摩托車車禍合併腋動脈剝離及臂神經叢病變：病例報告

在現實環境摩托車車禍實屬常見，它除了造成一般皮肉外傷外，卻也能夠造成骨折、血管栓塞及神經損傷。本篇病例報告一位二十三歲男性病人，因摩托車車禍造成全身多處擦傷，經急診室放射線檢查，全身並無骨折現象，但病患卻無法提起右上臂。原先歸咎於疼痛造成，但在急診室留觀五個小時之後，病患發現右上肢冰冷且無脈搏現象。緊急安排血管攝影檢查後，發現右側腋動脈栓塞及血管內膜剝離，立即會診血管外科，緊急實施人工血管置換術。受傷後兩星期經肌電神經學檢查發現右側腋神經、橈神經及尺神經損傷。經半年之積極復健治療，病患之右上肢體功能雖有明顯改善，但右側腋神經、橈神經損傷仍無明確恢復，故轉介至外科做手術評估。本病歷報告在提醒臨床醫師，腋動脈栓塞剝離合併臂神經叢損傷在臨床上實屬少見，而只由一般挫傷造成更是少見之病因，故一般臨床醫師對於車禍造成之肢體疼痛無力，診治上不可不慎，以免延誤病情造成不必要的醫療糾紛。而對於上述病症，病患應接受積極性的整體復健治療，儘可能改善其日常生活功能。

關鍵字

腋動脈栓塞剝離；臂神經叢病變；摩托車意外

並列摘要

At present time, motorcycle accident can be found frequently. It not only can lead to abrasion, and fracture, thrombosis and nerve injury as well. This case report presented with a 23 year-old male suffered from a motorcycle accident, with multiple abrasion wound over body. He was first sent to emergency room at LMD with x-ray taken and revealed no fracture. This patient presented with inability to raise his right arm, thus the doctor attributed the condition to his pain. After five hours at observation room, patient and his family found his right upper limb was cold and pulseless. The emergency angiography revealed thrombosis and dissected media intima over right axillary artery. The segmental resection and interposition of PTEE graft were performed by cardiovascular surgeon. Two weeks later, the EMG/NCS study revealed axillary, radial and ulnar nerve injury over right side. After aggressive rehabilitation for half a year the function of his right upper limb had much improvement. However definitive recovery of right axillary and ulnar nerve were not found, so he was transferred to department of cardiovascular surgery for surgical evaluation. This case report reminded us that axillary artery thrombosis with brachial plexopathy is unusual. And contusion leads to even less axillary artery thrombosis with brachial plexopathy. Thus, clinicians must be aware with patients suffer from traffic accident presenting with limbs pain or weakness in avoiding any delay treatment or legal problems. For the disease of axillary artery thrombosis with brachial plexopathy, patients should received aggressive rehabilitation program to improve their dependency and ADL function.

並列關鍵字

axillary artery thrombosis and dissection ； brachial plexopathy ； motorcycle accident

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摩托車車禍合併腋動脈剝離及臂神經叢病變：病例報告

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