- 期刊
Application of Ultrasonography in the Diagnosis and Treatment (5% Dextrose Hydrodissection) for Entrapment of Spinal Accessory Nerve: A Case Report
超音波於脊椎副神經損傷之臨床應用：個案報告
摘要
The anatomical structure of the neck area is exceedingly complex; thus, cervical nerve damage during surgical procedures is not uncommon. A 25-year-old woman underwent excisional biopsy for neck lymphadenopathy. The patient reported left upper back pain and left shoulder weakness 1 day after the surgery. Physical examination revealed weakness of the left upper trapezius muscle and winging of the left scapula. A nerve conduction study indicated decreased compound muscle action potential amplitude on stimulation of the left spinal accessory nerve (SAN); electromyography also revealed denervation changes with the presence of voluntary motor unit action potentials in the left upper trapezius muscle. The findings indicated an incomplete SAN injury. A musculoskeletal (MSK) ultrasound found adhesion between the SAN and the surrounding scar tissue. In addition to conventional physiotherapy, the authors performed ultrasound-guided hydrodissection of the left SAN with 5% glucose. Subsequently, the patient exhibited considerable improvement. In this case report, the authors demonstrate the use of MSK ultrasound for the diagnosis and treatment of peripheral nerve entrapment in the cervical region after an iatrogenic event.
並列摘要
近年來骨骼肌肉、神經超音波在臨床診斷的應用上日益廣泛，合併超音波及神經傳導檢查更能精準地掌握周邊神經損傷的部位與嚴重度。25歲女性無意間發現左側頸部有2公分的腫塊，因疑似淋巴瘤，故接受淋巴結切除術。術後一天自覺左上背疼痛及左肩無力，身體檢查發現左上斜方肌肌力下降，且呈現翼狀肩胛（winged scapula）。神經傳導檢查發現左側脊椎副神經（spinal accessory nerve）複合肌肉動作電位波（compound muscle action potential）振幅較右側下降了96%，傳導潛期延長3.34倍。肌電圖檢查發現左上斜方肌有去神經（denervation）現象，多相波增加和肌肉徵召下降（reduced recruitment），但尚可偵測到主動收縮運動神經元電位波。左側胸鎖乳突肌（sternocleidomastoid）和第四頸椎旁肌肉也有多相波比率增加現象。超音波檢查發現左側脊椎副神經與周圍組織手術後疤痕有沾黏現象，且產生逆行性腫脹。診斷為左側脊椎副神經因頸部淋巴結切片後之沾黏造成部份損傷。病人接受物理治療，每週三次，總共六週。開始復健一個月後回診發現症狀只有些微改善，便於一個月後給予超音波導引神經解套術（hydrodissection），每月一次，共三次。病人表示注射後一個月，肩膀症狀、功能和肩關節活動度大幅改善。追蹤神經傳導檢查也有明顯改善。高解析度的肌肉、骨骼、神經超音波對於脊椎副神經損傷的診斷及治療均有助益。