三叉神经—颈反射检测方法的建立和正常值及在神经损伤时的评估作用

目的 建立三叉神经－颈反射的肌电检测方法，测量国人正常值，探讨其临床应用。方法 70例志愿者，取仰卧位，轻度收缩胸锁乳突肌，于眶下孔附近刺激，胸锁乳突肌记录。结果 刺激正常受试者一侧的眶下神经，可引起双侧的正／负波。结论 三叉神经－颈反射能够可靠测定，在下位脑干损伤的定位诊断中有一定作用。     

三叉神经-颈反射检测方法的建立和正常值及在神经损伤时的评估作用

目的建立三叉神经-颈反射的肌电检测方法,测量国人正常值,探讨其临床应用。方法70例志愿者,取仰卧位,轻度收缩胸锁乳突肌,于眶下孔附近刺激,胸锁乳突肌记录。结果刺激正常受试者一侧的眶下神经,可引起双侧的正/负波。结论三叉神经-颈反射能够可靠测定,在下位脑干损伤的定位诊断中有一定作用。     

三叉神经-颈反射对运动神经元病球部损害的诊断价值

背景:运动神经元病的最早及好发部位为颈膨大,随病情发展,最早累及邻近的上部颈段及延髓区,三叉神经-颈反射受累较早。目的:建立三叉神经-颈反射的肌电检测方法,分析三叉神经-颈反射对运动神经元病球部损害的诊断价值。设计:病例-对照观察。单位:北京大学第三医院神经内科电生理检查室。对象:北京大学第三医院2002/2005就诊的运动神经元病患者主要为肌萎缩性侧索硬化症30例及健康志愿者70例。运动神经元病患者符合西班牙ElEscorial会议诊断标准。方法:受检测者取仰卧位,头部轻度抬高。使胸锁乳突肌轻度收缩。刺激一侧眶下神经,于双侧胸锁乳突肌记录峰潜伏期和波幅。所用检测仪器为Keypoint肌电图仪。所用电极均为Ag/Agcl表面电极。主要观察指标:正/负波潜伏期(P20/N30),波幅比率的平方根,即A值。结果:刺激对照者一侧的眶下神经,可于双侧胸锁乳突肌引出正/负波。运动神经元病组7例正常(23.3%),8例未引出(26.7%),11例潜伏期延长(36.7%),4例双侧反射超常不对称(13.3%)。运动神经元病组三叉神经-颈反射正波/负波的峰潜伏期(P20/N30)明显高于正常对照组,差异有显著性。波幅比的平方根(峰值与刺激前波幅比值的平方根即A值)明显低于正常对照组,差异有显著性。结论:三叉神经-颈反射能够可靠测定,可作为颈-球区病变的一种辅助检查手段,有助于运动神经元病的早期诊断。     

三叉神经-颈反射对运动神经元病球部损害的诊断价值

背景：运动神经元病的最早及好发部位为颈膨大，随病情发展，最早累及邻近的上部颈段及延髓区，三叉神经-颈反射受累较早。 目的：建立三叉神经-颈反射的肌电检测方法，分析三叉神经-颈反射对运动神经元病球部损害的诊断价值。 设计：病例-对照观察。 单位：北京大学第三医院神经内科电生理检查室。 对象：北京大学第三医院2002／2005就诊的运动神经元病患者主要为肌萎缩性侧索硬化症30例及健康志愿者70例。运动神经元病患者符合西班牙EI Escorial会议诊断标准。 方法：受检测者取仰卧位，头部轻度抬高。使胸锁乳突肌轻度收缩。刺激-侧眶下神经，于双侧胸锁乳突肌记录峰潜伏期和波幅。所用检测仪器为Keypoint肌电图仪。所用电极均为Ag／Agcl表面电极。 主要观察指标：正／负波潜伏期（P20／N30），波幅比率的平方根，即A值。 结果：刺激对照者一侧的眶下神经，可于双侧胸锁乳突肌引出正／负波。运动神经元病组7例正常（23．3％），8例未引出（26．7％），11例潜伏期延长（36．7％），4例双侧反射超常不对称（13．3％）。运动神经元病组三叉神经-颈反射正波／负波的峰潜伏期（P20／N30）明显高于正常对照组．差异有显著性。波幅比的平方根（峰值与刺激前波幅比值的平方根即A值）明显低于正常对照组，差异有显著性。 结论：三叉神经-颈反射能够可靠测定，可作为颈-球区病变的一种辅助检查手段，有助于运动神经元病的早期诊断。     

