高场强MRI对臂丛神经损伤的诊断及其应用价值

目的探讨高场强MRI对臂丛神经损伤的诊断及其应用价值。方法回顾性分析我院2010年8月至2013年3月利用1.5T或3.0T MRI检查的20例臂丛神经损伤患者,将患者图像进行后处理,分析臂丛神经损伤的MRI影像学特点。结果臂丛神经损伤的类型按部位可分为节前损伤、节后损伤及混合型损伤(节前、节后均损伤)。MRI征象包括:(1)直接征象:1神经增粗,局部神经连续性中断,信号异常10例;2神经走行僵直、结构紊乱19例。(2)间接征象:1创伤性脊膜囊肿10例;2黑线征5例;3神经根袖形态变钝1例;4脊髓挫伤、肿胀及移位5例;5损伤的神经邻近软组织结构紊乱,水肿,肌肉萎缩,脂肪浸润18例。结论高场强MRI具有更高的软组织分辨率,能完整的显示臂丛神经的解剖及走行,能准确、直观的显示臂丛神经损伤的位置及范围。     

臂丛神经损伤致伤因素分析与神经电生理学诊断方法探讨

臂丛神经损伤是临床比较常见的神经损伤,其中又以外伤性损伤最为常见.由于臂丛神经解剖结构的复杂性及其致伤外力类型的多样性,使得外伤性臂丛神经损伤的诊断具有相当的难度.随着神经电生理技术的提高与发展,近年来神经电生理检查已成为臂丛神经损伤定性、定位诊断的一种重要手段.现将我院41例外伤性臂丛神经损伤的神经电生理检查结果结合临床分析报告如下.     

颈椎线圈联合体部阵列线圈使用 SPACE-STIR 序列对臂丛神经在 3.0 TMRI 上显示的应用价值简

目的探讨颈椎线圈联合体部阵列线圈使用SPACE-STIR序列对臂丛神经显示的应用价值。方法选择30例颈椎MRI检查的患者,其中男性18例．女性12例;年龄25-54岁,平均年龄33岁;无臂丛神经病史和相关临床症状。5例外伤后临床怀疑臂丛神经受累的患者．其中男性3例．女性2例：年龄17-54岁,中位年龄41岁。使用3．0TMRI对患者行MRI检查。采用横断位快速自旋回波T1WI、T2WI及冠状位SPACE-STIR序列,观察各序列中臂丛神经图像显示的情况及其病变的MRI影像学特征。检查中对同一被检者仅使用颈椎线圈和使用颈椎线圈联合体部相控阵线圈各检查1次,检验两种方法臂丛神经远端清晰显示率。结果30例颈椎检查者共60侧臂丛神经．使用颈椎线圈T1WI上臂丛神经显示优良率为50％,T2WI为52％,SPACE-STIR为70％;颈椎联合体部阵列线圈T1WI上臂丛神经显示优良率为67％,T2WI为77％,SPACE-STIR为97％。SPACE～STIR序列优于快速自旋回波T1WI、T2WI。使用颈椎线圈联合体部阵列线圈臂丛神经远端清晰显示率为93％,而单独使用颈椎线圈清晰显示率为52％;两者比较,差异具有统计学意义（χ^2=26．12,P〈0．05）。5例臂丛神经损伤诊断结果MRI示神经连续性中断。结论联合线圈成像结果对臂丛神经显示较单个线圈全面、清晰,且对准确判断病变累及范围特别是远端更有优势。联合常规T1WI、T2WI序列更能有效、全面地显示臂丛神经。     

