本文選題：放射性 + 臂叢神經(jīng)損害��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討神經(jīng)松解并背闊肌皮瓣移植對(duì)放射性臂叢神經(jīng)炎的治療效果。方法:2005年1月到2017年1月廣西醫(yī)科大學(xué)第一附屬醫(yī)院收治的16例放射性臂叢神經(jīng)炎患者,14例乳腺癌術(shù)后放療,1例喉癌術(shù)后放療,1例鼻咽癌術(shù)后放療。12例行神經(jīng)松解并背闊肌皮瓣移植術(shù),1例單純臂叢神經(jīng)松解,3例因腫瘤遠(yuǎn)處轉(zhuǎn)移而未行手術(shù)治療。收集16例患者疾病進(jìn)程及診療經(jīng)過的資料,隨訪了解患者術(shù)后疼痛、肌力、皮膚感覺及手功能改善情況,對(duì)比手術(shù)前后不適癥狀及病情緩解情況來(lái)評(píng)判神經(jīng)松解并背闊肌皮瓣移植對(duì)放射性臂叢神經(jīng)炎的治療效果。結(jié)果:16例患者,死亡3例,失訪4例,成功隨訪9例,均予行了臂叢神經(jīng)松解并背闊肌皮瓣移植術(shù),隨訪3個(gè)月-7年。疼痛:VRS疼痛評(píng)分:術(shù)前I級(jí)3例、II級(jí)5例、III級(jí)1例。術(shù)后疼痛好轉(zhuǎn)7例,4例由I-II級(jí)恢復(fù)到0級(jí),2例由II級(jí)改善到I級(jí),1例由III級(jí)改善到II級(jí);2例逐漸加重,均由II級(jí)加重到III級(jí)。肌力:屈指肌力MRC分級(jí):術(shù)前II級(jí)4例、IV級(jí)3例、V級(jí)2例,術(shù)后1例由II級(jí)恢復(fù)到III級(jí);2例由IV級(jí)恢復(fù)V級(jí),但分別于術(shù)后3、5個(gè)月再次開始下降到IV級(jí);2例II級(jí)恢復(fù)不明顯,但均無(wú)加重;2例逐漸嚴(yán)重,1例由II級(jí)下降到I級(jí),1例由IV級(jí)下降到II級(jí)。伸腕肌力MRC分級(jí):術(shù)前I級(jí)1例、II級(jí)2例、III級(jí)1例、IV級(jí)1例、V級(jí)4例,術(shù)后1例由I級(jí)恢復(fù)到III級(jí)、1例由IV級(jí)恢復(fù)到V級(jí),但分別于術(shù)后4、6個(gè)月再次開始下降到術(shù)前水平;1例II級(jí)與1例III級(jí)無(wú)明顯恢復(fù),但均無(wú)加重;2例逐漸加重,1例由V級(jí)下降到II級(jí),1例由II級(jí)下降到I級(jí)。屈肘肌力MRC分級(jí):術(shù)前III級(jí)1例、IV級(jí)4例、V級(jí)4例。術(shù)后1例由III級(jí)恢復(fù)到IV級(jí);1例由IV級(jí)恢復(fù)到V級(jí),但于術(shù)后3個(gè)月再次開始下降到IV級(jí);1例IV級(jí)無(wú)改善,但也無(wú)加重;2例逐漸加重,由IV級(jí)下降到II級(jí)與III級(jí)。肩外展肌力MRC分級(jí):術(shù)前II級(jí)1例、III級(jí)2例、IV級(jí)2例、V級(jí)4例。術(shù)后1例由IV級(jí)恢復(fù)到V級(jí),但于術(shù)后6個(gè)月肌力再次開始下降至IV級(jí);1例II級(jí)、1例III級(jí)無(wú)改善,但也無(wú)加重;2例逐漸加重,1例由IV級(jí)下降到II級(jí),1例由III級(jí)下降I級(jí)。手部感覺:手感覺檢查分級(jí):術(shù)前2例S2、4例S3、1例S4、2例S5,術(shù)后3例明顯好轉(zhuǎn),由S3-S4恢復(fù)到S5;2例逐漸好轉(zhuǎn),由S2-S3改善到S4;2例逐漸加重,由S2-S3減退到S1。結(jié)論:神經(jīng)松解并背闊肌皮瓣移植術(shù)對(duì)放射性臂叢神經(jīng)炎患者起到緩解疼痛、改善皮膚感覺,控制病情發(fā)展的作用,從而提高患者生活質(zhì)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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R622

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