弯套针旋转多向注射法注射臭氧治疗腰椎间盘突出症的电生理评价

目的:比较弯套针旋转多向注射法及常规注射方法注射臭氧治疗腰椎间盘突出症(LDH)的电生理改变。方法:自2005年5月至2009年6月,选择100例LDH患者,其中男68例,女32例;年龄25～58岁,平均为44岁;病程3个月～8年,平均8.8个月。全部患者按就诊顺序编号,并运用DPS软件完全随机地分成观察组(A组)和对照组(B组),每组50例。A组采用弯套针旋转多向注射法注射臭氧至病变的椎间盘内治疗,B组采用常规注射方法。所有患者于治疗前及治疗后3个月时进行电生理检查,检测患肢主要肌群及相应节段的椎旁竖脊肌的肌电图,计算运动单元电位(MUP)时限和多相比,并检查双下肢胫神经H反射,记录异常例数及H波潜伏期。结果:两组治疗后出现异常肌电图的肌肉数均有不同程度减少,但A组减少更显著(P0.05或0.01);两组患者治疗后患侧下肢肌群的MUP时限和多相比均减少,并接近正常水平,经统计学分析均有统计学意义(P0.01),且两组间比较,A组变化优于B组,具有统计学意义(P0.05或0.01)。治疗前两组间H反射异常例数比较无统计学差异,治疗后A组明显少于B组(P0.05)。两组治疗后H波潜伏期均明显缩短且趋于正常,但A组比B组更明显,差异有统计学意义(P0.05)。结论:神经电生理的异常表现可以反映神经根受压损害的程度,是判断神经肌肉功能的客观指标之一。运用弯套针旋转多向注射法比常规注射方法注射臭氧治疗LDH能更好地改善电生理异常。     

肌松药对术中肌电检测的影响

目的 研究肌松药卡肌宁（阿曲可林，Ａｔｒａｃｕｒｉｕｍ Ｂｅｓｉｌａｔｅ）对周围神经患者术中肌电检测的影响。方法 选取２５例患者，按临床麻醉常规给予术中肌桦药卡股宁的方法分为三组。Ａ组：用电脑注射泵匀速注入，维持肌肉松弛程度于四个成串刺激ＴＯＦ中的第一个颤搐波Ｔ１始终为０〈Ｔ１〈５％。Ｂ组：用卡肌宁０．６ｍｇ／ｋｇ间断注入，维持Ｔ１始终为０。Ｃ组：用卡肌宁０．３ｍｇ／ｋｇ间断注入，同样维持Ｔ１为０     

术中持续肌电监测在周围神经损伤诊治中应用

近年采用术中持续肌电电生理监测新方法对２４例周围神经损伤患者进行术中诊治，并取得良好疗效，我们认为，术中招标肌电监测不仅能明确周围神经损伤的部位与性质，帮助手术医师选择最佳手术方法，而且能了解手术疗效，避免手术中再生神经纤维损伤。并且通过持续电刺激能促进神经再生。术中持续肌电监测不失为一种提高周围神经损伤疗效的好方法。     

术中持续肌电监测在周围神经损伤诊治中的应用

近年采用术中持续肌电电生理监测新方法对２４例周围神经损伤患者进行术中诊治，并取得良好疗效。我们认为，术中持续肌电监测不仅能明确周围神经损伤的部位与性质，帮助手术医师选择最佳手术方法，而且能了解手术疗效，避免手术中再生神经纤维损伤。并且通过持续电刺激能促进神经再生。术中持续肌电监测不失为一种提高周围神经损伤疗效的好方法。     

术中持续肌电监测在周围神经损伤诊治中的应用

近年采用术中持续肌电电生理监测新方法对２４例周围神经损伤患者进行术中诊治，并取得良好疗效。我们认为，术中持续肌电监测不仅能明确周围神经损伤的部位与性质，帮助手术医师选择最佳手术方法，而且能了解手术疗效，避免手术中再生神经纤维损伤。并且通过持续电刺激能促进神经再生。术中持续肌电监测不失为一种提高周围神经损伤疗效的好方法。     

腕管综合征术中神经电生理检测与手术疗效评价的初步探讨

目的 通过对腕管综合征术前、术中正中神经-拇短展肌复合肌肉动作电位(compound muscle action potential,CMAP)变化的观察,寻求检测手术效果的可靠指标和时机.方法 对15例腕管综合征行腕管切开正中神经松解术的患者,分别于术前(臂丛神经阻滞麻醉后)、正中神经松解术毕松止血带后即刻及1、3、5、7 min检测正中神经-拇短展肌CMAP潜伏期和波幅的动态变化,并与术前检测值进行统计学分析.方果 正中神经松解术毕松止血带后即刻至5 min,正中神经.拇短展肌CMAP的潜伏期和波幅随时间变化而有显著改变(P<0.05),5 min以后的变化差异无统计学意义(P>0.05).正中神经-拇短展肌CMAP的潜伏期比术前缩短,差异有统计学意义(P<0.05),但波幅与术前相比差异有明显统计学意义(P<0.01).方论 对腕管综合征行神经松解术后,拇短展肌CMAP的波幅比其潜伏期更能体现神经松解的疗效,而在松止血带5 min后进行神经电生理检测来评价手术效果更为可靠.     

