Seo Yeui-Seok, Lee HoWon, Hwang Jihyo, Park Chanwool, Lee MinJae, Yoon Yonghyun, Yu HyeMi, Choi Jaeik, Ko Gyungseog, Su Daniel Chiung-Jui, Reeves Keneath Dean, Suryadi Teinny, Suhaimi Anwar, Lam King Hei Stanley
Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, Soeul 06591, Republic of Korea.
Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea.
Diagnostics (Basel). 2025 Aug 21;15(16):2106. doi: 10.3390/diagnostics15162106.
Non-palpable migrated contraceptive implants pose significant challenges for removal and are associated with neurovascular complications. Traditional open surgery near nerves is associated with postoperative morbidity. Migrated or deeply embedded implants near critical structures can result in severe complications, such as neuropathy, and their removal typically requires open surgical intervention. We report a novel, minimally invasive, ultrasound (US)-guided technique for removing a migrated etonogestrel Implanon implant that caused ulnar neuropathy. A 38-year-old woman presented with severe neuropathic pain and paresthesia (NPRS 10/10; QuickDASH 55) along her left ulnar nerve following multiple failed removal attempts that induced deep migration. US confirmed the proximity of the implant to the ulnar nerve. Initial US-guided removal exacerbated her symptoms. Hydrodissection (HD) with 50 mL of 5% dextrose in water (D5W) without local anesthetic (LA) was performed to reduce inflammation and achieve separation. The implant migrated proximally during extraction. An additional HD with 50 mL of D5W without LA distally repositioned the implant. Percutaneous stabilization using a 25-gauge needle enabled secure removal. The intact 4 cm implant was extracted under real-time US guidance without open surgery. The patient experienced immediate symptom relief (NPRS 2/10; QuickDASH 4.5 at one month) and full resolution (NPRS 0/10; QuickDASH 0) with no motor deficits at one year. This case represents the first documented percutaneous removal of a nerve-adherent implant using combined US-guided D5W HD and needle stabilization, marking a paradigm shift in the management of such cases. This approach confirms the safety of US-guided foreign body removal using HD for nerve-adjacent implants and demonstrates the efficacy of combining D5W HD with needle stabilization. Surgical morbidity was avoided, while excellent long-term outcomes were achieved.
无法触及的移位避孕植入物给取出带来了重大挑战，并与神经血管并发症相关。在神经附近进行传统的开放手术会导致术后发病。在关键结构附近移位或深深嵌入的植入物可能会导致严重并发症，如神经病变，其取出通常需要开放手术干预。我们报告了一种新颖的、微创的、超声（US）引导技术，用于取出导致尺神经病变的移位依托孕烯依姆平植入物。一名38岁女性在多次取出尝试失败并导致植入物深度移位后，出现沿左尺神经的严重神经病理性疼痛和感觉异常（数字疼痛评分量表[NPRS]为10/10；快速残疾评定量表[QuickDASH]为55）。超声检查证实植入物靠近尺神经。最初的超声引导下取出加重了她的症状。在未使用局部麻醉剂（LA）的情况下，用50毫升5%葡萄糖水溶液（D5W）进行水分离（HD）以减轻炎症并实现分离。在取出过程中植入物向近端移位。在远端再用50毫升未加局部麻醉剂的D5W进行一次水分离将植入物重新定位。使用25号针进行经皮固定以便安全取出。在实时超声引导下，完整的4厘米植入物未进行开放手术即被取出。患者症状立即缓解（NPRS为2/10；1个月时QuickDASH为4.5），1年后完全恢复（NPRS为0/10；QuickDASH为0），且无运动功能缺损。该病例是首次记录的使用联合超声引导下D5W水分离和针固定经皮取出与神经粘连的植入物，标志着此类病例管理的范式转变。这种方法证实了对于与神经相邻的植入物，使用水分离进行超声引导下异物取出的安全性，并证明了D5W水分离与针固定相结合的有效性。避免了手术并发症，同时取得了优异的长期效果。
