儿童周围神经损伤康复治疗的肌电观察

目的观察儿童神经损伤后采用康复治疗的肌电变化。方法康复治疗采用理疗，穴位水针注射，神经促通手法，传统按摩和功能锻炼的综合手段。每例治疗前及治疗后１～３个月做肌电图检查，观察３１例周围神经损伤患儿共观察１５５块肌肉的肌电变化：失神经电位，运动单位电位波幅，相数，运动单位电位募集型，神经传导速度。结果治疗前后效果，差异有显性，Ｐ＜０．００５。结论综合康复对儿童神经损伤有明显疗效。     

儿童周围神经损伤康复治疗的肌电视察

目的观察儿童神经损伤后采用康复治疗的肌电变化。方法　康复治疗采用理疗,穴位水针注射,神经促通手法,传统按摩和功能锻炼的综合手段。每例治疗前及治疗后１—３个月做肌电图检查,观察３１例周围神经损伤患儿共观察１５５块肌肉的肌电变化：失神经电位,运动单位电位波幅,相数,运动单位电位募集型,神经传导速度。结果治疗前后效果,差异有显著性,Ｐ＜０．００５。结论综合康复对儿童神经损伤有明显疗效。     

物理康复小儿腓总神经重度损伤1例

患儿女,4岁。因扁桃腺炎肌注青霉素,左臀部注射第3针时剧痛哭闹,注后不能行走,数小时后左足下垂、跛行。六周后肌电图检查:左胫前肌放松时多纤颤电位,自发频率30～40次/秒,用力时无自主性活动电位。腘部2ms50V方波刺激无反应,300ms方波刺激有反应,诊断为左腓总神经重度损伤收入院。查体:左足下垂,左小腿前外侧肌肉萎缩,痛觉明显减退,胫前肌及腓骨肌伸肌伸趾肌张力低,肌力0级,行走呈跨阈步态。给予超短波、蜡疗、电动体操、体疗和电按摩治疗。治疗后80天检查左小腿肌肉萎缩及肌张力改善。肌电图复查左胫前肌放松时少量纤颤和正相电位,轻用力见运动单位电位及多相电     

物理疗法应用于周围性面瘫的疗效观察

目的:观察物理疗法应用于周围性面瘫的疗效。方法:在急性期采用超短波、红外线,在恢复期采用超短波、中频电疗和功能训练进行治疗。治疗前后均采用Portmann简易评分法及表情肌肌电信号测定进行评分。结果:治疗前、后Portmann简易评分比较差异有显著性意义(治疗前2.9835±1.6371,治疗后15.6209±1.8743,P<0.01);治疗前、后表情肌肌电信号评分差异同样有显著性意义(额肌:治疗前17.55±5.45,治疗后41.35±7.46,P<0.01;眼轮匝肌:治疗前20.75±5.95,治疗后55.40±10.52,P<0.01;提上唇肌,治疗前24.80±7.56,治疗后79.35±36.83,P<0.01;口轮匝肌,治疗前63.45±15.85,治疗后88.40±15.61,P<0.01)。结论:在急性期采用超短波、红外线,在恢复期采用超短波、中频电疗和功能训练治疗周围性面瘫有明显的疗效。     

硬膜外注药治疗腰椎间盘突出症的电生理变化

目的观察硬膜外注药治疗腰椎间盘突出症的电生理变化。方法70例腰椎间盘突出患者,采用康宁克通40mg,2%利多卡因注射液2ml,维生素B1100mg,维生素B12500μg硬膜外注射,于注射前1～3d和注射后1～3个月做肌电图检查,共观察350块肌肉的电生理变化:失神经电位,运动单位电位波幅、时限、相数、募集型,神经传导速度,F波传导速度。结果治疗前后资料经统计学处理差异有显著性意义,P<0.05。结论硬膜外注射治疗腰椎间盘突出症的电生理变化显示明显优于治疗前。     

