联系。结论指神经卡压征以指掌面半侧麻木、感觉障碍为主要诊断依据。早期以保守治疗为主,一旦出现明显的感觉功能障碍症状,宜早期手术治疗。     

肩胛背神经卡压征32例的临床治疗

目的观察肩胛背神经的局部解剖、分析肩胛背神经被卡压的因素及其治疗方法。方法对30具60侧陈旧性成人尸体进行解剖学观察,观察肩胛背神经的起点、行径及与周边的关系。分析32例肩胛背神经卡压征的治疗方法及随访结果。结果肩胛背神经的起始段常和胸长神经合干,由前内侧向后外侧从中斜角肌中穿过,此处常有腱性组织包绕,与胸长神经分开走行后,发出分支至肩胛部和腋下。32例中均作保守治疗,23例24侧疗效较好。7例8侧保守治疗无效,改作手术治疗,术后随访3个月至2年,症状完全或基本解除。结论肩胛背神经卡压大部分包括于胸廓出口综合征中,但也可以单独出现。治疗以局部封闭为首选,症状严重者可考虑手术治疗。     

Neurolysis of the distal superficial radial nerve for dysaesthesia due to nerve tethering

The subcutaneous course of the superficial radial nerve over the radial border of the wrist and hand renders it very susceptible to injury. Both traumatic and iatrogenic injury can produce tethering of this nerve, presenting as dysaesthesia. This study was designed to evaluate the efficacy of neurolysis of the distal superficial radial nerve for this condition. Twenty-five cases of tethered superficial radial nerves underwent neurolysis. At final follow-up (mean 3.5 years), fourteen cases reported symptomatic resolution while eleven continued to experience dysaesthesia. Intra-operatively, evidence of external abnormality, scarring, or compression was identified in only six cases, and its presence did not correlate with symptomatic outcome. Although the majority of patients were improved postoperatively, the success rate was lower than anticipated. Therefore, while neurolysis of the superficial radial nerve offers the opportunity for pain relief, it does not reliably produce success.     

Compression du rameau superficiel du nerf radial par un kyste synovial du coude (À propos d’un cas et revue de littérature)

Compression of the radial nerve at the elbow is quite rare; entrapment of its superficial branch is exceptional. Extrinsic compression is the most frequent etiology. Magnetic resonance imaging plays a major role in the diagnosis, and early surgical excision or echoguided drainage – in case of synovial ganglion – allows a total recovery. The authors report the case of a compression of the superficial branch of radial nerve by an elbow synovial cyst treated by surgical resection.     

Superficial radial nerve compression caused by a parosteal lipoma of proximal radius: a case report.

The superficial radial nerve might be compressed or injured at various anatomical sites along its course in the forearm. Most of the superficial radial nerve neuropathy are caused by pathological lesions such as trauma, a mass or tight band at the distal third of the forearm. Wartenberg's syndrome is the most common cause of sensory radial entrapment at the distal forearm. Compression of superficial radial nerve occurring at the proximal third of forearm is unusual. We present a rare case of superficial radial nerve compression due to a parosteal lipoma of proximal radius. Results of complete physical and radiological examinations are also presented. Surgical intervention of the tumour mass was performed for nerve decompression. The patient reported total relief of the neurological symptom post-operatively. This rare case demonstrates the unique characteristics of parosteal lipoma with unusual superficial radial nerve neuropathy at the proximal radius. This report reminds us that there is the possibility of superficial nerve compression caused by tumour mass over the proximal third of forearm.     

Parosteal lipoma of the proximal radius: A report of five cases

Parosteal lipoma of the proximal radius is a benign, slow-growing tumor. It may cause compression of either the posterior interosseous or the superficial branch of the radial nerve. Surgical excision usually leads to complete recovery. Five cases of parosteal lipoma of the proximal radius are presented. X-ray films demonstrated a radiolucent mass in contact with the radius. Two patients had signs of posterior interosseous nerve compression, and two showed signs of superficial radial nerve compression. In one case the lipoma surrounded an exostosis arising from the proximal radius. The tumors were excised in four patients. The three patients with neurologic involvement recovered fully. One patient refused surgery, and posterior interosseous nerve paralysis developed.     