先天性肌性斜颈患儿围手术期康复护理

先天性肌性斜颈是小儿常见的一种颈部畸形，多是由于产伤等原因造成的胸锁乳突肌血肿，机化，以致胸锁乳突肌硬化、挛缩，使头颈向一侧偏斜。随年龄增长，症状加重，严重者可继发颈椎侧凸和面部畸形，甚至斜视。除少数患儿在1岁内行手法按摩成功外，大多需行胸锁乳突肌切断术。我院自1995年1月-2005年12月手术治疗该病患儿94例，均取得满意效果，现将护理体会报告如下。     

下胸段脊旁肌肌电图在运动神经元病诊断中的应用

目的探讨下胸段脊旁肌肌电图在诊断运动神经元病(MND)中的价值。方法共检查3组受试者，即A组为102例确诊的MND患者行常规上下肢肌肉、下胸段脊旁肌和胸锁乳突肌肌电图检测；B组为性别、年龄相匹配的96例颈腰脊神经根损害患者，行常规上下肢肌肉、下胸段脊旁肌肌电图检测；C组为性别、年龄相匹配的100名健康人．行常规上下肢肌肉、下胸段脊旁肌肌电图检测。结果102例MND患者中，87例(85．3％)下胸段脊旁肌肌电图可见大量纤颤电位和正锐波，94例(92．1％)胸锁乳突肌肌电图运动单位时限增宽、波幅增高。96例颈腰脊神经根损害的患者中，6例(6．2％)下胸段脊旁肌肌电图可见少量自发电位。100名健康人下胸段脊旁肌肌电图未见异常。结论下胸段脊旁肌肌电图有助于MND的诊断。     

胸锁乳突肌下端切除术治疗肌性斜颈的疗效

目的：评价胸锁突肌下端切除术治疗肌性斜颈（muscular torticollis,MT)的疗效。方法：1992年以来应用胸锁乳突肌下端切断术治疗MT126例，经6个月－8年随访60例，年龄2－17例，平均8．5岁，从功能和美容两方面进行了术前和术后评估。结果：优良率达90％，其中2－7岁组优良率达100％，结论：胸锁乳突肌下端切断术治疗MT仍是简单，方便，并发症少，疗效高的传统方法。     