硬膜外注药治疗腰椎间盘突出症的电生理变化

目的 观察硬膜外注药治疗腰椎间盘突出症的电生理变化。方法 70例腰椎间盘突出患，采用康宁克通40mg,2%利多卡因注射液2ml，维生素B1 100mg,维生素B12 500μg硬膜外注射，于注射前1－3d和注射后1－3个月做肌电图检查，共观察350块肌肉的电生理变化：失神经电位，运动单位电位波幅、时限、相数、慕集型，神经传导速度，F波传导速度。结果 治疗前后资料经统计学处理差异有显性意义，P＜0．05。结论 硬膜外注射治疗腰椎间盘突出症的电生理变化显示明显优于治疗前。     

正骨推拿对腰椎间盘突出症部分相关肌群的电生理影响

目的观察正骨推拿对腰椎间盘突出症部分相关肌群的电生理变化。方法对31例腰椎间盘突出症患者进行手法前后的肌电图检查,对腓肠肌内、外侧头,腓骨长肌,胫骨前肌作最大收缩时的运动电位进行测定和比较。结果推拿治疗后比治疗前腓肠肌内、外侧头,腓骨长肌作最大收缩时的运动电位有显著性差异(P<0.05),胫骨前肌的运动电位无显著性差异(P<0.05).结论下骨推拿对腰椎间盘突出症所致神经操作有康复作用,从部分相关肌群的功能恢复来扒断正骨推拿对腰椎关突出症作用机制为解除神经根的压迫,消除软组织炎症和粘连,并使椎间盘发生位移     

物理方法治疗周围性面神经麻痹

结合面神经的解剖、病理特点和相关文献,可以得出综合运用几种物理疗法效果优于单纯一种方法治疗;急性期(发病10d内)超短波治周围性面神经麻痹效果显著;运动是治疗周围性面神经麻痹有效的方法;低频脉冲电刺激治疗周围性面神经麻痹有一定的疗效,但对面肌的失用性肌萎缩的效果不显著。     

银质针治疗腰椎间盘突出症的临床肌电图观察

本文对１２例腰椎间盘突出症采用银质针刺疗法治疗前后进行腰部骶棘肌临床肌电图对照检查,以观察该症引起的腰部神经肌肉功能变化与治疗效果的关系。结果提示治疗前全部病 有自发性电活动,经银质针疗法后７例减少,４例消失,３例患者治疗前运动单位平均时限低于正常的８０％,为肌源性损害表现,治疗后全部恢复正常;６例患者治疗后一周检查最大用力收缩动作电位出现混合相,单纯混合相、单纯相波形,与治疗后临床出现短暂的下肢     

物理方法治疗周围性面神经麻痹

结合面神经的解剖、病理特点和相关献，可以得出综合运用几种物理疗法效果优于单纯一种方法治疗；急性期(发病10d内)超短波治周围性面神经麻痹效果显；运动是治疗周围性面神经麻痹有效的方法；低频脉冲电刺激治疗周围性面神经麻痹有一定的疗效，但对面肌的失用性肌萎缩的效果不显。     

经皮神经肌肉电刺激促进周围神经再生的应用价值

背景周围神经损伤后的变性与再生是一个很复杂的病理生理过程,关于电刺激对神经再生恢复的促进作用仍需要探讨.目的比较经皮神经肌肉电刺激治疗促进不同部位周围神经再生的作用与效果.设计以患者为观察对象,病例分析.单位一所医学院附属医院的神经电理室和骨科.对象1999-10/2003-06宁夏医学院附属医院骨科、神经内科门诊及住院的周围神经损伤患者中,选择经临床诊断和肌电图证实的78例周围神经不全损伤患者.方法对入选78例周围神经不全损伤患者采用丹迪Cantata型肌电图仪对,进行经皮神经肌肉电刺激治疗,观察受损周围神经功能恢复情况,并行治疗前、后肌电图对比分析及不同病程治疗后的疗效对比分析.主要观察指标①治疗前后肌电图变化.②神经传导速度变化.③神经功能恢复情况.结果78例臂丛神经、坐骨神经不全损伤者,经1～10个疗程的治疗,53例患者肢体运动、感觉功能恢复正常,18例患者肢体运动、感觉功能明显改善,有效率91%(71/78).治疗后失神经电位,运动神经传导速度,感觉神经传导速度均较治疗前有明显改善.结论经皮神经肌肉电刺激治疗,可促进周围神经的再生,改善受损神经局部血液循环,提高神经肌肉的兴奋性.     

