前臂尺神经干动作电位在轻度肘管综合征诊断中的应用

目的寻求诊断肘管综合征的最敏感的电生理指标。方法2005年10月-2006年3月，对32例轻度肘管综合征的患者进行系统的电生理检测，并对数据进行分析。结果32例中肘段尺神经运动传导速度（MNCV）减低阳性率占50％，小指-腕感觉传导速度（SNCV）减慢及感觉电位波幅（AMP）降低的阳性率占40．6％，前臂尺神经干动作电位（NAP）波幅降低的阳性率占87．5％，肘段尺神经短段微移测定（SSCT）异常占59．4％，肌电图检测（EMG）阳性率占3．1％。结论前臂段（腕-肘）的尺神经NAP波幅较健侧下降〉50％，是诊断早期肘管综合征较敏感的电生理指标之一。     

应用环指感觉神经传导速度测定诊断腕管综合征

目的探讨应用环指感觉神经传导速度(sensory nerve conduction velocity, SCV)诊断腕管综合征的方法。方法对18例(26手)腕部感觉动作电位潜伏期正常的患者，行顺向感觉神经传导速度测定，测定环指正中神经和尺神经SCV，中指正中神经SCV，对其结果进行比较，并与15例正常人(30手)作对照。结果中指正中神经SCV的异常率为50％，环指正中神经与尺神经SCV差值的异常率为84．6％。刺激6例(9手)患者环指后在正中神经腕部可记录到双峰波，对照组则未见。结论在腕管综合征肌电图的诊断中，比较正中神经和尺神经SCV的差值是早期诊断腕管综合征的敏感指标之一。     

内窥镜治疗腕管综合征的疗效观察

目的：观察内窥镜治疗腕管综合征的临床疗效。方法2009年至今,利用内窥镜单切口入路,通过切开腕管、松解正中神经,治疗腕管综合征18例（30侧）。术前及术后3个月进行神经电生理测试,测定正中神经掌腕段感觉及运动传导速度。结果本组患者术后随访6个月,术后3个月正中神经感觉、运动神经传导速度明显较术前加快（P〈0.05）,患者肢体感觉基本恢复正常,未见复发。结论内窥镜治疗腕管综合征疗效确切,术后正中神经功能恢复明显。     

环指感觉神经动作电位潜伏期诊断轻度腕管综合征的作用

目的　寻找诊断轻度腕管综合征 (carpaltunnelsydrome ,CTS)电生理的敏感诊断指标。方法　将临床症状、体征符合CTS ,而正中神经末端运动动作电位潜伏期正常的患者 3 8例为CTS组 ,取年龄、性别相匹配的健康人 46名为对照组。采用顺向法分别测定 2组指 4(环指 )正中神经和尺神经感觉动作电位的潜伏期 (Lat) ,并比较其差值。结果　环指正中神经和尺神经感觉动作电位潜伏期差值的异常率为91% (≥ 0 4ms)。刺激环指后 16例患者腕部正中神经处记录到双峰电位 ,对照组则未见。结论　环指正中神经和尺神经感觉动作电位潜伏期之差≥ 0 4ms ,即可诊断为轻度CTS。在怀疑轻度CTS时 ,该法最敏感 ,可作为常规的电生理检查方法。     

骨间前神经卡压征的电生理研究

目的分析总结骨间前神经卡压征的神经电生理特点,探讨其对骨间前神经卡压征的诊断意义。方法对12例骨间前神经卡压征患者进行神经电生理检测：（1）惠侧及对侧骨间前神经运动潜伏期及复合肌肉动作电位波幅：（2）患侧正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅：（3）患侧拇短展肌、指浅屈肌、旋前方肌、拇长屈肌肌电图。结果10例骨间前神经运动潜伏期延长;12例骨间前神经复合肌肉动作电位波幅降低;12例正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅正常：12例旋前方肌、10例拇长屈肌肌电图示神经性损害;12例拇短展肌、指浅屈肌肌电图正常。结论骨间前神经卡压征的神经电生理表现特点为：骨间前神经运动传导潜伏期延长及复合肌肉动作电位波幅降低,其支配肌肉肌电图示神经性损害,而正中神经运动及感觉传导正常．其支配肌肉肌电图正常。骨间前神经卡压征的神经电生理表现可为该病提供客观、准确的诊断与鉴别诊断依据。     

