Clanet M, Mansat M, Durroux R, Testut M F, Guiraud B, Rascol A, Conte J
Rev Neurol (Paris). 1981;137(10):613-24.
Since 1975, various entrapment neuropathies have been reported in patients undergoing periodic haemodialysis, the most frequent being the carpal tunnel syndrome. Ten patients on chronic haemodialysis developing 15 carpal tunnel syndromes (5 unilateral and 5 bilateral) are reported. Various causes for the renal failure were present and clinical signs of the carpal tunnel syndrome developed at a late stage. The arteriovenous fistula required for extrarenal epuration was antebrachial and of the laterolateral type, except in one case when it was lateroterminal. The carpal tunnel syndrome was always on the same side as the fistula, developing at a later stage on th contralateral side in the 5 cases of bilateral disorders. Lesions were severe, in 11 of the 15 cases. Some patients noted fluctuations in pain symptoms during haemodialysis, either improving or becoming worse. Gross pathological findings during operation (13 cases) were tenosynovitis with epineural hypervascularisation on the opposite side. In 9 cases, however, atypical hypertrophic tenosynovitis was observed. Histological examination in 12 cases demonstrated typical tenosynovitis in 3 patients, but granulomatous tenosynovitis with amyloid deposits was reported in 9 patients. Lesions were bilateral in 2 cases thus present, on the side opposite to the fistula. Ultrastructural study confirmed the amyloid nature of the deposits in 3 cases, the microfibrillary appearance (80 to 100 A) being characteristic of amyloid substance. This rare complication does not represent a common carpal tunnel syndrome, and three mechanisms may be involved in its induction : peripheral uraemic neuropathy, haemodynamic modifications resulting from the antebrachial arteriovenous shunt, and amyloid formation in the flexor synovial sheaths. In the latter case, the type of amyloid disease may be a primary systemic amyloidosis not previously detected, or an elective amyloid process localised to the tenosynovial and periarticular tissues.
自1975年以来，已有报道称接受定期血液透析的患者会出现各种卡压性神经病变，其中最常见的是腕管综合征。本文报告了10例接受慢性血液透析的患者发生了15例腕管综合征（5例单侧，5例双侧）。这些患者存在各种导致肾衰竭的病因，且腕管综合征的临床症状出现较晚。除1例为外侧终末型外，用于肾外净化的动静脉瘘均位于前臂且为外侧型。腕管综合征总是发生在与瘘管同侧，在5例双侧病变中，对侧在后期也会出现。15例中有11例病变严重。一些患者注意到血液透析期间疼痛症状有波动，时好时坏。手术中的大体病理发现（13例）为对侧腱鞘炎伴神经外膜血管增生。然而，9例观察到非典型肥厚性腱鞘炎。12例的组织学检查显示，3例患者为典型腱鞘炎，但9例患者报告为伴有淀粉样沉积的肉芽肿性腱鞘炎。2例病变为双侧，位于与瘘管相对的一侧。超微结构研究证实3例沉积物具有淀粉样性质，其微纤维外观（80至100埃）是淀粉样物质的特征。这种罕见的并发症并非普通的腕管综合征，其诱发可能涉及三种机制：周围性尿毒症神经病变、前臂动静脉分流导致的血流动力学改变以及屈肌滑膜鞘内淀粉样物质形成。在后一种情况下，淀粉样疾病的类型可能是先前未检测到的原发性系统性淀粉样变性，或者是局限于滑膜和关节周围组织的选择性淀粉样变过程。