超短波对急性脊髓损伤大鼠神经功能及BDNF-TrkB表达的影响

目的:观察无热量超短波对急性脊髓损伤大鼠神经功能恢复和BDNF-TrkB表达的影响,并探讨其可能作用机制。方法:成年雌性SD大鼠72只,随机分为Sham组(24只)、SCI组(24只)和USW组(24只)。应用改良Allen法制备大鼠脊髓损伤模型。Sham组仅行椎板切除术暴露硬脊膜,不予打击,直接缝合,术后不给予任何治疗。USW组在脊髓损伤造模后24h给予受损部位无热量超短波治疗(最大输出功率40W,实际输出功率11.58W),10min/次,1次/d,至取材前。SCI组造模后不给予任何治疗。在造模后1d、7d、14d和21d用BBB评分、体感诱发电位(SEPs)和运动诱发电位(MEPs)评定脊髓损伤后后肢功能恢复情况并获取损伤段脊髓标本,术后4周取材,用免疫组织化学方法检测SCI组和USW组脊髓在损伤后不同时段BDNF及TrkB的表达,并行阳性细胞计数。结果:BBB评分结果提示,USW组大鼠7d、14d、21d时的运动功能恢复较SCI组明显提高(P0.01);SEPs和MEPs结果显示,USW组大鼠7d、14d、21d时的神经功能较SCI组明显改善(P0.05);免疫组织化学方法提示,与SCI组相比,USW组在一定时间段能上调损伤脊髓区BDNF-TrkB的表达(P0.05)。结论:无热量超短波能在一定程度上促进损伤脊髓的神经功能恢复,其机制可能与超短波上调损伤区脊髓BDNF-TrkB的表达有关。     

Electrophysiologic studies of the median nerve and its palmar cutaneous branches after nerve grafting

Electromyography (EMG) and nerve conduction studies were performed on a patient with an incomplete lesion of the median nerve involving the motor fibers to the thenar muscles, the palmar cutaneous branches, and the sensory fibers to the index finger. The studies were done before, and 13 weeks, 16 weeks, and one year after grafting. The preoperative electrodiagnostic evaluation showed abnormalities involving the median motor fibers and the palmar cutaneous branch. Electromyography of the opponens pollicis and abductor pollicis brevis before surgery showed severe active denervation. Thirteen weeks after nerve grafting, the median motor distal latency was prolonged and the amplitude of the evoked potential of the median motor and index finger digital sensory nerves were decreased. At 16 weeks, both the latency and amplitude showed improvement, as did EMG of the affected muscles. One year later, the electrophysiologic findings were normal except for a slightly prolonged median motor distal latency. Clinical and functional improvement after grafting correlated well with the electrophysiologic findings. We conclude that EMG and nerve conduction studies are useful tools for following the progression of recovery after nerve grafting.     

Motor unit synchronization is reduced in anterior knee pain.

Anterior knee pain (AKP) is common and has been argued to be related to poor patellofemoral joint control due to impaired coordination of the vasti muscles. However, there are conflicting data. Changes in motor unit firing may provide more definitive evidence. Synchronization of motor unit action potentials (MUAPs) in vastus medialis obliquus (VMO) and vastus lateralis (VL) may contribute to coordination in patellofemoral joint control. We hypothesized that synchronization may be reduced in AKP. Recordings of single MUAPs were made from VMO and multiunit electromyograph (EMG) recordings were made from VL. Averages of VL EMG recordings were triggered from the single MUAPs in VMO. Motor units in VL firing in association with the VMO motor units would appear as a peak in the VL EMG average. Data were compared to previous normative data. The proportion of trials in which a peak was identified in the triggered averages of VL EMG was reduced in people with AKP (38%) compared to controls (90%). Notably, although 80% of subjects had values less than controls, 20% were within normal limits. These results provide new evidence that motor unit synchronization is modified in the presence of pain and provide evidence for motor control dysfunction in AKP. PERSPECTIVE: This study shows that coordination of motor units between the medial and lateral vasti muscles in people with anterior knee pain is reduced compared to people without knee pain. It confirms that motor control dysfunction is a factor in this condition and has implications for selection of rehabilitation strategies.     

