摘要目的:通过对沙漏样狭窄性神经病的解剖、临床特点、病因和治疗的研究，以加深对该病的认识。方法:我们自2007年至2020年收治27例(29根神经)由沙漏样狭窄导致的自发性神经麻痹病例，术前进行超声和电生理检查。对轻至中度狭窄行神经束膜松解手术，对神经束已经完全断裂的重度狭窄进行神经缝合手术。术后进行长期规律的随访。结果:急性发作的疼痛往往是首发症状，疼痛持续短时间后即出现肌肉麻痹，症状进展快，程度重。手术探查显示神经呈沙漏样狭窄，但却找不到与狭窄有关的外在卡压结构。电生理检查显示严重的失神经改变，组织病理检查显示炎性细胞浸润。对于重度狭窄，神经缝合的有效率为66.7%(6/9)，神经束膜松解的有效率接近100%(3/3)。所有轻、中度狭窄均通过束膜松解的方式成功治疗(13/13)。结论:沙漏样狭窄性神经病的发生是多种致病因素综合作用的结果。对于没有自发性恢复，且超声检查证实存在沙漏样狭窄病灶的患者，尽早的手术干预是有意义的。我们推荐对轻、中度狭窄进行神经束膜松解手术，对神经连续性已经中断的严重狭窄行神经缝合手术。

abstractsObjective:To deepen the understanding of Hourglass-like constriction neuropathy through the study of anatomy, clinical characteristics, etiology and treatment of it.Methods:From 2007 to 2020, 27 cases (29 nerves) of spontaneous nerve paralysis caused by Hourglass-like constriction were treated. The ultrasound and electrophysiological examination were performed before operation. The interfascicular neurolysis was performed for mild to moderate constriction and neurorrhaphy for severe constriction with fasciculus completely ruptured. The long-term regular follow-up was performed after operation.Results:Acute onset pain is often the first symptom. Muscle paralysis occurs after the pain lasts for a short time. The symptoms progress quickly and the degree is serious. Surgical exploration showed that the nerve was Hourglass-like constriction, but the external compression structure related to the constriction could not be found. The electrophysiological examination showed severe denervation, and the histopathological examination showed inflammatory cell infiltration. For severe constriction, the effective rate of neurorrhaphy was 66.7% (6/9), and the effective rate of neurolysis was close to 100% (3/3). All mild and moderate constriction were successfully treated by interfascicular neurolysis (13/13).Conclusion:The occurrence of Hourglass-like constriction neuropathy is the result of the comprehensive action of many pathogenic factors. For patients without spontaneous recovery and with Hourglass-like constriction confirmed by ultrasonography, early surgical intervention is meaningful. We recommend interfascicular neurolysis for mild and moderate constriction and neurorrhaphy for severe constriction with interrupted nerve continuity.