背阔肌电生理支配权重分析在同侧C7神经根移位术中的临床意义

目的 通过比较健侧G移位术中背阔肌上、中、下份复合肌肉动作电位（compound muscle action potential，CMAP）波幅的差异，了解臂丛神经根对背阔肌的支配权重，从而为同侧G移位术的应用提供电生理依据。方法于健侧G移位术中依次刺激臂丛神经上、中、下干，分别于背阔肌上、中、下份记录CMAP，比较CMAP波幅差异，确定各臂丛神经对背阔肌的支配权重。术后4周随访背阔肌肌力。结果CMAP波幅提示背阔肌上份主要受臂丛中干和上中干支配占60％，受上干支配仅10％；中份受中干支配占70％，受上干支配占15％；下份受中、下干和中干支配占70％，无单独上干支配。综合背阔肌上中下份分析显示由上干主要支配仅占8％、由中干主要支配占33％、由下干主要支配占10％、中下干支配占23％、上中下干支配占8％。术后4周随访背阔肌功能无明显影响。结论通过术中对背阔肌所受臂丛神经支配的电生理权重的研究，证实了同侧G神经根移位术的安全性。     

肌皮神经肱肌肌支移位术的电生理研究

目的应用电生理技术研究肱肌肌支的神经根来源及探索肱肌肌支移位术的可行性和有效性。方法选择10名臂丛损伤作健侧C7移位术的患者,术中暴露正常的臂丛神经,用Reporter四道程肌电诱发电位仪,刺激C5~T1神经根,在肱肌记录诱发电位并计算其潜伏期及波幅。对1例肩外展、屈肘功能正常而手部无功能的C7脊髓损伤患者,在右侧上肢行肌皮神经肱肌肌支移位术,术中将肱肌肌支移至骨间前神经,以恢复手指屈曲功能。结果10名行健侧C7移位者术中刺激C5~C7均记录到复合肌肉动作电位(compoundmuscleactionpotential,CMAP),而刺激C8T1则无CMAP出现。C5~7CMAP的潜伏期为[(6.32±1.50)ms,x-±s,下同]、(6.51±1.36)ms和(6.99±1.33)ms,波幅为(2.81±3.17)mV、(3.01±3.20)mV和(1.55±1.99)mV。其中以C6的波幅最大,提示C6支配肱肌的纤维数可能最多,但经统计学处理,各神经根间的差异无统计学意义(P>0.05)。1例患者术后第2天检查屈肘功能正常,电生理检测肱二头肌为单纯相。术后1年半随访,术侧拇示指出现屈曲动作。结论肱肌同时接受来自C5~7神经纤维的支配,该肌支移位至C8T1为主支配的正中神经是可行及有效的。     

探讨肘管综合征电生理分期的定量指标

目的探讨并制定肘管综合征轻度、中度、重度三期电生理的分期定量指标,为临床分期提供电生理依据。方法对临床诊断为肘管综合征的82例(82侧)患者,测定以下电生理检查：(1)第一背侧骨间肌,小指展肌,尺侧屈腕肌的肌电图(EMG)；(2)肘段尺神经运动神经传导速度(MNCV)的测定；(3)感觉诱发电位的测定(小指→腕,腕→肘)。结果轻度：EMG(-),肘段MNCV≥45．0m/s,尺神经感觉电位或神经于(腕→肘)电位波幅较健侧下降≥50%。中度：EMG(±),肘段MNCV＜45．0m/s,尺神经小指感觉电位波幅及尺神经干电位波幅均较健侧下降＞50%,重度：EMG(+),肘段MNCV＜40．0m/s,复合肌肉动作电位(CMAP)消失,尺神经小指感觉电位或尺神经干的CMAP电位引不出。结论肘管综合征电生理的分期指标,主要看尺神经肘段的MNCV,MNCV≥45．0m/s提示为轻度,MNCV＜45．0m/s提示为中度,MNCV＜40．0m/s提示为重度。     

神经电生理各项指标在肘管综合征诊断中的价值

目的 探讨神经电生理指标在肘管综合征诊断中的作用和价值,将众多的指标归纳为较少的指标,并确定诊断该病的客观指标.方法 对肘管综合征患者和健康志愿者各120例进行神经电生理15项指标的测定,采用t检验、主成分分析、判别分析的方法行统计学分析.结果 同一指标的两组间t检验,15项指标差异均有统计学意义;主成分分析表明前三个主成分累积贡献率达92.14%,故选取前三个主成分;判别分析获得的判别方程为:患者组Y1=-126.04+0.98X1+3.67X2-0.63X3,对照组Y2=-309.14+2.01X1+2.01X2-1.09X3.将指标代入方程,如Y1>Y2,则为异常;如Y1相似文献   