颈椎线圈联合体部阵列线圈使用SPACE-STIR序列对臂丛神经在3.0T MRI上显示的应用价值

目的探讨颈椎线圈联合体部阵列线圈使用SPACE-STIR序列对臂丛神经显示的应用价值。方法选择30例颈椎MRI检查的患者,其中男性18例,女性12例;年龄25~54岁,平均年龄33岁;无臂丛神经病史和相关临床症状。5例外伤后临床怀疑臂丛神经受累的患者,其中男性3例,女性2例;年龄17~54岁,中位年龄41岁。使用3.0 T MRI对患者行MRI检查。采用横断位快速自旋回波T1WI、T2WI及冠状位SPACE-STIR序列,观察各序列中臂丛神经图像显示的情况及其病变的MRI影像学特征。检查中对同一被检者仅使用颈椎线圈和使用颈椎线圈联合体部相控阵线圈各检查1次,检验两种方法臂丛神经远端清晰显示率。结果30例颈椎检查者共60侧臂丛神经,使用颈椎线圈T1WI上臂丛神经显示优良率为50%,T2WI为52%,SPACE-STIR为70%;颈椎联合体部阵列线圈T1WI上臂丛神经显示优良率为67%,T2WI为77%,SPACE-STIR为97%。SPACE-STIR序列优于快速自旋回波T1WI、T2WI。使用颈椎线圈联合体部阵列线圈臂丛神经远端清晰显示率为93%,而单独使用颈椎线圈清晰显示率为52%;两者比较,差异具有统计学意义(χ2=26.12,P0.05)。5例臂丛神经损伤诊断结果 MRI示神经连续性中断。结论联合线圈成像结果对臂丛神经显示较单个线圈全面、清晰,且对准确判断病变累及范围特别是远端更有优势。联合常规T1WI、T2WI序列更能有效、全面地显示臂丛神经。     

膈神经的解剖及临床应用研究进展

目的:为膈神经移位治疗臂丛根性撕托伤,提供应用解剖学资料.方法:查阅与膈神经移位治疗臂丛根性撕托伤相关的解剖与临床文献资料,分析其应用价值和意义.结果:提供膈神经在颈部、胸腔内和膈肌内的走行、位置、毗邻及分支分布资料.结论:膈神经移位是用来治疗臂丛根性撕托伤的主要动力神经;臂丛探索仍是诊断臂丛损伤的全标准.     

臀丛神经损伤的诊断

<正> 文中报告了684例臂丛神经损伤病例。结合术前、术后功能检查,并对各臂丛神经恨的机能支配及其临床意义进行了分析。提出了臂丛神经损防的诊断步骤:(1) 有无臂丛神经损伤;(2) 判断损伤部位;(3) 根、干、束、支的定位诊     

臂丛神经损伤患者膈神经移植肌皮神经的电生理观察

目的：评估膈神经功能测定在臂丛神经损伤神经移植前的应用价值,术后电生理观察神经移植恢复状况。方法：对50例臂丛神经损伤患者术前进行了膈神经功能测定,对其中10例膈神经功能正常者,行同侧膈神经移植肌皮神经手术,术后神经电生理随访观察肱二头肌肌电图及肌皮神经运动传导功能状况。结果：臂丛神经损伤患者约28％伴膈神经损伤,损伤的膈神经不能选择为移植动力神经。隔神经移植肌皮神经后,最早3个月出现再生电位,6个月后出现运动单位电位,12个月后运动单位电位明显增多。术后肱二头肌肌力18个月后恢复优良占80％。7例术后12个月肌皮神经引出运动神经传导电位。结论：膈神经功能测定在臂丛神经损伤患者术前可评估选择移植神经,术后电生理可随访观察神经功能恢复状况,对臂丛神经损伤患者的手术治疗有一定指导作用。     

囊性嗜铬细胞瘤的诊断和治疗进展

囊性嗜铬细胞瘤是非常罕见的神经内分泌肿瘤,大多无明显临床症状,术前经常不能被准确诊断.当影像学检查发现肾上腺区囊性占位时均应筛查囊性嗜铬细胞瘤的可能.目前最有效的治疗方式是手术切除,腹腔镜肾上腺切除术已成为首选术式,充分的术前准备和严密的术后监护是确保患者围手术期安全的重要前提.     