肌电图变化分析先天性肌性斜颈患儿胸锁乳突肌的病变特征

目的：通过对先天性肌性斜颈患儿作肌电图检查，分析胸锁乳突肌的病变特征与病因之间的关系。方法：选取武汉市儿童医院矫形外科2002-12／2003-12经临床确诊为先天性肌性斜颈患儿，共22例，男14例，女8例；右14例，左8例。按年龄分为新生儿组，日龄20～50d，共8例，均可扪及患侧胸锁乳突肌包块。幼儿少年组14例，年龄2～14岁，痉挛型8例，肥厚型6例。行患侧胸锁乳突肌肌电图检查，检测项目包括轻收缩及强收缩时运动单元电位的时限、波幅及相位。同时对健侧胸锁乳突肌进行相同检测作为正常对照组。结果：新生儿组中轻收缩运动单元电位时限缩短(4．15&;#177;1．23)ms，波幅降低(0．28&;#177;0．11)mV，多相波增多(65&;#177;10)％，强收缩波幅明显降低(0．42&;#177;0．14)mV，各项检测值与正常对照组差异有显著性意义(P&;lt;0．01)。幼儿少年组中痉挛型轻收缩运动单元电位时限(4．53&;#177;1．28)ms、波幅(0．28&;#177;0．15)mV均降低，多相波增多(65&;#177;15)％，强收缩波幅明显降低(0．52&;#177;0．25)mV，且呈病理干扰相，与正常对照组差异有显著性意义(P&;lt;0．05)。肥厚型轻收缩运动单元电位时限(5．52&;#177;0．33)ms，波幅(0．48&;#177;0．23)mV稍降低，强收缩波幅降低(0．92&;#177;0．2)mV也呈病理干扰相，与正常对照组差异有显著性意义(P&;lt;0．05)。幼儿少年组痉挛型与肥厚型检测结果对比分析，差异有显著性意义(P&;lt;0．05)。结论：患侧胸锁乳突肌存在肌源性病变，痉挛型胸锁乳突肌的病变较肥厚型重。依据肌电图检测结果推测先天性肌性斜颈病因为胸锁乳突肌血循环障碍所致。     

先天性肌性斜颈胸锁乳突肌细胞外基质的组织化学研究

目的检测先天性肌性斜颈 ( Congenital Muscular Torticollis,CMT) 胸锁乳突肌细胞外基质胶原及糖胺聚糖 ( glycosaminoglyc ans,GAG) 的含量变化 , 探讨其与发病机制的关系 . 方法采用组织化学方法 Masson三色和严格电解质浓度的 Alcian blue染色 , 对 30例 CMT及 5例非 CMT小儿尸体胸锁乳突肌标本进行胶原和 GAG的检测 . 结果 CMT胸锁乳突肌胶原和 GAG含量比对照组高 , 有极显著性差异 ( P <0.01)。结论 CMT胸锁乳突肌纤维化可能与其胶原及GAG的含量显著增高有关.     

小儿胸锁乳突肌假性肿瘤的超声诊断

小儿胸锁乳突肌假性肿瘤，又称肌性斜颈，是由于一侧胸锁乳突肌挛缩所致头部向患侧偏斜，并随患者年龄增长而逐渐引起面部及头颅畸形的一种常见病。该病以儿童为主，在婴幼儿发病率为0．4％-1．3％。其临床表面为患侧颈部有突起的肿块，质硬，随胸锁乳突肌被动移动，肿块表面不红，温度正常，无压痛，若早期得不到合理治疗，随年龄增长畸形将逐渐加重，将对病人各个方面带来很大的影响。因此对该病早期诊断、早期治疗有着重大意义。本文通过对我院前几年就诊的36例小儿胸锁乳突肌假性肿瘤的声像图进行回顾性总结分析，以提高超声对该病的诊断符合率。     

腰椎间盘突出症的电生理检查分析

为探讨电生理检查对腰椎间盘突出症的诊断意义,对１２３例（病例组）腰椎间盘突出症患者进行肌电图、运动神经传导速度、Ｆ波传导速度和Ｈ反射检测,并与正常人组比较和健患侧对比。结果：病例组肌电图和Ｈ反射的异常率分别为８７．８％和９０．０％,Ｆ波传导速度减慢显著。提示：综合电生理检查能早期定位神经根病损的范围,判断程度和预后,有助于腰椎间盘突出症的诊断。     