Sensorimotor integration in Complex Regional Pain Syndrome: a transcranial magnetic stimulation study

There is evidence that patients with Complex Regional Pain Syndrome (CRPS) have altered central sensorimotor processing. Sensory input can influence motor output either through indirect pathways or through direct connections from the sensory to motor cortex. The purpose of this study was to investigate sensorimotor interaction via direct connections in patients with CRPS and to compare the results with normal subjects'. Direct short-latency sensory-motor interaction was evaluated in eight patients with CRPS1 affecting a hand. Modulation of EMG responses to transcranial magnetic stimulation (TMS) induced by concomitant median nerve stimulation was measured, the so-called, short-latency afferent inhibition (SAI). Results were compared with eight normal subjects who were age and sex matched with the patients. As expected, all the normal subjects' EMG responses to TMS with median nerve stimulation were smaller than responses to TMS alone. In seven of the eight CRPS patients EMG responses to TMS were suppressed when paired with median nerve stimulation. Only one CRPS patient's results showed no suppression of EMG responses. These results suggest that the disease mechanisms of CRPS1 do not typically affect the direct neural circuit between sensory and motor cortex and that normal sensorimotor interaction is occurring via this route.     

Polyneuropathy: potential cause of difficult weaning

Severe critically ill polyneuropathy (CIP) is a neurologic syndrome with potential effects on ventilatory weaning. Fifteen CIP patients with the following clinical criteria were diagnosed: limb weakness, amyotrophy, and reduced deep tendon reflexes. Electromyogram (EMG) confirmed polyneuropathy by the following signs: denervation, normal nerve conduction velocities, normal distal latencies, and decreased compound action potential. It was observed that motor signs were more important than sensitivity. EMG performed during ICU hospitalization showed axonal abnormalities. Ventilation and mean duration of weaning were unusually long. Four patients had EMG a few years after discharge; the recovery was delayed and incomplete. The present study suggests that CIP is a multifactorial disease.     

神经电图-肌电图检测对多灶性运动神经病的评估作用

目的:探讨神经电图(ENG)和肌电图(EMG)检查对多灶性运动神经病(multifocalmotorneuropathy,MMN)的诊断价值及康复干预的评估作用。方法:对16例诊断为MMN的患者进行电生理检查,受试者为MMN组16例和正常组16例,分别进行运动神经传导速度(MCV)和感觉神经传导速度(SCV)检查,记录刺激引出的复合肌肉动作电位(compoundmus-cleactionpotentials,CMAP)的波幅、波宽、面积、位相、时限进行对比分析,判定是否有运动神经传导阻滞(conductionblock,CB)或暂时性离散(temporaldispersion,TD)。并有选择性地进行常规肌电图检查。结果:16例患者中均见有一根以上运动神经或至少一根运动神经的一个以上部位出现CB或TD。其中13例双上肢正中神经,尺神经出现CB,3例首发为正中神经尺神经的远端出现CB,随病情进展出现下肢腓深神经CB。仅有两例感觉神经传导速度稍有减慢,波幅略有降低。16例患者神经受累区域以下所支配肌肉肌电图检查见有运动神经源性受损改变。结论:MMN病是一种以远端神经受累为主的不对称性周围神经病,神经电生理检查对诊断和鉴别诊断MMN起重要作用,CB是MMN特征性表现。     

