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硬纤维瘤型纤维瘤病导致的桡神经麻痹:一例报告并文献复习

Radial Nerve Palsy Caused by Desmoid-Type Fibromatosis: A Case Report and Review of the Literature.

作者信息

Iwanaga Ryuta, Mihara Atsushi, Sakai Takashi, Muramatsu Keiichi, Hashimoto Takahiro

机构信息

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, JPN.

Department of Hand and Microsurgery, Nagato General Hospital, Nagato, JPN.

出版信息

Cureus. 2024 Jul 20;16(7):e65008. doi: 10.7759/cureus.65008. eCollection 2024 Jul.

Abstract

Radial nerve palsy (RNP) is classified as traumatic, non-traumatic, or iatrogenic. The most frequent etiologic agent is the fracture of the humerus of the shaftand distal. We experienced a case of RNP caused by desmoid-type fibromatosis around the radial nerve. The RNP caused by desmoid-type fibromatosis has not been reported in the literature. We present this case here with a review of the RNP literature. The patient is a 16-year-old female, right-hand dominant, who became aware of the difficulty in extending her right little finger without any triggers five months ago. She was also aware of the difficulty in extending the ring finger, and her symptoms gradually worsened. She was referred to our hospital after consulting a home doctor. MRI of the elbow showed a high-intensity occupying lesion on T2-weighted images (T2WI) slightly proximal to the elbow joint. Ultrasonography (US) showed a partial nerve constriction and radial nerve enlargement on the distal side of the constriction. The approach was made from the posterior lateral side of the distal upper arm, and the radial nerve was exposed. There was a 1 cm white tissue strongly adherent on the radial nerve, which was compressing the radial nerve, and it was resected piece by piece. After the resection, the radial nerve was indented. The pathological diagnosis of the resected tissue was fibromatosis. Gradually, she was able to extend her fingers after the surgery and recovered completely in six months.

摘要

桡神经麻痹(RNP)分为创伤性、非创伤性或医源性。最常见的病因是肱骨干和远端骨折。我们遇到了一例由桡神经周围硬纤维瘤病引起的RNP。硬纤维瘤病引起的RNP在文献中尚未见报道。我们在此报告该病例,并对RNP文献进行综述。患者为16岁女性,右利手,5个月前无任何诱因出现右手小指伸展困难。她还意识到无名指伸展困难,症状逐渐加重。在家医咨询后转诊至我院。肘部MRI显示在肘关节稍近端的T2加权像(T2WI)上有一高强度占位性病变。超声检查(US)显示神经局部受压,受压远端桡神经增粗。从远端上臂后外侧入路,显露桡神经。桡神经上有一块1厘米的白色组织与之紧密粘连,压迫桡神经,遂将其逐块切除。切除后,桡神经出现压痕。切除组织的病理诊断为纤维瘤病。术后她逐渐能够伸展手指,并在6个月内完全康复。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e68f/11333107/0927bf454a13/cureus-0016-00000065008-i01.jpg

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