Hooper Jette, O'Connor Ian T, Golub Ivan J, Decilveo Alexander P, Wittig James C
Orthopedics. 2017 Nov 1;40(6):e1036-e1043. doi: 10.3928/01477447-20170925-05. Epub 2017 Oct 3.
A Tinel's sign, a percussion-induced, painful sensation, has been reported as the most useful sign for diagnosing a schwannoma. On magnetic resonance imaging, schwannomas often exhibit a split fat sign and a target sign. The typical treatment for schwannomas is surgical excision; however, excision often results in high rates of neurological deficit. The authors retrospectively reviewed 20 patients who underwent excision of a schwannoma from 2007 to 2015. Twenty patients presented with a split fat sign and 12 patients presented with a Tinel's sign on magnetic resonance imaging. Only 3 patients presented with a target sign on magnetic resonance imaging. The operative approach involved removing the schwannoma, preserving the nearby nerve fascicles, and leaving the epineurium open. Follow-up ranged from 3 to 91 months (average, 29 months). At final follow-up, all patients were pain free. Nineteen patients had normal sensation and full function of their affected limb. One patient developed postoperative posterior interosseous nerve palsy. A Tinel's sign, preoperative pain, and a split fat sign on preoperative magnetic resonance imaging are the clinical symptoms most useful for diagnosing a schwannoma. Schwannomas can be safely removed via intracapsular surgical excision with minimal complications, yielding eradication of preoperative pain, normal sensation, and full function. [Orthopedics. 2017; 40(6):e1036-e1043.].
据报道，Tinel征（叩击引起的疼痛感觉）是诊断神经鞘瘤最有用的体征。在磁共振成像上，神经鞘瘤常表现为脂肪分离征和靶征。神经鞘瘤的典型治疗方法是手术切除；然而，切除术后神经功能缺损的发生率往往很高。作者回顾性分析了2007年至2015年接受神经鞘瘤切除手术的20例患者。20例患者在磁共振成像上表现为脂肪分离征，12例表现为Tinel征。只有3例患者在磁共振成像上表现为靶征。手术方法包括切除神经鞘瘤，保留附近的神经束，并保持神经外膜开放。随访时间为3至91个月（平均29个月）。在最后一次随访时，所有患者均无疼痛。19例患者患侧肢体感觉正常，功能完全。1例患者术后出现骨间后神经麻痹。Tinel征、术前疼痛以及术前磁共振成像上的脂肪分离征是诊断神经鞘瘤最有用的临床症状。通过囊内手术切除神经鞘瘤可安全进行，并发症最少，可消除术前疼痛，恢复正常感觉和完全功能。[《骨科》。2017；40(6):e1036 - e1043。]
