Raj C, Chantelot C, Saab M
Service d'Orthopédie-Traumatologie, Hôpital Roger-Salengro, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France.
Service d'Orthopédie-Traumatologie, Hôpital Roger-Salengro, CHU de Lille, avenue Oscar-Lambret, 59000 Lille, France.
Hand Surg Rehabil. 2020 May;39(3):229-234. doi: 10.1016/j.hansur.2020.02.001. Epub 2020 Feb 27.
Schwannomas are the most frequent benign tumors of the peripheral nerves. Tumor enucleation is the traditional surgical treatment. The incidence of neurological complications after surgery varies and predictive factors for these complications are not clearly defined. The aim of this study was to find predictive factors of postoperative neurological deficit after surgical treatment of schwannomas of the upper limb. Twenty-four schwannomas removed from 21 patients were analyzed retrospectively. The patients' mean age was 45.4years and the mean follow-up was 64.4months. Clinical parameters studied were age, gender, nature of preoperative symptoms, duration of symptoms, type of surgery performed, tumor location and size, nerve involved, QuickDASH and DN4 scores. Postoperative neurological deficits occurred in 14 patients (67%), with 11 having a sensory deficit and 7 a motor weakness. Eleven did not exist before surgery (6 sensory, 5 motor). In the postoperative deficit subgroup, 6 schwannomas involved the brachial plexus, 4 the ulnar nerve, and 4 the median nerve. All patients who had a fascicular resection because tumor enucleation was not feasible were in the postoperative deficit subgroup. Ten patients had either unchanged or worse QuickDASH and/or DN4 scores after surgery. Surgical treatment of schwannomas can lead to postoperative complications. Although none of our findings were statistically significant, advanced age, large tumor size, more than 16months between the first symptoms and surgery, and brachial plexus location seem to be more frequently observed in those with a postoperative neurological deficit.
神经鞘瘤是周围神经最常见的良性肿瘤。肿瘤摘除术是传统的外科治疗方法。手术后神经并发症的发生率各不相同，且这些并发症的预测因素尚未明确界定。本研究的目的是找出上肢神经鞘瘤手术治疗后术后神经功能缺损的预测因素。对从21例患者身上切除的24个神经鞘瘤进行了回顾性分析。患者的平均年龄为45.4岁，平均随访时间为64.4个月。所研究的临床参数包括年龄、性别、术前症状的性质、症状持续时间、手术类型、肿瘤位置和大小、受累神经、QuickDASH和DN4评分。14例患者（67%）出现术后神经功能缺损，其中11例有感觉缺损，7例有运动无力。11例术前不存在（6例感觉，5例运动）。在术后缺损亚组中，6个神经鞘瘤累及臂丛神经，4个累及尺神经，4个累及正中神经。所有因无法进行肿瘤摘除而进行束状切除的患者均在术后缺损亚组中。10例患者术后QuickDASH和/或DN4评分未改变或恶化。神经鞘瘤的手术治疗可导致术后并发症。尽管我们的研究结果均无统计学意义，但高龄、肿瘤体积大、首发症状与手术间隔超过16个月以及臂丛神经位置似乎在术后神经功能缺损患者中更为常见。
