Laumonerie Pierre, Blasco Laurent, Tibbo Meagan E, Leclair Olivier, Kerezoudis Panagiotis, Chantalat Elodie, Mansat Pierre
Department of Orthopaedic Surgery, Institut Locomoteur, Hôpital Pierre-Paul Riquet, Toulouse, France; Anatomy Laboratory, Department of Orthopaedic Surgery, Faculty of Medicine, Toulouse, France.
Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France.
World Neurosurg. 2018 Mar;111:317-325. doi: 10.1016/j.wneu.2017.12.160. Epub 2018 Jan 5.
Despite demonstrable safety and efficacy of subdermal contraceptive implants (SCIs), both insertion and removal of SCIs in the arm have been associated with neurovascular complications. The aim of this study was to investigate type and prognosis of nerve injuries associated with SCIs.
We performed a comprehensive search of 4 electronic databases for studies pertaining to patients with nerve injury and concurrent SCI. Studies published between January 1987 and June 2017 were included. Implant location, damaged nerves, clinical presentation, preoperative imaging (x-ray, ultrasound, magnetic resonance imaging), neurologic evaluation (nerve conduction studies, electromyography), and treatment methods were reviewed. To outline management strategies, 2 illustrative cases of major nerve injury caused by SCI removal were presented.
We analyzed 10 studies including 12 patients. Fourteen nerve injuries in 12 patients were reported during SCI insertion (n = 1) and removal (n = 11). Medial antebrachial cutaneous (n = 5) and median (n = 5) nerves were primarily affected. Neuropathic pain was the main symptom. Primary reasons for nerve injury were pulling or grasping of the nerve (n = 9) after mistaking it for the implant. Neurapraxia (n = 7) was the most common lesion and was treated with implant removal and clinical surveillance (n = 6). Five patients completely recovered; the remaining patients continued to have motor and/or sensory deficit at mean follow-up of 0.7 year (range, 0-2 years).
Nerve injuries related to SCIs are rare but potentially serious. For nonpalpable SCIs, a multidisciplinary approach, including practitioners with experience treating peripheral nerve injuries, is invaluable.
尽管皮下避孕植入物（SCI）具有已证实的安全性和有效性，但在手臂中植入和取出SCI均与神经血管并发症相关。本研究的目的是调查与SCI相关的神经损伤的类型和预后。
我们对4个电子数据库进行了全面检索，以查找与神经损伤并发SCI的患者相关的研究。纳入了1987年1月至2017年6月发表的研究。对植入部位、受损神经、临床表现、术前影像学检查（X线、超声、磁共振成像）、神经学评估（神经传导研究、肌电图）和治疗方法进行了回顾。为概述管理策略，介绍了2例因取出SCI导致主要神经损伤的典型病例。
我们分析了10项研究，包括12例患者。在SCI植入（n = 1）和取出（n = 11）过程中，12例患者共报告了14例神经损伤。主要受累神经为前臂内侧皮神经（n = 5）和正中神经（n = 5）。神经性疼痛是主要症状。神经损伤的主要原因是误将神经当作植入物进行牵拉或抓捏（n = 9）。神经失用（n = 7）是最常见的损伤类型，并通过取出植入物和临床监测进行治疗（n = 6）。5例患者完全康复；其余患者在平均0.7年（范围0 - 2年）的随访中仍有运动和/或感觉功能缺损。
与SCI相关的神经损伤虽罕见但可能很严重。对于无法触及的SCI，采用多学科方法，包括有治疗周围神经损伤经验的从业者，非常重要。
