神经型胸廓出口综合征两种诊断性阻滞方法的比较研究

发布时间：2018-06-15 18:01

本文选题：神经型胸廓出口综合征 + 阻滞　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:神经型胸廓出口综合征(Neurogenic Thoracic Outlet Syndrome,NTOS)是臂丛神经在胸廓出口区域内受到结构和/或体位性卡压所引起的一组症候群。由于其复杂多变的症状和体征、缺乏特异敏感的辅助检查、以及多种相关疾病的混淆,NTOS一直被认为是外科领域诊断最困难的疾病之一。作为NTOS的一种诊断性试验,诊断性局部阻滞封闭技术成为临床上可以选择的一项诊断指标。本文通过对“第四颈椎横突阻滞”与“前、中斜角肌阻滞”两种不同的诊断性阻滞方法的比较,观察研究其优、缺点,为NTOS的诊断寻找更科学、更可靠的诊断性阻滞方法。方法:选取2016年1月—2016年9月就诊于吉林大学中日联谊医院的诊断为NTOS的60例患者,入选患者均满足NTOS的筛选标准,均有颈、肩、上肢不同程度的疼痛、麻木。年龄在36-59岁之间,体重在50-75kg之间,计划行保守治疗。将本研究的60例患者随机分成两组(n=30):第四颈椎横突阻滞组(T)和前、中斜角肌阻滞组(S)。T组患者均行第四颈椎横突阻滞,S组患者均在超声引导下行前、中斜角肌阻滞。阻滞所用药物为包括1%罗哌卡因2m L、0.9%生理盐水1m L、含碘造影剂1m L的混合液。注射后所有患者均在30分钟内行X线荧光透视检查,阻滞后行诊断效果、不良反应的记录。结果:两组患者一般状态无显著性差异(P0.05)。(1)通过X线荧光透视检查分析颈部显影的肌肉群。两组前、中斜角肌均显影,无显著性差异。与S组相比,T组中可见头长肌明显显影。(2)T组患者声音嘶哑的发生率明显高于S组(30%VS 6.6%);T组患者霍纳氏综合征(30%VS 6.6%)、窒息感(13.3%VS 6.6%)、颈部麻木感(40%VS 3.3%)的发生率均高于S组,有统计学意义。同时,与S组相比,T组患者上肢麻木(6.7%VS 16.7%)的发生率明显降低,有统计学意义。(3)阻滞后症状缓解率T组为93.3%、S组为83.3%。即S组较T组效果不佳率更高(16.7%VS 6.7%),对于阻滞效果:优、良、可、差的比例,两组之间无显著性差异。结论:1.第四颈椎横突阻滞,药物扩散途径复杂、扩散剂量随机不可控。药物除局部浸润至前、中斜角肌外,还可扩散至头长肌、椎前筋膜相关的颈丛、颈交感干、迷走神经/喉返神经、隔神经等。症状缓解与多途径作用相关,不能精准的反应前、中斜角肌紧张程度与神经症状的相关性。2.超声引导下的前、中斜角肌阻滞,药物能够准确注射入前、中斜角肌,并可在超声引导下定点定量注入预定部位。通过调整注射部位,能够有效避免因药物局部浸润而出现的神经阻滞。症状缓解与前、中斜角肌紧张程度密切相关。3.超声引导下的前、中斜角肌阻滞对NTOS的诊断更准确可靠。
[Abstract]:Objective: neurogenic Thoracic outlet SyndromeNTOS (NTOS) is a group of syndromes caused by structural and / or postural compression of brachial plexus nerve in thoracic outlet region. Because of its complex and changeable symptoms and signs, the lack of specific and sensitive adjuvant examination, and the confusion of many related diseases, NTOS has been considered as one of the most difficult diseases in the field of surgery. As a diagnostic test of NTOS, diagnostic local block blocking technique has become a clinical diagnostic index. By comparing the two different diagnostic block methods of "fourth cervical vertebra transverse process block" and "anterior and middle scalene block", the authors observed their advantages and disadvantages, and found a more scientific and reliable diagnostic block method for the diagnosis of NTOS. Methods: sixty patients who were diagnosed as NTOS from January 2016 to September 2016 were selected. All the patients met the screening criteria of NTOS. All patients had pain and numbness in neck, shoulder and upper limb. Aged 36-59 years, weight between 50-75kg and planned conservative treatment. 60 patients in this study were randomly divided into two groups: the fourth cervical transverse process block group (T3) and the anterior scalene muscle block group (S group). All the patients in the fourth cervical vertebrae transverse process block group (S group) were treated with anterior and middle scalene muscle block under the guidance of ultrasound. The mixture of 1% ropivacaine 2m L, 0.9% normal saline 1m L and iodine contrast agent 1m L were used in the block. X-ray fluoroscopy was performed within 30 minutes after injection, diagnostic effect and adverse reaction were recorded after block. Results: there was no significant difference in general state between the two groups. There was no significant difference in the development of the middle scalene muscle between the two groups. Compared with group S, the incidence of hoarseness in group T was significantly higher than that in group S (30 vs 6.6), the incidence of asphyxia was 13.3VS 6.6 and the incidence of numbness in neck was higher than that in group S (P < 0.05). There was significant difference in the incidence of hoarseness between group A and group S (P < 0.05). The incidence of hoarseness in group T was significantly higher than that in group S (P < 0.05), and the incidence of hoarseness in group T was significantly higher than that in group S (P < 0.05). The incidence of hoarseness in group T was significantly higher than that in group S. At the same time, compared with S group, the incidence of upper limb numbness in T group was significantly lower than that in S group (P < 0.05). That is to say, the bad rate of group S was higher than that of group T, and there was no significant difference between the two groups in the effect of block: excellent, good, fair and poor. Conclusion 1. The fourth cervical vertebra transverse process block, the drug diffusion path is complex, the diffusion dose is not controlled at random. In addition to local infiltration to the anterior and middle scalene muscles, the drug can also spread to the head long muscle, the cervical plexus associated with the prevertebral fascia, the cervical sympathetic trunk, the vagus / recurrent laryngeal nerve, the septal nerve, and so on. Symptom relief is related to multiple pathways, and the correlation between the degree of tension of the middle scalene muscle and the neurological symptoms before the accurate response. 2. Ultrasound-guided anterior and middle scalene block, drugs can be accurately injected into the anterior and middle scalene muscles, and under the guidance of ultrasound fixed point quantitative injection of the predetermined site. By adjusting the injection site, the nerve block caused by local drug infiltration can be effectively avoided. Symptom relief was closely related to the degree of tension in the anterior and middle scalene muscles. Anterior scalene block guided by ultrasound is more accurate and reliable in the diagnosis of NTOS.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R688

【相似文献】