肌电图与MRI检查结合诊断臂丛神经损伤的研究

目的：评价肌电图和MRI检查以及两者结合在臂丛神经损伤诊断治疗中的价值。方法：对27例臂丛神经损伤患进行术前肌电图、MRI和术中肌电图检查,并与手术探查中的发现进行比较;比较术前肌电图与MRI检查同术中体感诱发电位（SEP）在确定神经完全性损伤中的作用。结果：术前肌电图检查对臂丛损伤定性、定位诊断的完全符合率为70．37％,符合率为96．3％术前肌电图和MRI检查对臂丛神经根撕脱诊断的符合率分别为55．56％和68．52％,术前肌电图检查和MRI检查结合可提高诊断符合率至85．19％;SEP对完全性臂丛损伤的诊断率高于肌电图和MRI,但差异无显著性。结论：肌电图检查和MRI检查可明显提高完全5和基本符合率,是一种有前途的辅助诊断、指导治疗臂丛神经损伤的途径,术中进行SEP检查更加有利于手术方式的选择。     

神经电生理检查对臂丛神经损伤的定位诊断

目的:探讨神经电生理检测技术在臂丛神经损伤定位诊断中的作用.方法:对299例单肢体、闭合性臂丛神经损伤的病人根据病情需要分别进行肌电图、神经电图以及体感诱发电位( SEP)检查,并与术中所见对比.结果:全臂丛神经C5 - TI根性完全性损伤63人.其中,根性节前完全性损伤26人,根性节后完全性损伤21人,根性节前节后联合性损伤16人;最高受损部位在臂丛神经干及其以下的115人;最高受损部位在束支部及其以下的121人.通过手术证实诊断符合率在90％以上.结论:对于臂丛神经损伤,应用神经电生理检测技术可以作出较明确的定位诊断.     

Systematic evaluation of brachial plexus injuries

Brachial plexus injuries offer a unique challenge to the athletic trainer because of their relatively high frequency rate in contact sports and because of the complexity of the neuroanatomy in the cervical area. During a game, athletic trainers must make a fast, accurate decision regarding a player's return to competition. It is imperative that the athletic trainer be able to quickly differentiate between minor injuries and more serious injuries warranting removal from the game and/or physician referral. A systematic approach to the evaluation of a brachial plexus injury is essential to ensure proper treatment. This paper will present a structured approach to an on-the-field assessment of brachial plexus injuries.     

What has changed in brachial plexus surgery?

Brachial plexus injuries, in all their severity and complexity, have been extensively studied. Although brachial plexus injuries are associated with serious and often definitive sequelae, many concepts have changed since the 1950s, when this pathological condition began to be treated more aggressively. Looking back over the last 20 years, it can be seen that the entire approach, from diagnosis to treatment, has changed significantly. Some concepts have become better established, while others have been introduced; thus, it can be said that currently, something can always be offered in terms of functional recovery, regardless of the degree of injury. Advances in microsurgical techniques have enabled improved results after neurolysis and have made it possible to perform neurotization, which has undoubtedly become the greatest differential in treating brachial plexus injuries. Improvements in imaging devices and electrical studies have allowed quick decisions that are reflected in better surgical outcomes.In this review, we intend to show the many developments in brachial plexus surgery that have significantly changed the results and have provided hope to the victims of this serious injury.     

Non-Stimulation Needle with External Indwelling Cannula for Brachial Plexus Block and Pain Management in 62 Patients Undergoing Upper-Limb Surgery

Objective: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. Methods: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA) with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula. The outcome measurements included anesthetic effect, acute or chronic complications, postoperative analgesic effect and patient''s satisfaction. Results: The success rate of anesthesia was 96.8%. The single attempt placement with the external indwelling cannula was achieved in 85.2% of patients with axillary brachial plexus block and 78.8% with modified interscalene brachial plexus block. The incidence of severe intoxication was 3.7% with axillary brachial plexus block and 3.0% with modified interscalene brachial plexus block. No hematoma at the injection site, Horner''s syndrome, hoarseness or dyspnea was observed. Postoperative analgesic effect was achieved in 100% and activities were slightly lowered in 91.7%. The incidence of nausea and vomit was 8.3%; patient''s satisfaction was 9.1 on a 10-point scale system. Infection, nerve injury and respiratory depression were absent during the catheter indwelling. The indwelling time of external indwelling cannula was 30.5 h on average. There was no nerve injury related complication after withdrawing the external indwelling catheter. Conclusions: Brachial plexus block using a non-stimulation needle with an external indwelling cannula has favorable intra-operative anesthetic benefit and provides an excellent postoperative analgesic outcome. The low incidence of complications and favorable patient''s satisfaction suggest that non-stimulation needle with an external indwelling cannula is a useful and safe anesthetic tool in brachial nerve block and acute postoperative pain management.     

