Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
The Nukada Institute for Medical and Biological Research, Chiba, Japan.
J Hand Surg Am. 2020 Oct;45(10):990.e1-990.e6. doi: 10.1016/j.jhsa.2019.12.011. Epub 2020 Mar 7.
We report the pathological findings of hourglass-like fascicular constriction (HLFC) under optical and electron microscopy. A 24-year-old man with spontaneous posterior interosseous nerve palsy was treated by interfascicular neurolysis at 29 weeks after onset. One fascicle in the radial nerve presented severe HLFC with torsion at 5 cm proximal to the elbow. Functional recovery was achieved by resection of the enlarged fascicle including HLFC and sural nerve grafting. Proximal to the HLFC, the endoneurium was filled with clusters of regenerating nerve fibers. At the level of the HLFC, a complete loss of myelinated nerve fibers and vascular occlusion of endo- and perineurial vessels were found. Few regenerating nerve fibers were observed. Distal to the HLFC, severe endoneurial edema, a complete loss of myelinated and unmyelinated nerve fibers, and bands of Büngner were noted. These electron microscopic findings demonstrated a detailed pathology of the nerve around the HLFC.
我们在光学和电子显微镜下报告了沙漏状束状收缩（HLFC）的病理发现。一名 24 岁男性在发病后 29 周因自发性骨间后神经麻痹接受束间神经松解术治疗。在肘近端 5cm 处，桡神经的一个束呈现严重的 HLFC 伴扭转。通过切除包括 HLFC 在内的增大束并进行腓肠神经移植，实现了功能恢复。在 HLFC 近端，神经内膜内充满了再生神经纤维簇。在 HLFC 水平，发现有髓神经纤维完全丧失和内外膜血管闭塞。观察到很少的再生神经纤维。在 HLFC 远端，可见严重的神经内膜水肿、有髓和无髓神经纤维完全丧失以及邦格带。这些电子显微镜发现显示了 HLFC 周围神经的详细病理。
