Puhaindran M E, Wong H P
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Singapore Med J. 2003 Dec;44(12):653-5.
Palsies involving the anterior interosseous nerve comprise less than 1% of all upper extremity nerve palsies. Patients often present initially with acute pain in the proximal forearm, lasting several hours to days. The pain subsides, to be followed by paresis or total paralysis of the pronator quadratus, flexor pollicis longus and the radial half of the flexor profundus, either individually or together. Patients with a complete lesion will have a characteristic pinch deformity. We report a case of anterior interosseous syndrome in a 42-year-old male. The patient was admitted initially for chronic osteomyelitis of the left calcaneum. He had a peripherally inserted central catheter (PICC) line inserted into a brachial vein for the administration of intravenous antibiotics, and developed anterior interosseous nerve palsy as a complication of this procedure. The catheter was subsequently removed and a new line was placed on the other side, and his neurological deficit has been improving since. This case highlights the potential hazards of venupuncture or arterial puncture of the brachial vein or artery respectively, even under controlled conditions with the benefit of ultrasound guidance. It also serves as a reminder to look out for the complications of these common procedures, and to be able to react appropriately when they arise.
涉及骨间前神经的麻痹占所有上肢神经麻痹的比例不到1%。患者最初常表现为前臂近端急性疼痛，持续数小时至数天。疼痛消退后，旋前方肌、拇长屈肌和指深屈肌桡侧半会单独或共同出现轻瘫或完全麻痹。完全性损伤的患者会出现典型的捏物畸形。我们报告一例42岁男性的骨间前综合征病例。该患者最初因左跟骨慢性骨髓炎入院。他通过外周静脉穿刺中心静脉置管（PICC）将导管插入肱静脉以输注静脉抗生素，并在此过程中并发骨间前神经麻痹。随后拔除导管并在另一侧重新置管，此后他的神经功能缺损一直在改善。该病例强调了分别对肱静脉或动脉进行静脉穿刺或动脉穿刺的潜在风险，即使在超声引导的可控条件下也是如此。它还提醒人们留意这些常见操作的并发症，并在并发症出现时能够做出适当反应。
