Osterman A L
Hospital of the University of Pennsylvania, Philadelphia.
Orthop Clin North Am. 1988 Jan;19(1):147-55.
Multilevel lesions along a peripheral nerve trunk do occur. In the double crush syndrome as postulated by Upton and McComas, the presence of a more proximal lesion does seem to render the more distal nerve trunk more vulnerable to compression. While the exact pathophysiologic mechanism of this interaction is not yet elucidated, it most likely relates to disturbances in axonal flow kinetics and the disruption of the neurofilament architecture. On a practical level our studies show that given a more proximal root compression less involvement of the median nerve across the carpal tunnel was required to produce symptoms. Furthermore, the surgical outcome of carpal tunnel release in this double crush group was poorer than in that group with isolated carpal tunnel involvement. It is important to preoperatively identify those patients who may have double crush lesions and thus anticipate a less than optimal result from surgical release of the peripheral nerve. Finally, when the double crush syndrome is present, both entrapments may require treatment for optimal results.
沿周围神经干确实会出现多级病变。在厄普顿和麦科马斯提出的双重压迫综合征中，更靠近近端的病变似乎确实会使更远端的神经干更容易受到压迫。虽然这种相互作用的确切病理生理机制尚未阐明，但很可能与轴浆流动动力学的紊乱和神经丝结构的破坏有关。从实际层面来看，我们的研究表明，在存在更靠近近端的神经根受压的情况下，正中神经在腕管内较少受累就能产生症状。此外，该双重压迫组腕管松解术的手术效果比单纯腕管受累组更差。术前识别那些可能有双重压迫病变的患者并因此预期外周神经手术松解的效果不理想很重要。最后，当存在双重压迫综合征时，两处卡压都可能需要治疗才能取得最佳效果。
