Im Yu Jin, Kang Min Soo, Kim Sun Woong, Sung Duk Hyun
Department of Physical Medicine and Rehabilitation, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea.
Department of Physical Medicine and Rehabilitation, Guro Hospital, Korea University, Seoul 08308, Korea.
Diagnostics (Basel). 2021 Oct 14;11(10):1896. doi: 10.3390/diagnostics11101896.
In cardiac surgery, median sternotomy is often necessary during certain surgical processes and it can cause the rare complication of brachial plexus injury. Retraction of the rib cage during median sternotomy may produce a fracture of the first thoracic rib at the costovertebral junction which might penetrate or irritate the lower root of the brachial plexus. Because the C8 ventral root is located immediately superior to the first thoracic rib, the extraforaminal C8 root is thought to be the key location of brachial plexus injury by the first rib fracture. This report describes three cases of brachial plexus injury after median sternotomy in a single center. In our cases, fracture of the first rib and consequent brachial plexus injury is confirmed with imaging and electrophysiologic studies. The fracture of the first rib is not detected with standard plain images and it is confirmed only with CT or MRI studies. Advanced imaging tools are recommended to assess the first rib fracture when brachial plexus injury is suspected after median sternotomy.
在心脏手术中，正中胸骨切开术在某些手术过程中常常是必要的，并且它可能导致臂丛神经损伤这种罕见的并发症。正中胸骨切开术期间胸廓的牵开可能会导致第一肋骨在肋椎关节处骨折，这可能会穿透或刺激臂丛神经的下根。由于C8腹侧神经根紧邻第一肋骨上方，因此椎间孔外的C8神经根被认为是第一肋骨骨折导致臂丛神经损伤的关键部位。本报告描述了一个单中心的3例正中胸骨切开术后臂丛神经损伤的病例。在我们的病例中，通过影像学和电生理研究证实了第一肋骨骨折及随之而来的臂丛神经损伤。标准的X线平片未检测到第一肋骨骨折，仅通过CT或MRI检查得以证实。当怀疑正中胸骨切开术后发生臂丛神经损伤时，建议使用先进的影像学工具来评估第一肋骨骨折情况。