H反射在脑卒中后上肢偏瘫患者中的特征表现及分析

目的:通过研究脑卒中后上肢偏瘫患者H反射的特征表现,及其与偏瘫肢体肌张力的关系,探讨H反射在脑卒中后上肢偏瘫患者神经电生理评定中的应用价值。方法:选择符合本研究入选标准的脑卒中恢复期偏瘫患者42例。分别对患者双侧正中神经、尺神经、桡神经所支配的拇短展肌、小指展肌、指总伸肌进行H反射检查,并对患侧上肢给予改良Ashworth痉挛量表(MAS)评定,确定上述神经中哪些更容易引出H反射,并对其所引出的H反射结果及其与MAS的相关性进行比较和分析。结果:患者双侧正中神经、尺神经所支配的拇短展肌、小指展肌均较易引出H反射,引出率100%。桡神经所支配的指总伸肌不易(3例/42例,引出率7.14%)引出H反射。患侧正中神经和尺神经的H反射潜伏期分别为(25.89±3.66)ms、(25.71±3.26)ms;健侧正中神经和尺神经的H反射潜伏期分别为(26.60±3.11)ms、(26.44±2.87)ms。配对t检验分析,差异均有显著性意义(P<0.05);Hmax/Mmax比值均数用中位数表示,患侧正中神经和尺神经的Hmax/Mmax比值分别为0.185和0.217;健侧Hmax/Mmax比值分别为0.126和0.112,用Wilcoxon符号秩检验分析,患侧与健侧差异均有显著性意义(P<0.05)。用Kruskal-WallisH检验分析显示:患侧上肢正中神经、尺神经H反射潜伏期在MAS不同级别中没有差异,而Hmax/Mmax比值在MAS不同级别中有差异。Spearman秩相关检验结果显示:患侧上肢正中神经H反射潜伏期、Hmax/Mmax比值以及尺神经H反射潜伏期与MAS不相关;而患侧上肢尺神经Hmax/Mmax比值与MAS存在秩相关关系。结论:上肢H反射与MAS存在一定关系,其中Hmax/Mmax比值是评估下运动神经元兴奋性的较好指标,可以成为临床评价痉挛的客观神经电生理指标。     

胫前肌腓骨长肌改良H反射的正常值及对L5神经根受压的临床应用

54名健康受试者接受H反射检查,胫前肌、腓骨长肌静息时刺激腓总神经,有12名可引出微弱的H反射.改良H反射是指测试肌收缩时所进行的测试,所有受试者都可记录到H反射波.足背屈时可增强庄前肌的H反射,跖屈时减弱;腓骨长肌H反射与之相反.H反射幅度在同一受试者双侧或不同受试者之间差异显著.改良H反射应用于16例L_5神经根受压患者,其中13例发现异常,表现为:双侧潜伏时差超过正常范围,单侧或双侧潜伏时延长,反射减弱或消失.实验表明改良H反射对脊神经根损伤的功能完整性评价是一项重要可靠的试验.     

Somatosensory evoked potentials are unchanged by reflex sympathetic dystrophy and by stellate ganglion block.

Median nerve somatosensory evoked potentials (SEPs) were monitored in patients with chronic pain before and after stellate ganglion blockade. A change caused by the syndrome or by the block would suggest that SEPs might be useful in the diagnosis and treatment of chronic pain. We observed 20 subjects. Group I (n = 10) had chronic pain not involving the upper extremity. Group II (n = 8) had reflex sympathetic dystrophy of the arm. All patients underwent unilateral stellate ganglion block using an anterior paratracheal approach. The SEPs were recorded by median nerve stimulation on the blocked (affected) side and unblocked (unaffected) side before and 30 min after the block. Recording sites were ipsilateral brachial plexus, the cervical spinal cord, and the contralateral sensory cortex. There were no between-group differences before or after the block. Paired analysis within each group showed that the SEPs were not different from baseline (unaffected side before block) at any time throughout the study. We conclude that since SEPs are not changed by the reflex sympathetic dystrophy or stellate ganglion block, they would not be useful in the evaluation of pain or in determining the effectiveness of sympathetic block. Both the pain and the block appear to involve alteration of conducting pathways separate from those monitored by median nerve SEPs.     

