末梢神経疾患の鑑別診断と手術適応・将来展望  [in Japanese] Differential Diagnosis and Operative Indication of Peripheral Nerve Entrapment Neuropathy and Future Perspective  [in Japanese]

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Author(s)

    • 原 政人 Hara Masahito
    • 稲沢市民病院脳神経外科・脊髄末梢神経センター Department of Neurosurgery/Spine and Peripheral Nerve Center, Inazawa Municipal Hospital
    • 赤堀 翔 Akabori Sho
    • 稲沢市民病院脳神経外科・脊髄末梢神経センター Department of Neurosurgery/Spine and Peripheral Nerve Center, Inazawa Municipal Hospital
    • 深谷 宜央 Fukaya Nobuhisa
    • 稲沢市民病院脳神経外科・脊髄末梢神経センター Department of Neurosurgery/Spine and Peripheral Nerve Center, Inazawa Municipal Hospital
    • 山本 優 Yamamoto Yuu
    • 稲沢市民病院脳神経外科・脊髄末梢神経センター Department of Neurosurgery/Spine and Peripheral Nerve Center, Inazawa Municipal Hospital

Abstract

<p> 上下肢のしびれや痛みを主訴に来院する患者は多い. 鑑別診断を行うにあたり最も重要なのは, 神経診断を確実に行うことである. 症候と神経診断である程度の診断を固めた後に, 画像所見, 電気生理学的所見を総括し, 診断を確定する. 神経高位として, 脳・脊髄・神経根以外に上肢では, 胸郭出口症候群, 手根管症候群, 肘部管症候群, ギオン管症候群などを, 下肢では, 腓骨神経絞扼障害, 足根管症候群, 梨状筋症候群などを考慮する必要がある. 末梢神経絞扼障害においては, しびれ・痛みの神経支配領域を考えるのが診断にたどり着く近道である. Tinel徴候, 肢位による症状誘発テストは末梢神経疾患の診断においては今なお非常に有用である. 最近では, MRIや超音波検査などの画像診断が発達してきているが, 電気生理学的検査が今も重視されている.</p><p> 末梢神経絞扼障害においては, 初期の症状においては局所安静が非常に有用で, その他, 理学療法, 薬物療法などの保存的治療が中心になる. 症状が強く日常生活に支障をきたしているもの, 筋力低下をきたしているもの, 症状が進行するものに対しては手術を考慮する.</p><p> 日本は, 諸外国とは異なり, 神経診断と外科治療が分担されておらず, このためむしろフィードバックが確実に得られ, 診断能力の向上, ひいては手術手技の向上に寄与している可能性がある. 診断においては神経内科医, 治療に関しては整形外科医も関与しているが, 末梢神経疾患は神経全体を扱うことのできる脳神経外科医が取り組むべき疾患である.</p>

<p>  Many patients come to the hospital with complaints of numbness and pain in their upper and lower limbs. In this situation, the most important thing in conducting a differential diagnosis is to ensure that the proper neurological examinations are conducted. The brain, spinal cord, nerve roots and peripheral nerves are the responsible sites for neurological symptoms. After making a conceivable diagnosis by consolidating the patients symptoms and neurological examination results, we perform imaging and electrophysiological studies and finally determine the affected site. Some of the more common peripheral nerve entrapment neuropathies are carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, peroneal nerve entrapment neuropathy, tarsal tunnel syndrome and so on. In peripheral nerve entrapment disorders, comprehending the skin innervation area of numbness or pain is a key point in making an accurate diagnosis. Tinel's sign and symptom induction tests according to patient some posture are still very useful in the diagnosis of peripheral nerve disorders. Recently, imaging studies such as MRI and high-resolution ultrasonography have been developed and have become more reliable for diagnosing of the severity of the nerve degeneration, but electrophysiological examination is still important. For peripheral nerve entrapment disorders, immobilization or rest of the affected site is very useful in the early stage, and conservative treatment such as physical therapy and medication therapy should also be performed. Surgical treatment might be recommended for the cases with severe symptoms, symptom progression and daily life impairment by severe pain.</p><p>  Japan is different from other countries in the point of clinical practice. Neurosurgeons must diagnose the disease, perform surgeries and then take care of patients. As the diagnosis, surgery and postoperative follow-up are not independent for Japanese neurosurgeons, so patient feedback can be reliably obtained, which may contribute to improving the diagnostic ability and surgical techniques. Although neurologists are also involved in diagnosis and orthopedic surgeons are also involved in the surgical treatment, surgical treatment for peripheral nerve entrapment disorders should be guided in the future by neurosurgeons who can handle the whole nervous system.</p>

Journal

  • Japanese Journal of Neurosurgery

    Japanese Journal of Neurosurgery 27(4), 300-306, 2018

    The Japanese Congress of Neurological Surgeons

Codes

  • NII Article ID (NAID)
    130006725944
  • Text Lang
    JPN
  • ISSN
    0917-950X
  • Data Source
    J-STAGE 
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