Femoral Nerve Injury Following Transfemoral Angiography: A Case Report

因各項治療或診斷性手術操作而導致股神經損傷，可能源自不同情形：包括髖關節置換術、婦產科手術、泌尿系統手術、鼠蹊部神經阻斷術、腫瘤術後，以及血管攝影術後等。由於血管攝影術是一項臨床上經常執行的必要診斷或治療步驟，然而造成股神經損傷併發症的病例卻很罕見，引起的症狀包括股四頭肌萎縮無力、膝部深部肌腱反射減弱、大腿前側及小腿內側感覺缺損等。早期診斷與治療，有助於患者的復原。我們報告一名54歲女性患者，有糖尿病、高血壓及乳癌術後的病史。一年前右側小腿血管罹患阻塞性病變，接受過動脈繞道(bypass)手術治療，此次因爲右小腿疼痛就醫，理學檢查發現右側膝膕動脈及足背動脈脈動微弱，因此安排血管攝影，經由左側股動脈進行攝影檢查。由於嚴重血管阻塞，經過內膜切除術及肝素投予治療後無效，小腿逐漸壞死，因而一週後進行右側下肢膝上截肢。術後傷口復原良好，但是左下肢膝部無力伸直且大腿前側感覺缺失。術後兩個月接受神經肌肉電學檢查，顯示左側鼠蹊韌帶下方的股神經損傷，推斷與血管攝影術後的併發症相關。藉此病例報告，我們將探討醫源性股神經損傷的發生、經股動脈血管攝影術的相關併發症，與股神經損傷的評估與治療，並討論股神經損傷與對側膝上部位截肢兩症並存時，患者的復健療程與預後。

關鍵字

股神經；血管攝影術；復健

並列摘要

Femoral nerve injury is a rare complication after femoral angiography. Symptoms including quadriceps weakness and atrophy, absent or reduced knee jerk and sensory impairment along the anterior thigh and medial lower leg have been found. This leads to both muscular weakness and sensory deficit, which impairs walking and interferes with quality of life. Early identification and management of femoral nerve injury could result in better prognosis. We report on the history, diagnosis and rehabilitative outcome of a 54-year-old woman with a medical history of peripheral arterial occlusion disease. She developed significant femoral neuropathy one month after angiography. Severe neurological deficits were noted in this patient, including quadriceps paralysis and loss of sensation at the anterior aspect of the thigh. Subsequent above-knee amputation was performed due to failed conservative treatment for arterial occlusion. After about six months of intensive rehabilitation, the patient achieved clinical improvements in her functional locomotion activities. We also discuss the femoral nerve anatomy, incidence of iatrogenic femoral nerve injury, puncture-site complications in transfemoral angiography, evaluation and treatment of femoral nerve injury and our rehabilitation experience with femoral neuropathy combined with contralateral above-knee amputation.

並列關鍵字

femoral nerve ； angiography ； rehabilitation

國際替代計量

Femoral Nerve Injury Following Transfemoral Angiography: A Case Report

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