Positional Cervical Spinal Cord Compression and Fibromyalgia: A Novel Comorbidity With Important Diagnostic and Treatment Implications

The variable presentation and treatment response of fibromyalgia (FM) may be related to comorbidities, including positional cervical cord compression (PC3). Prevalence of PC3 among routine referrals for rheumatology consultation was assessed over 2 random months (January and February 2006) from a 4-year experience of 1100 patients. PC3 was defined as cord abutment, compression or flattening with a spinal canal diameter of <10 mm by magnetic resonance sagittal flexion, neutral, and extension images. Of 107 referrals, 53 had FM, 32 had a connective tissue disease (CTD) without FM, and 22 had chronic widespread pain (CWP) without FM criteria. The dynamic cervical spine images were obtained in 70 patients: 49 of 53 with FM, 20 of 22 with CWP and 1 of 32 with CTD, based on history and examination. Among those who received magnetic resonance imaging [MRI], 52 patients met PC3 criteria (71% of FM group [35/49], 85% of CWP group [17/20]). Two patients had a Chiari malformation (FM), 1 had multiple sclerosis (CWP), and 1 had multiple myeloma (CWP). Extension views were required for diagnosis for 37 of these 52 (71%) subjects, as well as for 8 patients who also had cervical spinal cord flattening. The pilot data suggest that further evaluation of PC3 in a controlled trial is warranted among patients with FM and CWP.PerspectiveFibromyalgia is complex and poorly understood. Recognition of unsuspected, comorbid cervical cord compression may provide new insight into its variable presentation, leading to novel treatment considerations. Also, dissemination of this dynamic MRI protocol may promote further study of this emerging concept of cervical cord irritation.     

30例多发性硬化患者视诱发电位检测

目的研究视诱发电位（VEP）异常与多发性硬化症的关系。方法对临床确诊的30例多发性硬化患者和30例神经内科诊断为非多发性硬化症患者进行VEP检查，并分析VEP的检查结果与临床症状间的关系。结果多发性硬化患者VEP检查的异常率为76．7％。而82．6％的VEP异常者在临床上表现出视觉症状。结论多发性硬化患者的VEP检查中有较高的异常率，对多发性硬化的诊断有参考价值。     

多发性硬化患者的视觉、脑干听觉诱发电位测定及其意义

目的；探讨视觉诱发电位（VEP）、脑干听觉诱发电位（BAEP）对多发性硬化（MS）的诊断意义。方法：对20例临床诊断为MS的患者进行VEP、BAEP检测，并与对照组进行比较分析。结果：MS患者VEP、BAEP的异常率分别为70％和55％。VEP、BAEP异常者中，各有72％和63％的患者，临床有相应的症状；各有28％和37％的患者临床无相应症状。结论：VEP、BAEP检测对MS的诊断有重要意义。     

Paroxysmal stabbing headache in the multiple dermatomes of the head and neck: a variant of primary stabbing headache or occipital neuralgia?

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2(nd) Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.     

Plasma renin and serum dopamine-beta-hydroxylase during orthostatic hypotension in quadriplegic man

To determine whether orthostatic hypotension in patients with cervical spinal cord lesions is the result of impaired sympathetic nerve response and/or impaired renin release, serum dopamine-beta-hydroxylase (DbetaH) activity and plasma renin activity (PRA) were examined during passive tilting in 6 quadriplegic patients and in 6 able-bodied control subjects. Serum DbetaH was measured by an isotopic enzymatic method and PRA by radioimmunoassay. Following head-up tilting, quadriplegic subjects demonstrated a prompt, significant decrease in mean arterial pressure (MAP) and increase in heart rate (HR). DbetaH and PRA both increased significantly 15 minutes after tilt. In normal subjects, although HR increased, MAP was unchanged; DbetaH and PRA did not increase significantly during head-up tilt. The finding of increased DbetaH during tilt hypotension in quadriplegic patients provides evidence that reflex sympathetic nerve stimulation persists despite cervical cord transection. Increased PRA may be attributed to decreased renal perfusion pressure and increased sympathetic stimulation during tilt hypotension. These data suggest that orthostatic hypotension in quadriplegia patients cannot be attributed solely to failure of the sympathetic nervous system or the renin-angiotensin system to respond to the stimulus of orthostasis.