Rosing James H, Lance Samuel, Wong Michael S
Department of Plastic and Reconstructive Surgery, UC Davis Health System, Sacramento, California 95817, USA.
J Emerg Med. 2012 Oct;43(4):e223-5. doi: 10.1016/j.jemermed.2010.01.019. Epub 2010 Mar 29.
Chest tube placement is a frequently required surgical procedure among patients in the emergency department. Although the procedure is often simple, occasionally there are known complications, including unresolved pneumothorax or hemopneumothorax, extrathoracic placement of the tube, and damage to the intercostal neurovascular bundle.
We report an unusual yet noteworthy complication of ulnar neuropathy after chest tube placement for pneumothorax. Awareness of the association between acute ulnar neuropathy and chest tube placement will alert the physician to reposition the tube and prevent ongoing compression.
A 43-year-old man developed right-sided rib fractures (6-9 and 12) and a pneumothorax from blunt trauma to the right chest wall. Upon insertion of a 36 French chest tube, the patient reported immediate ulnar nerve distribution paresthesias of the ipsilateral arm. The tube was subsequently repositioned with improvement of symptoms. He was later discharged with occupational therapy outpatient follow-up.
Ulnar neuropathy is a rare, though significant, complication associated with tube thoracostomy. Management of persistent symptoms is expectant, with early upper extremity range of motion and strength exercise.
胸腔闭式引流管置入术是急诊科患者经常需要进行的外科手术。尽管该手术通常较为简单，但偶尔也会出现已知的并发症，包括气胸或血气胸未缓解、引流管置于胸外以及肋间神经血管束损伤。
我们报告了1例气胸患者胸腔闭式引流管置入术后发生尺神经病变这一罕见但值得关注的并发症。了解急性尺神经病变与胸腔闭式引流管置入之间的关联，将提醒医生重新放置引流管并防止持续压迫。
一名43岁男性因右侧胸壁钝性创伤导致右侧肋骨骨折（第6至9肋及第12肋）和气胸。在插入一根36F的胸腔闭式引流管时，患者报告同侧手臂立即出现尺神经分布区感觉异常。随后重新放置引流管，症状有所改善。他后来出院，并接受职业治疗门诊随访。
尺神经病变是与胸腔闭式引流术相关的一种罕见但严重的并发症。对于持续症状的处理是观察等待，并尽早进行上肢活动范围和力量锻炼。