神经电生理检查对神经根型颈椎病与肘管综合征的鉴别诊断价值

目的：探讨神经电生理检查对神经根型颈椎病与肘管综合征的鉴别诊断价值。方法：对14例以手部内在肌萎缩为主要临床表现的患者进行双上肢体感诱发电位（somatosensory evoked potential，SEP）、双侧正中神经和尺神经传导速度（nerve conduction velocity，NCV）、双侧第一背侧骨间肌和尺侧腕屈肌肌电罔（electromyogram，EMG）检查。结果：3例以尺神经肘上-肘下段传导速度减慢大于10m／s及第一背侧骨间肌神经源性损害为主，诊断为肘管综合征；4例以SEP颈髓至外周电位（N9-N13）峰间潜伏期延长和尺侧腕屈肌、第一背侧骨间肌神经源性损害为主，诊断为神经根型颈椎病；7例为尺侧腕屈肌及第一背侧骨间肌神经源性损害、尺神经肘上-肘下段传导速度减慢大于10m／s、SEPN9-N13峰间潜伏期延长，诊断为二者合并存在。手术治疗10例，术中所见均与神经电生理检查结果相符。结论：神经电生理检查在神经根型颈椎病与肘管综合征的鉴别诊断中具有重要提示意义。     

拇指感觉神经传导速度对轻度腕管综合征的诊断作用

感觉神经传导速度(sensoly conduction velocity，SCV)的测定对轻度腕管综合征有一定的诊断价值。为了提高对轻度腕管综合征的诊断率，2001年1月～2002年8月，我们对23例轻度腕管综合征患者和23例(46手)志愿者，测定了腕部正中神经和桡神经的感觉神经传导速度，并进行了对比研究。结果证实只要桡神经的SCV正常，正中神经的SCV延迟，即可诊断为轻度腕管综征。     

探讨腕管综合征电生理分期的定量指标

目的　探讨并制定腕管综合征早、中、晚 3期电生理的分期定量指标 ,为临床分期提供电生理依据。方法　对临床诊断为腕管综合征患者的 74例 12 0侧 ,测定拇短展肌的肌电图 (EMG) ,正中神经远端运动电位的潜伏期 (distalmotorlatency ,DML) ,1～ 3指的感觉电位 (SNAP) ,以及环指在正中、尺神经上SNAP潜伏期的差值及感觉神经传导速度 ,并对其结果进行分析。结果　早期 :EMG( -)。DML <4 5ms。感觉电位 :正中、尺神经环指感觉电位潜伏期差值异常 (≥ 0 4ms) ,1～ 3指中至少有 1指的波幅较健侧下降超过 1/2。中期 :EMG(± )。DML≥ 4 5ms。感觉电位 :1～ 3指的感觉电位可引出 ,但传导速度减慢 ( <40 0ms)。晚期 :EMG( )。DML明显延长或消长。感觉电位 :1～ 4指中至少有 1指的感觉电位消失。结论　早期和中期腕管综合征的分期指标为DML ,而中期和晚期腕管综合征的分期指标为运动或感觉电位的存在与否。     

肘部尺神经卡压的定位诊断和电生理学研究

目的：对肘部尺神经卡压进行精确定位和电生理学研究。方法：对４６例临床诊断为肘部尺神经卡压患者，除进行常规ＥＭＧ、ＮＣＶ、和尺神经混合神经动作电位（ＭＮＡＰ）测定以外，还进行尺神经短段传导时间（ｓｈｏｒｔｓｅｇｍｅｎｔｃｏｎｄｕｃｔｉｏｎｔｉｍｅ，ＳＳＣＴ）测定。结果：４６例经ＳＳＣＴ测定，发现了卡压最常发生的４个部位，即肱骨内上髁后神经沟、肱尺弓、尺侧腕屈肌的出口和内侧肌间隔。结论：和传统的电生理测定方法相比较，ＳＳＣＴ技术可以更精确地对尺神经卡压进行定位诊断     

单纤维肌电图在诊断腕管综合征中的表现和评价

目的 分析、评价单纤维肌电图(single fiber electromyography,SFEMG)在诊断腕管综合征中的表现和作用.方法 将临床确诊的14例腕管综合征患者(共20侧)根据常规电生理神经传导检测数据分为两组:患侧跨腕段SNCV(感觉神经传导)均减慢,但拇短展肌CMAP(复合肌肉动作电位)潜伏期正常者为腕管Ⅰ组(10侧),拇短展肌CMAP的潜伏期4.3ms者为腕管Ⅱ组(10侧).各组均行SFEMG检测,得到拇短展肌的纤维密度(fiber density,FD)和单纤维动作电位间间隔的连续差均值(mean of consecutive difference,MCD).10例(10侧)健康志愿者为对照组,同法测取FD、MCD值.结果 术前各组SFEbfG检测结果 :拇短展肌MCD平均值,腕管Ⅰ组为67.86μs,较对照组延长了27.47μs;腕管Ⅱ组为83.36μs,较对照组延长了42.97μs.拇短展肌FD平均值,腕管Ⅰ组较对照组增加了0.46,腕管Ⅱ组较对照组增加了0.60.腕管Ⅰ、Ⅱ组的MCD、FD明显高于对照组,Ⅱ组MCD又明显高于Ⅰ组,而Ⅰ组、Ⅱ组FD则无明显差异.结论 单纤维肌电图检测为腕部正中神经卡压,特别是早期卡压的诊断提供了一项新的更为直接的客观指标.     

