1 Department of Radiology, Northwell Health, 300 Community Dr, Manhasset, NY 11030.
2 Department of Radiology, NYU Langone Health, New York, NY.
AJR Am J Roentgenol. 2019 Mar;212(3):W73-W82. doi: 10.2214/AJR.18.20047. Epub 2019 Jan 30.
The purpose of this study was to describe clinical experience with ultrasound-guided therapeutic procedures and associated pathologic conditions involving the peripheral nerves of the upper extremity over 5 years at a large academic institution.
A retrospective database search of procedure codes was performed for all ultrasound-guided upper extremity peripheral nerve procedures between 2012 and 2017. Retrospective review of the electronic medical record for patient demographics, indications, interval follow-up pain relief, and complications was undertaken. Retrospective review of ultrasound and other correlative imaging findings was performed to assess for neural and perineural abnormalities.
In total, 242 procedures performed on a cohort of 183 patients (53% women, 47% men; mean age, 53 years; range, 15-97 years) were reviewed. Nine patients underwent multifocal injections in a single encounter, and 39 underwent repeat injections of previously documented symptom generators. Perineural injections included ulnar (n = 109), median (n = 81), posterior interosseous-deep radial (n = 39), sensory branch of the radial (n = 7), anterior interosseous (n = 2), axillary (n = 2), suprascapular (n = 1), and digital (n = 1) nerves. Structural or dynamic abnormality seen either during the procedure or at preprocedural imaging included loss of normal morphologic features (n = 148), nerve subluxation (n = 8), ganglion cyst (n = 4), and neuroma (n = 7). Forty-four patients reported immediate pain relief after the procedure. Of the 89 patients with documented clinical follow-up, 52 reported a period of symptom relief (mean, 125 days), and six reported complete resolution of symptoms. Subsequent surgical procedures were performed on 32 patients, a combination of those who did (n = 12) and did not (n = 20) experience a period of symptom relief from the perineural injection. There were no complications with regard to the site or distribution of perineural injections. Three episodes of vasovagal reaction were reported.
Ultrasound-guided percutaneous interventions for upper extremity neural abnormalities can be safely performed for a variety of indications. Real-time ultra-sound evaluation during the procedure allows assessment for neural and perineural abnormalities and tailoring of the procedure to potentially symptomatic structural abnormalities.
本研究旨在描述在一所大型学术机构中，5 年来在超声引导下对上肢周围神经进行治疗操作的临床经验，以及相关的病理情况。
对 2012 年至 2017 年间所有超声引导的上肢周围神经操作的程序代码进行回顾性数据库搜索。对电子病历中的患者人口统计学、适应证、间隔随访疼痛缓解和并发症进行回顾性审查。对超声和其他相关影像学发现进行回顾性评估，以评估神经和神经周围异常。
共对 183 例患者（53%为女性，47%为男性；平均年龄 53 岁；范围为 15-97 岁）的 242 例操作进行了回顾。9 例患者在单次就诊时进行了多灶注射，39 例患者对先前记录的症状发生器进行了重复注射。神经周围注射包括尺神经（n = 109）、正中神经（n = 81）、骨间后动脉-深桡神经（n = 39）、桡神经感觉支（n = 7）、骨间前动脉（n = 2）、腋神经（n = 2）、肩胛上神经（n = 1）和指神经（n = 1）。在操作过程中或术前影像学检查中发现的结构或动态异常包括正常形态特征丧失（n = 148）、神经半脱位（n = 8）、神经节囊肿（n = 4）和神经瘤（n = 7）。44 例患者在术后立即报告疼痛缓解。在有记录的临床随访的 89 例患者中，52 例报告有一段时间的症状缓解（平均 125 天），6 例报告症状完全缓解。32 例患者随后进行了手术，其中包括那些有（n = 12）和没有（n = 20）从神经周围注射中获得症状缓解的患者。神经周围注射部位或分布无并发症。报告了 3 例血管迷走性反应。
超声引导的上肢神经异常经皮介入治疗可安全用于多种适应证。在操作过程中实时超声评估可评估神经和神经周围异常，并根据潜在的症状性结构异常调整操作。