臂丛神经损伤的神经电生理研究

目的：研究神经电生理检查在臂丛神经损伤中的应用价值。方法：对84例臂丛神经损伤患者患肢分别进行MCV、末端潜伏期、CMAP、SCV及F波检测,观察神经损伤情况。同时用同心针电极对受损神经所支配的肌肉进行肌电图检查。必要时与健侧手进行对比。结果：本组患者84例,多见于男性青壮年患者。其中全臂丛损伤25例,臂丛神经上中干损伤37例,臂丛神经下干损伤22例,臂丛神经节前损伤22例,臂丛神经节后损伤28例。结论：神经电生理检查可以提供臂丛神经五大分支的功能状态、受损程度及损伤部位,对临床诊断、治疗和预后判断起着重要作用。     

Anatomical variation in formation of brachial plexus and its branching

Variant brachial plexus formation with two trunks and two cords is uncommon and has clinical implications as it may result in failure of regional brachial or axillary block. During routine anatomical dissection, unilateral variation in the formation of brachial plexus accompanied by unusual positional relationship with axillary artery was discovered in the left upper extremity of a 52-year-old Indian male cadaver. Brachial plexus showed two trunks formed by ventral rami of C5, C6 and C7, C8, T1 spinal nerves, respectively, which first split and then reunited in an unusual manner to form two cords: posterior and lateral instead of three. Medial cord was absent. The branching pattern of the brachial plexus also showed important variations. Second part of axillary artery was found lying inferomedial to brachial plexus instead of passing between medial and lateral cords. Transverse cervical artery was found to be coursing between two trunks instead of passing superficial to brachial plexus. Median nerve was observed to be formed from a single root, instead of usual two roots. Embryologically, this rare variation may be due to the development of axillary artery from ninth segmental artery instead of usual seventh cervical intersegmental artery. Such rare variation is clinically important as this knowledge may help the anesthesiologists and the surgeons to avoid any inadvertent damage to nerves and axillary artery during blocks and surgical interventions.     

臂丛根部的显微外科解剖研究及其临床意义

为进一步认识臂丛神经诸根间根部损伤后其病理特点差异的形态学基础，用显微外科解剖及ＨＥ，Ｍａｓｓｏｎ＇ｓ染色组织病理检查方法对椎管内臂丛神经诸根的显微结构进行观测。结果提示：臂丛神经诸根之间在解剖结构上存在一定的差异，由于这种差异的存在，造成颈５．６神经根在受到同等暴力作用下较７．８及胸１神经根不易形成根性撕脱。即使颈５．６神经根根性撕脱，亦往往伴有节后损伤。作者认为对于臂丛上干近椎间孔的节后损伤，     