无热量超短波治疗对大鼠脑缺血再灌注损伤后SPCA1的影响

目的 观察无热量超短波治疗对大鼠脑细胞缺血再灌注损伤后脑梗死体积、分泌途径衍生钙离子转运ATP酶（Secretory-pathway Ca2+-ATPase,SPCA）1的影响。 方法 选取80只SD大鼠,将大鼠分为假手术组（8只）、模型组（36只）、超短波组（36只）。用线栓法制备一侧大脑中动脉栓塞再灌注大鼠模型,模型组和超短波组大鼠进行造模处理,假手术组大鼠处理同模型组和超短波组,但不插入线栓。模型组按照再灌注时间分为模型1d组（12只）、模型3d组（12只）、模型7d组（12只）,超短波治疗组分为超短波1d组（12只）、超短波3d组（12只）、超短波7d组（12只）。各亚组分别于造模后1d、3d、7d处死取标本。用红四氮唑染色法观察并计算每组大鼠的脑梗死体积,采用Western blot法检测患侧海马SPCA1蛋白变化。 结果 假手术组大鼠脑切片均红染,未见梗死灶。缺血再灌注后,模型组和超短波组大鼠脑缺血区域出现白色梗死灶,随着时间延长,脑梗死体积均减小。与模型组同时间点比较,超短波组脑梗死体积均较小（P<0.05）。与假手术组比较,除超短波7d组外,各组大鼠SPCA1均降低 (P<0.05)。随着时间延长,模型组和超短波组大鼠SPCA1增加(P<0.05)。与模型组同时间点比较,超短波1d组大鼠SPCA1轻度增加,但差异无统计学意义（P>0.05）,超短波3d组、超短波7d组大鼠SPCA1较模型组3d组、模型组7d组显著增加,差异有统计学意义（P<0.05）。 结论 无热量超短波治疗可减小脑梗死体积,减轻脑缺血再灌注损伤,其机制可能是抑制了SPCA1表达水平下调,从而减轻了神经细胞凋亡,促进神经功能恢复。     

小儿坐骨神经注射性麻痹的肌电图观察

背景肌电图检测是确诊注射性坐骨神经损伤重要方法之一,但其早期异常表现,异常程度与病程的相关性及各项指标的差异比较尚缺乏深入研究.目的探讨注射性坐骨神经损伤的电生理特点.设计以诊断为依据临床观察分析.地点和对象104例南京医科大学附属脑科医院门诊确诊患儿,年龄4个月～14岁,病前均有明确臀部肌肉注射史,既往无其他神经肌肉疾病.干预应用丹迪Neuromatic 2000 M型肌电仪检测患儿的患肢肌电图.主要观察指标检测患儿的患肢腓总神经和胫神经/胫后神经的感觉传导速度(sensory conduction velocity,SCV)、运动传导速度(motor conduction velocity,MCV)、末端运动潜伏期(distal motor latency,dML)和末端复合肌肉动作电位波幅(distal compound muscle action potential amplitude,dCMAPA)、感觉神经动作电位波幅(sensory nerve action potential ampli-tude,SNAPA);同时检测坐骨神经支配肌的针极肌电图.结果肌注后2～7 d已可检出多项电生理异常.腓总神经支的神经传导速度(nerve conduction velocity,NCV)异常率(68.0%)明显高于胫神经支(43.5%)(x2=12.199,P＜0.005).腓总神经SCV,SNAPA和dML,dCMAPA异常程度与病程正相关(r=0.306 8,P＜0.005;r=0.296 3,P＜0.005;r=0.337 6,P＜0.001;r=0.215 7,P＜0.05).8个月以上病程患儿的SCV, SNAPA和dML异常程度明显增加(F=3.105,P＜0.05;F=4.095,P＜0.01;F=5.904,P＜0.01),较8个月内有显著差异.腓总神经NCV各项配对t检验发现运动纤维dML和dCMAPA异常程度重于感觉纤维SCV和SNAPA(t=2.070,P＜0.05;t=3.520,P＜0.001).结论化学药物对神经髓鞘传导功能有直接损伤.坐骨神经运动纤维的电生理异常早于且重于感觉纤维.腓总神经运动传导功能检测是本病早期诊断的重要依据.8个月以上病程的损伤神经恢复难度增加.