Relative slowing of the median antidromic sensory nerve conduction velocity to the ring finger in screening for carpal tunnel syndrome

PURPOSE: This study analyzed the accuracy of the relative slowing of the antidromic sensory conduction velocity of the median nerve in comparison with the ulnar nerve, from the wrist to the ring finger, in the diagnosis of carpal tunnel syndrome (CTS). METHODS: Eighty-two patients had been referred consecutively to our department to confirm or exclude CTS. The antidromic sensory conduction velocities of the median nerve and the ulnar nerve from the wrist to the ring finger were determined. The difference between the 2 values was calculated to express the relative slowing of the median nerve compared with the ulnar nerve. Carpal tunnel syndrome was diagnosed when the patient had clinical symptoms compatible with CTS confirmed by an established electrophysiologic investigation. The accuracy of a relative slowing of 5 m/s, 10 m/s, and 15 m/s of the median antidromic sensory conduction velocity to the ring finger was determined to diagnose CTS. RESULTS: At a cut-off value of 5 m/s the sensitivity was 95%, the specificity was 63%, and the efficiency was 79%. At a cut-off value of 10 m/s the sensitivity was 90%, the specificity was 85%, and the efficiency was 88%. At a cut-off value of 15 m/s the sensitivity decreased to 83%, the specificity increased to 93%, and the efficiency was 88%. CONCLUSIONS: A high accuracy is achieved in the diagnosis of CTS by determining the relative slowing of the median antidromic sensory nerve conduction velocity from the wrist to the ring finger.     

Carpal tunnel syndrome secondary to wrist and finger flexor spasticity

Ten patients with spastic wrist flexion deformities secondary to traumatic brain injury were evaluated for carpal tunnel syndrome. The angle of wrist flexion deformity averaged 75 degrees (range, 58 to 115 degrees). Nerve conduction studies demonstrated prolonged median motor and/or sensory latencies in all patients. Preoperative wick catheter measurements of carpal tunnel pressures in eight patients averaged 11 mm Hg in the resting position, 21 mm Hg in maximal wrist flexion, and 15 mm Hg in maximal extension. Each patient had carpal tunnel release with simultaneous wrist and finger flexor tendon releases or lengthenings. At surgery nine of the median nerves were constricted at the proximal edge of the transverse carpal ligament. The presence of normal carpal tunnel pressures and impingement of the median nerve at the proximal edge of the transverse carpal ligament indicates that the chronically flexed posture of the wrist resulted in median nerve compression, and this condition may be aggravated by underlying pressure from the spastic finger flexors.     

Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury

Because of the poor clinical results in achieving hand function in patients with complete brachial plexus root avulsion with other nerve transfers, we evaluated 111 patients prospectively to evaluate the technique of the hemi-contralateral C7 transfer to the median nerve. The transfer was performed as a primary procedure in 62 patients and as a secondary procedure in additional 49 patients. Twenty-one of the 62 patients in the primary group had sufficient follow-up (at least 3 years) to assess the motor and sensory recovery in the median nerve. The adverse effects of the operation were also analyzed in all 111 patients. Six of the 21 (29%) patients obtained M3 and 4 (19%) experienced M2 recovery of the wrist and finger flexors. Ten (48%) patients obtained S3 and 7 (33%) had S2 recovery in the median nerve area. The rate of the advancing Tinel's sign was markedly different between those achieving M3 function and the remaining patients. Although the age of the patient did not correlate with outcome, patients aged 18 and younger had the best motor recovery (ie, achieving M3 function in 3 of 6 cases). There was no correlation between the timing of the surgery after the initial injury, medical comorbidities, and clinical outcome. After surgery 108 of 111 (97%) patients experienced temporary paresthesia in the median nerve area, which resolved by an average of 2.8 months. Three (3%) patients had motor weakness of the donor limb; this resolved completely in 2 patients and left a mild deficit in wrist extension in 1 patient.     

Carpal tunnel syndrome: Neurographical parameters in different stages of median nerve compression

In a series of 47 cases and 55 hands operated upon for carpal tunnel syndrome, the pre-operative electrodiagnostic findings have been compared retrospectively with the morphological findings within the carpal tunnel during operation. As a main result there was no significant correlation between the degree of electrophysiological changes and the degree of median nerve compression. Only the lack of any motor or sensory response seems to indicate a more severe median nerve compression. In about 20% of cases with operatively proven marked median nerve compression, both distal motor latency and motor nerve conduction velocity were well within normal limits and would not have led to the diagnosis of a carpal tunnel syndrome in these cases. The diagnosis, therefore, cannot be made on the basis of electrodiagnostic pathological values only of distal motor latency and motor nerve conduction velocity, but has to take into account as well the sensory nerve conduction velocity as well as the clinical picture and neurological findings.     

