雙側旋前肌症候群：病例報告

在壓迫性神經病變中，正中神經受壓迫造成的旋前肌症候群並不常見，回顧文獻，目前只報導一例雙側旋前肌症候群。本篇報導的病例為一位51歲女性病患，主訴因雙手麻痛多年，曾被診斷為雙側腕隧道症候群並接受減壓手術，可是術後4個月，病患仍在雙側前臂近端及手指有麻木及握拳無力情形而前來復健科門診求治，經神經電生理學檢查發現在右側正中神經的感覺、運動神經及左側感覺神經刺激並沒有反應，而刺激左側正中神經的運動神經，其傳導速度雖然正常，但其傳導潛期卻明顯延長，反應波幅明顯下降；在雙側外展拇短肌、屈拇長肌、旋前圓肌及右側屈指淺肌均有去神經現象；多相波、干擾現象下降在雙側外展拇短肌、屈指淺肌及旋前圓肌均可發現。基於病史，理學檢查及神經電生理學檢查診斷為雙側旋前肌症候群。後來在左側前臂近端行正中神經減壓手術，發現有一纖維化結締組織壓迫正中神經，術後於門診追蹤時，發現左側前三指屈指肌力及麻木有明顯改善。本病患因從事雙手粗重工作可能造成反覆性創傷及微出血，而產生纖維化結締組織壓迫正中神經，引發雙側旋前肌症候群。本文描述病患之臨床症狀及診斷，並回顧相關文獻資料，以作為臨床醫師處理此類疾病的參考。

關鍵字

壓迫性神經病變；正中神經；旋前肌症候群

並列摘要

Pronator syndrome as a compression of median nerve at proximal forearm level is uncommon in all entrapment neuropathies. Only one case with bilateral pronator syndrome has been reported in the literature. A 51 year-old female suffered from numbness over bilateral hands for years, then she received neurolysis of median nerves at wrist level under the impression of bilateral carpal tunnel syndrome. Four months after operation, she still suffered from grip weakness and numbness over forearms and bilateral radial 3 and half fingers. Electrophysiological examination in our clinic showed non-pick up for stimulating sensory and motor nerve of right median nerve and sensory nerve of left median nerve. Besides, prolonged latency and decreased amplitude of left median motor nerve were noted although conduction velocity was normal. Also, denervation sign were found over bilateral abductor pollicis brevis, flexor pollicis longus, flexor digitorum superficialis and pronator teres . The polyphasic wave with decreased interference pattern over bilateral abductor pollicis brevis, flexor digitorum superficialis and pronator teres were also noted. According to history, physical examination and electrophsiological study, she was diagnosed as bilateral pronator syndrome. She received surgical intervention and compression of a fibrotic band over median nerve was found. After neurolysis and decompression were performed, significant improvement of weakness and numbness of left radial 3 and half fingers was noted at follow up. Repeated trauma resulting from heavy work , inducing fibrotic compression over median nerve, may be the possible cause in this case.

並列關鍵字

entrapment neuropathy ； median nerve ； pronator syndrome

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雙側旋前肌症候群：病例報告

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