Somogyi E, Irányi J
Semmelweis Orvostudományi Egyetem Igazságügyi Orvostani Intézete.
Orv Hetil. 1996 Apr 14;137(15):803-6.
The authors give a survey of the clinical and medical-legal characteristics of the accessory nerve injury. In the past two decades the conception of the successfulness of the surgical treatment of the accessory nerve injury became prevailing. About the medical-legal aspects of the iatrogenic injury of the nerve reported in connection of the reconstructive surgery chiefly also departments of neurosurgery, orthopedics and traumatology. In the case of the authors a 70 year old patient suffered 10 years ago a iatrogenic accessory nerve injury. The mild trapezius palsy recovered spontaneously practically with cosmetic disadvantage. In connection with the development of extreme dorso-lumbal scoliosis associated with torsion the trapezius atrophy worsened. Physical therapy was partly successful. But the patient became unfit for manual work. Their observations sustain the data of authors who established that in the case of accessory nerve injury not only the surgical but also conservative treatment is usually successful. In opposite to certain data of the literature the authors establish that the iatrogenic injuries of the accessory nerve may lead to significant lifelong disability. The diagnosis is not always made in time with consequent delay in repair. This may be regarded as an unfavorable issue during medical-legal discussions. The authors recommend in interest to prevent nerve injury in the posterior triangle of the neck to perform operation in special department.
作者对副神经损伤的临床和医学法律特征进行了综述。在过去二十年中，副神经损伤手术治疗成功的观念逐渐流行。关于与重建手术相关的神经医源性损伤的医学法律方面，主要也见于神经外科、骨科和创伤科。作者的病例中，一名70岁患者于10年前遭受医源性副神经损伤。轻度斜方肌麻痹几乎自发恢复，但存在外观缺陷。随着与扭转相关的极度背腰脊柱侧弯的发展，斜方肌萎缩加重。物理治疗部分成功。但患者无法从事体力劳动。他们的观察结果支持了其他作者的数据，即对于副神经损伤，通常手术治疗和保守治疗都能取得成功。与文献中的某些数据相反，作者发现副神经的医源性损伤可能导致严重的终身残疾。诊断并不总是及时做出，导致修复延迟。在医学法律讨论中，这可能被视为一个不利因素。作者出于预防颈部后三角区神经损伤的考虑，建议在专科进行手术。