Increased risk of median nerve dysfunction in floor cleaners: a controlled clinical and neurophysiological study.

We studied median nerve involvement in a group of asymptomatic handworkers at risk for carpal tunnel syndrome, and we evaluated damage to thin and thick nerve fibres in the distribution area of the median nerve. Considering floor cleaners as workers at high risk of developing cumulative traumatic disorders in the wrist, we included 42 cleaners and 41 controls. We assessed nerve conduction studies, vibration threshold, and temperature and pain thresholds of the median nerve. The cleaners had significantly impaired motor nerve conduction velocity (p = 0.006), longer sensory distal latency (p = 0.01), lower sensory amplitude (p = 0.0005), and increased difference in heat and cold threshold of the median nerve (p = 0.0002). Increased temperature threshold was associated with prolonged sensory distal latency of the median nerve in the cleaners. In conclusion, impaired neurophysiological variables in the median nerve in floor cleaners compared with controls confirm the hypothesis that those workers are at risk of developing median nerve dysfunction. Sensory nerves seem to be more susceptible to injury than motor branches.     

Increased risk of median nerve dysfunction in floor cleaners: a controlled clinical and neurophysiological study

We studied median nerve involvement in a group of asymptomatic handworkers at risk for carpal tunnel syndrome, and we evaluated damage to thin and thick nerve fibres in the distribution area of the median nerve. Considering floor cleaners as workers at high risk of developing cumulative traumatic disorders in the wrist, we included 42 cleaners and 41 controls. We assessed nerve conduction studies, vibration threshold, and temperature and pain thresholds of the median nerve. The cleaners had significantly impaired motor nerve conduction velocity (p = 0.006), longer sensory distal latency (p = 0.01), lower sensory amplitude (p = 0.0005), and increased difference in heat and cold threshold of the median nerve (p = 0.0002). Increased temperature threshold was associated with prolonged sensory distal latency of the median nerve in the cleaners. In conclusion, impaired neurophysiological variables in the median nerve in floor cleaners compared with controls confirm the hypothesis that those workers are at risk of developing median nerve dysfunction. Sensory nerves seem to be more susceptible to injury than motor branches.     

Median to radial nerve transfer for treatment of radial nerve palsy. Case report

The purpose of this study is to report a surgical technique of nerve transfer to restore radial nerve function after a complete palsy due to a proximal injury to the radial nerve. The authors report the case of a patient who underwent direct nerve transfer of redundant or expendable motor branches of the median nerve in the proximal forearm to the extensor carpi radialis brevis and the posterior interosseous branches of the radial nerve. Assessment included degree of recovery of wrist and finger extension, and median nerve function including pinch and grip strength. Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median nerve were noted, and the patient is very satisfied with her degree of functional restoration. Transfer of redundant synergistic motor branches of the median nerve can successfully reinnervate the finger and wrist extensor muscles to restore radial nerve function. This median to radial nerve transfer offers an alternative to nerve repair, graft, or tendon transfer for the treatment of radial nerve palsy.     

臂丛神经阻滞时神经刺激器诱发患者不同运动反应与桡神经阻滞效果的关系

目的 评价臂丛神经阻滞时神经刺激器诱发患者不同运动反应与桡神经阻滞效果的关系.方法 择期拟行手、腕或前臂手术患者120例,性别不限,ASA I或Ⅱ级,年龄18～60岁,随机分为2组(n=60),三点腋路臂丛神经阻滞在周围神经刺激器引导下,采用1%利多卡因与0.33%罗哌卡因混合液注射于肌皮神经、正中神经,分别为5、10 ml,I组和Ⅱ组分别诱发前臂外展或腕及手指外展时,采用上述混合液20 ml注射于桡神经周围,于注射完毕后5、10、15、20、25和30 min时采用针刺法评价肌皮神经、正中神经的感觉阻滞情况,桡神经近端和远端的感觉及运动阻滞情况.记录神经阻滞操作时间,记录桡神经定位次数,评价桡神经定位的难易程度.结果 与I组相比,Ⅱ组感觉完全阻滞成功率高,桡神经远端感觉及运动阻滞成功率高,神经阻滞操作时间长,桡神经定位困难程度高(P<0.05或0.01).结论 臂丛神经阻滞时,当神经刺激器诱发患者腕及手指外展较诱发前臂外展应用1%利多卡因与0.33%罗哌卡因混合液20 ml阻滞桡神经的效果更完善.