Ergebnisse der Plattenosteosynthese der Radiusschaftfraktur über den volaren Zugang. Theoretische Grundlagen—klinische Ergebnisse

This retrospective study analyses the results of 80 shaft fractures of the radius treated by open reduction and plating by a volar approach. Studies about strain distribution on the radius shaft worked out a varying pattern of tensile forces and a continuously change of the tension bend side through full range of motion. So from the biomechanical aspect an ideal position for compression plating is not determinated and dorsal or volar plating brings the same stability. The advantage of the volar approach by Henry is the possibility of an easy extension of the approach to the distal or proximal part of the forearm and an optimal covering of the plate by soft tissue. To expose the superficial radial nerve is obligate, if necessary the deep radial nerve should be exposed too in proximal fractures. From 1973 to 1987 80 fractures of the shaft of the radius were treated by plating using the volar approach, since 1977 3.5 dynamic compression plate of the AO was used exclueively. Only two non-unions occurred in the beginning when the AO's third tube plate was used routinely. One massive callus formation had to be noticed with a complete loss of pronation and supination. One infection occurred, but normal wound healing and bone union could be achieved after early reoperation. Two incomplete lesions of the superficial radial nerve were seen, but normal sensibility occurred spontaneously. No other neural or vascular complication had to be noticed using this approach. In the follow-up 56 patients were seen two to 14 years postoperatively. Using the scheme of Oestern and Tscherne for the evaluation an excellen or good result could be achieved in 48 patients (85.7%), six patients had a fair result. Only in two patients a poor late outcome had to be noticed. The plate was removed in 45 of the 80 patients, only one refracture had to be seen as a late complication, since using the dynamic compression plate no refracture occurred.     

Superficial upper limb vasculature and its surgical implications

Any kind of anatomical variation whether encountered during cadaveric dissections or routine clinical or surgical procedures needs to be reported and taken into account. This can be quite helpful in planning surgeries accordingly and avoid disastrous complications. During routine cadaveric dissection, authors found a superficial course of arteries of the arm as well as the forearm, unilaterally in one cadaver. In this case, there were two brachial arteries – superficial and deep. Superficial brachial artery terminated into superficial radial and superficial ulnar artery. Deep brachial artery was trifurcated into common interosseous, medial and lateral artery branches. Authors have also discussed the developmental anomaly, which could have led to the observed morphological variation. Superficial vessels can provide large size pedicles for raising flaps for local reconstructive surgeries in the region of axilla, elbow, wrist or hand, or other regions.KEY WORDS: Artery, brachial, radial, superficial, ulnar     

Management and prognosis of transitional cell carcinoma superficial recurrence in muscle-invasive bladder cancer after bladder preservation

PURPOSE: To assess the bladder preservation rate and cancer-specific survival after conservative treatment of superficial relapses in invasive tumors after bladder preservation. MATERIAL AND METHODS: Fifty-one patients with invasive bladder tumor (T2) were treated using transurethral resection (TUR) followed by three cycles of systemic chemotherapy (carboplatin-vinblastine). After three weeks, an endoscopic reappraisal was made including deep TUR of the site of the original tumor and multiple cold cup biopsies. Forty-two patients retained their bladder (33 complete responses and 9 partial responses). RESULTS: With a median follow-up of 63 months, 18 patients recurred as superficial TCC tumor (43%). Fourteen patients with high grade superficial recurrence were treated with TUR and Bacillus Calmette-Guerin (BCG) instillations; two patients (G2-3 T1) with TUR as well as endovesical mytomicine, and two patients with low grade recurrence with only TUR. With a median follow-up of 44 months after TUR of first superficial relapse, there was only one case with progression of the disease without any evidence of bladder tumor. Two cystectomies were made due to carcinoma in situ (Cis) persistence and high grade superficial recurrence. Eighty-three percent of the patients who had superficial recurrence retained their bladders, with 94% cancer-specific survival. CONCLUSIONS: A very strict follow-up is mandatory due to the high rate of superficial relapses (43%). Cis is the most frequent type of superficial recurrence. Superficial recurrences in bladder preservation may be treated with TUR and BCG instillations when they are high grade and and/or associated with Cis. Superficial recurrences do not imply a worse prognosis for bladder preservation or cancer-specific survival.     

Neurosurgery of the Peripheral Nervous System: The Posterior Interosseous Nerve Syndrome

Introduction

The “posterior interosseous nerve syndrome” is caused by compression, in the upper third of the forearm, of the terminal motor branch of the radial nerve, called the deep radial nerve or posterior interosseous nerve (PIN). In most cases, this nerve is compressed at the arcade of Frohse. Proximally to this arcade, the main radial nerve and/or its branches, the sensory superficial radial nerve and the PIN, may be also compressed.