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首页> 外文期刊>Journal of Brachial Plexus and Peripheral Nerve Injury >Surgical fasciectomy of the trapezius muscle combined with neurolysis of the Spinal accessory nerve; results and long-term follow-up in 30 consecutive cases of refractory chronic whiplash syndrome
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Surgical fasciectomy of the trapezius muscle combined with neurolysis of the Spinal accessory nerve; results and long-term follow-up in 30 consecutive cases of refractory chronic whiplash syndrome

机译：斜方肌的外科筋膜切除术结合脊髓副神经的神经溶解;连续30例难治性慢性鞭打综合征患者的临床结果和长期随访

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BackgroundChronic problems from whiplash trauma generally include headache, pain and neck stiffness that may prove refractory to conservative treatment modalities. As has previously been reported, such afflicted patients may experience significant temporary relief with injections of local anesthetic to painful trigger points in muscles of the shoulder and neck, or lasting symptomatic improvement through surgical excision of myofascial trigger points. In a subset of patients who present with chronic whiplash syndrome, the clinical findings suggest an affliction of the spinal accessory nerve (CN XI, SAN) by entrapment under the fascia of the trapezius muscle. The present study was undertaken to assess the effectiveness of SAN neurolysis in chronic whiplash syndrome.MethodsA standardized questionnaire and a linear visual-analogue scale graded 0-10 was used to assess disability related to five symptoms (pain, headache, insomnia, weakness, and stiffness) before, and one year after surgery in a series of thirty consecutive patients.ResultsThe preoperative duration of symptoms ranged from seven months to 13 years. The following changes in disability scores were documented one year after surgery: Overall pain decreased from 9.5 +/- 0.9 to 3.2 +/- 2.6 (p < 0.001); headaches from 8.2 +/- 2.9 to 2.3 +/- 2.8 (p < 0.001); insomnia from 7.5 +/- 2.4 to 3.8 +/- 2.8 (p < 0.001); weakness from 7.6 +/- 2.6 to 3.6 +/- 2.8 (p < 0.001); and stiffness from 7.0 +/- 3.2 to 2.6 +/- 2.7 (p < 0.001).ConclusionsEntrapment of the spinal accessory nerve and/or chronic compartment syndrome of the trapezius muscle may cause chronic debilitating pain after whiplash trauma, without radiological or electrodiagnostic evidence of injury. In such cases, surgical treatment may provide lasting relief.
机译：背景技术鞭打创伤引起的慢性问题通常包括头痛，疼痛和颈部僵硬，可能证明对保守治疗方法无效。如先前报道的那样，通过在肩和颈部肌肉中注射局部麻醉药至疼痛的触发点，或通过手术切除肌筋膜触发点，持久的症状改善，这些患病的患者可能会经历明显的暂时缓解。在表现为慢性鞭打综合征的部分患者中，临床发现表明，斜方肌筋膜下的截留会累及脊髓副神经（CN XI，SAN）。本研究旨在评估SAN神经溶解在慢性鞭打综合征中的有效性。方法采用标准化问卷和等级为0-10的线性视觉模拟量表来评估与五种症状（疼痛，头痛，失眠，虚弱和连续30例患者在手术前和手术后一年）。结果症状的术前持续时间从7个月到13年不等。术后一年记录了以下残疾评分变化：总体疼痛从9.5 +/- 0.9降低到3.2 +/- 2.6（p <0.001）;头痛从8.2 +/- 2.9到2.3 +/- 2.8（p <0.001）;失眠从7.5 +/- 2.4降至3.8 +/- 2.8（p <0.001）;弱点从7.6 +/- 2.6降至3​​.6 +/- 2.8（p <0.001）;硬度从7.0 +/- 3.2到2.6 +/- 2.7（p <0.001）。结论脊柱副神经和/或斜方肌的慢性区室综合征的缠结可能会导致鞭打创伤后的慢性衰弱性疼痛，而没有影像学或电学诊断受伤在这种情况下，手术治疗可以提供持久的缓解。

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