Brachial plexus anatomy in the miniature swine as compared to human

Brachial plexus injury (BPI) occurs when the brachial plexus is compressed, stretched, or avulsed. Although rodents are commonly used to study BPI, these models poorly mimic human BPI due to the discrepancy in size. The objective of this study was to compare the brachial plexus between human and Wisconsin Miniature Swine^TM (WMS^TM), which are approximately the weight of an average human (68–91 kg), to determine if swine would be a suitable model for studying BPI mechanisms and treatments. To analyze the gross anatomy, WMS brachial plexuses were dissected both anteriorly and posteriorly. For histological analysis, sections from various nerves of human and WMS brachial plexuses were fixed in 2.5% glutaraldehyde, and postfixed with 2% osmium tetroxide. Subsequently paraffin sections were counter-stained with Masson's Trichrome. Gross anatomy revealed that the separation into three trunks and three cords is significantly less developed in the swine than in human. In swine, it takes the form of upper, middle, and lower systems with ventral and dorsal components. Histological evaluation of selected nerves revealed differences in nerve trunk diameters and the number of myelinated axons in the two species. The WMS had significantly fewer myelinated axons than humans in median (p = 0.0049), ulnar (p = 0.0002), and musculocutaneous nerves (p = 0.0454). The higher number of myelinated axons in these nerves for humans is expected because there is a high demand of fine motor and sensory functions in the human hand. Due to the stronger shoulder girdle muscles in WMS, the WMS suprascapular and axillary nerves were larger than in human. Overall, the WMS brachial plexus is similar in size and origin to human making them a very good model to study BPI. Future studies analyzing the effects of BPI in WMS should be conducted.     

Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging

Magnetic resonance images (MRI) of brachial plexus anatomy bilaterally, not possible by plain radiographs or CT, were presented to the Vascular Surgery, Neurology, and the Neurosurgery departments. Patients were requested for MRI of their brachial plexus. They were referred for imaging and the imaging results were presented to the faculty and housestaff. Our technique was accepted and adopted to begin referrals for MRI evaluation of brachial plexopathy. Over 175 patients have been studied. Eighty-five patients were imaged with the 1.5 Tesla magnet (Signa; General Electric Medical Systems, Milwaukee, WI) 3-D reconstruction MRI. Coronal, transverse (axial), oblique transverse, and sagittal plane T1-weighted and selected T2-weighted pulse sequences were obtained at 4–5 mm slice thickness, 40–45 full field of view, and a 512 × 256 size matrix. Saline water bags were used to enhance the signal between the neck and the thorax. Sites of brachial plexus compromise were demonstrated. Our technique with 3-D reconstruction increased the definition of brachial plexus pathology. The increased anatomical definition enabled the vascular surgeons and neurosurgeons to improve patient care. Brachial plexus in vivo anatomy as displayed by MRI, magnetic resonance angiography (MRA), and 3-D reconstruction offered an opportunity to augment the teaching of clinical anatomy to medical students and health professionals. Selected case presentations (body builder, anomalous muscle, fractured clavicle, thyroid goiter, silicone breast implant rupture, and cervical rib) demonstrated compromise of the brachial plexus displayed by MRI. The MRI and 3-D reconstruction techniques, demonstrating the bilateral landmark anatomy, increased the definition of the clinical anatomy and resulted in greater knowledge of patient care management. © 1995 WiIey-Liss, Inc.     

Brachial plexus variations during the fetal period

The brachial plexus is an important nervous system structure. It can be injured during the perinatal period and by postnatal damage. The goal of this study was to assess human fetal brachial plexus variability. A total of 220 brachial plexuses were surgically prepared from 110 human fetuses aged 14?C32?weeks of fetal life (50 females and 60 males) ranging in CRL from 80 to 233?mm. The study incorporated the following methods: dissectional and anthropological, digital image acquisition, digital image processing using Image J and GIMP software, and statistical methods (Statistica 9.0). Symmetry and sexual dimorphism were examined. Anomalies of the brachial plexuses were observed in 117 (53.18?%) cases. No sexual dimorphism was found. It was observed that cord variations occurred more often on the left side. Division variants (33.64?%) occurred most often, but also cords (18.18?%) as well as root nerves and terminal ramifications (15.90?%) were found. Trunk anomalies were rare and occurred in only 5.45?% of plexuses. Three height types of median nerve roots in combination with the nerve were distinguished. In one-third of cases, median nerve root connections were found below the axillary fossa and even half in the proximal part of the humerus. In conclusion, the brachial plexus was characterized for anatomical structural variability. Most often division and cord variations were observed. Anomalies occurred regardless of sex or body side except for cord variants. Brachial plexus variation recognition is significant from the neurosurgical and traumatological point of view.