神经松解并背阔肌皮瓣移植治疗放射性臂丛神经炎的回顾性分析

发布时间：2018-06-22 13:31

本文选题：放射性 + 臂丛神经损害　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨神经松解并背阔肌皮瓣移植对放射性臂丛神经炎的治疗效果。方法:2005年1月到2017年1月广西医科大学第一附属医院收治的16例放射性臂丛神经炎患者,14例乳腺癌术后放疗,1例喉癌术后放疗,1例鼻咽癌术后放疗。12例行神经松解并背阔肌皮瓣移植术,1例单纯臂丛神经松解,3例因肿瘤远处转移而未行手术治疗。收集16例患者疾病进程及诊疗经过的资料,随访了解患者术后疼痛、肌力、皮肤感觉及手功能改善情况,对比手术前后不适症状及病情缓解情况来评判神经松解并背阔肌皮瓣移植对放射性臂丛神经炎的治疗效果。结果:16例患者,死亡3例,失访4例,成功随访9例,均予行了臂丛神经松解并背阔肌皮瓣移植术,随访3个月-7年。疼痛:VRS疼痛评分:术前I级3例、II级5例、III级1例。术后疼痛好转7例,4例由I-II级恢复到0级,2例由II级改善到I级,1例由III级改善到II级;2例逐渐加重,均由II级加重到III级。肌力:屈指肌力MRC分级:术前II级4例、IV级3例、V级2例,术后1例由II级恢复到III级;2例由IV级恢复V级,但分别于术后3、5个月再次开始下降到IV级;2例II级恢复不明显,但均无加重;2例逐渐严重,1例由II级下降到I级,1例由IV级下降到II级。伸腕肌力MRC分级:术前I级1例、II级2例、III级1例、IV级1例、V级4例,术后1例由I级恢复到III级、1例由IV级恢复到V级,但分别于术后4、6个月再次开始下降到术前水平;1例II级与1例III级无明显恢复,但均无加重;2例逐渐加重,1例由V级下降到II级,1例由II级下降到I级。屈肘肌力MRC分级:术前III级1例、IV级4例、V级4例。术后1例由III级恢复到IV级;1例由IV级恢复到V级,但于术后3个月再次开始下降到IV级;1例IV级无改善,但也无加重;2例逐渐加重,由IV级下降到II级与III级。肩外展肌力MRC分级:术前II级1例、III级2例、IV级2例、V级4例。术后1例由IV级恢复到V级,但于术后6个月肌力再次开始下降至IV级;1例II级、1例III级无改善,但也无加重;2例逐渐加重,1例由IV级下降到II级,1例由III级下降I级。手部感觉:手感觉检查分级:术前2例S2、4例S3、1例S4、2例S5,术后3例明显好转,由S3-S4恢复到S5;2例逐渐好转,由S2-S3改善到S4;2例逐渐加重,由S2-S3减退到S1。结论:神经松解并背阔肌皮瓣移植术对放射性臂丛神经炎患者起到缓解疼痛、改善皮肤感觉,控制病情发展的作用,从而提高患者生活质量。
[Abstract]:Objective: to investigate the effect of nerve release and latissimus dorsi flap transplantation in the treatment of radiation brachial plexus neuritis. Methods: from January 2005 to January 2017, 16 cases of radiation brachial plexus neuritis were treated in the first affiliated Hospital of Guangxi Medical University. 14 cases of breast cancer were treated with postoperative radiotherapy and 1 case of laryngeal carcinoma with postoperative radiotherapy. 12 cases of nasopharyngeal carcinoma were treated with postoperative radiotherapy. One case of simple brachial plexus neurolysis with latissimus dorsi flap graft was performed without surgical treatment due to distant metastasis of the tumor. The clinical data of 16 patients were collected. The patients were followed up to find out the postoperative pain, muscle strength, skin sensation and improvement of hand function. To evaluate the effect of nerve release and latissimus dorsi flap transplantation on radiation brachial plexus neuritis. Results among 16 patients, 3 died, 4 lost, and 9 were followed up successfully. All patients were treated with brachial plexus nerve release and latissimus dorsi flap transplantation. The follow-up period was 3 months to 7 years. Pain: VRS pain score: 3 cases were grade I, 5 cases were grade II and 1 case was grade III. There were 7 cases of postoperative pain improvement, 4 cases recovered from I-II grade to 0 grade, 2 cases improved from grade II to grade I, 1 case improved from grade III to grade II, and 2 cases got worse gradually, from grade II to grade III. Muscle strength: MRC grade of flexion muscle strength: before operation, 4 cases had grade II, 3 cases had grade IV, 2 cases had grade V, 1 case recovered from grade II to grade III and 2 cases returned to grade V from grade IV, but it began to decrease to grade IV again in 3 months and 5 months after operation, and the recovery of grade II in 2 cases was not obvious. However, no exacerbation was found in 2 cases. One case decreased from grade II to grade I and one case decreased from grade IV to grade II. The MRC grade of extensor carpal muscle strength: 1 case was grade I, 2 cases were grade II, 1 case was grade IV, 1 case was grade V, 1 case recovered from grade I to grade III, 1 case recovered from grade IV to grade V, after operation, one case recovered from grade I to grade III, and one case recovered from grade IV to grade V. However, after 4 months and 6 months after operation, the level of grade II and grade III had no obvious recovery, but both cases had no aggravation, 1 case decreased from grade V to grade II and 1 case decreased from grade II to grade I. MRC grade of elbow flexion muscle strength: 1 case was grade III, 4 cases were grade IV, 4 cases were grade V. One case recovered from grade III to grade IV and one case recovered from grade IV to grade V, but at 3 months after operation, it decreased again to grade IV. No improvement was found in one case of grade IV, but no aggravation occurred in 2 cases, from grade IV to grade II and grade III. MRC grade of shoulder abductor muscle strength: 1 case of grade II, grade III, 2 cases of grade IV, 2 cases of grade V, 4 cases of grade V before operation. After operation, one case recovered from grade IV to grade V, but at 6 months after operation, muscle strength began to decrease again to grade IV, grade II, grade III, no improvement, but there was no aggravation in 2 cases, and gradually increased in 1 case, from grade IV to grade II, from grade II to grade I, from grade III to grade I. Hand sensory grade: before operation, 2 cases with S2 and 4 cases with S3, 1 case with S4 with S5, 3 cases with significant improvement, from S3-S4 to S5 in 2 cases, from S2-S3 to S4 in 2 cases, from S2-S3 to S1, and from S2-S3 to S1. Conclusion: nerve release combined with latissimus dorsi flap graft can relieve pain, improve skin sensation and control the development of disease in patients with radiation brachial plexus neuritis, thus improving the quality of life of patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

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