表现为上肢近端肌肉萎缩的平山病临床与影像学特点

目的 研究表现为上肢近端肌肉萎缩的平山病患者的临床表现和颈椎中立位、屈曲位MR影像特征.方法 3例临床上表现为上肢近端肌肉萎缩的平山病患者,行颈椎中立位及屈曲位MR检查,分析患者的临床表现及与影像学征象的关系,并与43例表现为手及前臂肌肉萎缩的平山病患者相比较.结果 (1)临床特点:3例患者均为青少年男性,表现为一侧胸大肌、三角肌、肱二头肌等上肢近端肌肉萎缩和肌无力,肌电图检查均提示双侧上肢神经源性损害.(2)颈椎MRI特点:3例患者中立位MRI示颈椎呈后凸畸形,脊髓未见压迫;屈曲位MRI示C3-5椎体水平的颈段脊髓和后方硬脊膜向前移位,C4.5椎体水平脊髓受到前方椎体或椎间盘和后方硬脊膜的压迫,硬脊膜外有扩张的椎管内静脉丛.43例表现为手及前臂肌肉萎缩的平山病患者也出现上述征象,脊髓受压部位在C6.7椎体水平.结论 平山病可表现为胸大肌、三角肌、肱二头肌等上肢近端肌肉的萎缩和无力,容易被误诊和漏诊;颈椎屈曲位MRI是本病早期诊断的重要依据.

Abstract：

Objective To investigate the clinical features and magnetic resonance imaging (MRI)findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy.Methods Three patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy received cervical spine MRI on neutral and flexion position. The relationship between MRI findings and their clinical symptoms were analyzed. The outcomes were compared with those of 43 patients who were diagnosed as Hirayama disease with muscular atrophy at the hand and forearm. Results 1) Clinical features:three patients were young men. The disease was characterized by unilateral weakness and atrophy of the proximal upper limbs, such as pectoralis major muscle, deltoid muscle, and biceps brachii muscle. Electromyogram (EMG) showed bilateral upper extremities neurogenic damage. 2) Cervical spine MRI findings:cervical spine kyphosis without spinal cord compression was found on neutral position. On flexion position,anterior shifting of C3-C5 cervical cord and the posterior wall of dural sac were found; C4-C5 cervical cord was compressed by vertebral body or intervertebral disc or dural sac. Engorged posterior internal vertebral venous plexus were observed in epidural space. In the 43 patients who were diagnosed Hirayama disease with muscular atrophy at the hand and forearm, similar MRI findings were found, while cervical cords compression were at C6-C7 level. Conclusion Hirayama disease could present as proximal upper extremity muscular atrophy and weakness, such as pectoralis major muscle, deltoid muscle, and biceps brachii muscle.Neglecting of this will result in diagnostic errors or missed diagnosis. Flexion position MRI is an important base of early diagnosis of Hirayama disease.     

平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的神经电生理特点

目的 探讨平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的上肢神经电生理特点.方法 回顾性分析87例平山病患者、83例肌萎缩性侧索硬化患者和28例远侧型肌萎缩型颈椎病患者的上肢神经电生理检测资料.其中87例平山病患者中,72例单侧上肢、15例双侧上肢出现肌肉萎缩;83例肌萎缩性侧索硬化患者中,30例单侧上肢、53例双侧上肢出现肌肉萎缩;28例远侧型肌萎缩型颈椎病患者中,20例单侧上肢、8例双侧上肢出现肌肉萎缩.结果 平山病患者患肢尺神经刺激的复合肌肉动作电位(compound muscle action potential,CMAP)波幅明显低于正中神经刺激的CMAP波幅,肌萎缩性侧索硬化患者患肢正中神经CMAP波幅明显低于尺神经CMAP波幅,远侧型肌萎缩型颈椎病患者正中神经和尺神经CMAP波幅降低程度相同.平山病患者的平均尺神经/正中神经(U/M)CMAP比为0.58±0.40,肌萎缩性侧索硬化为2.28±1.25,远侧型肌萎缩型颈椎病为1.31 ±0.63,三者比较差异有统计学意义.在U/M CMAP比值＜0.6的患肢中,平山病有62例,肌萎缩性侧索硬化和远侧型肌萎缩型颈椎病分别只有3例和1例;在U/M CMAP比值＞1.7的患肢中,肌萎缩性侧索硬化有57例,平山病有12例,远侧型肌萎缩型颈椎病有4例.所有患者双侧的运动神经和感觉神经传导速度、感觉神经动作电位波幅均正常,健肢的CMAP波幅均正常.结论 平山病患者小鱼际肌肉萎缩程度重于大鱼际肌,肌萎缩性侧索硬化患者与之相反,而远侧型肌萎缩型颈椎病患者大、小鱼际肌肉萎缩程度相似.     

平山病的诊疗进展

平山病于1959年由日本学者Hirayama等^[1]首次报道,以不对称的上肢远端肌力减弱和肌肉萎缩为首发症状,常累及手腕和手指并以骨间肌、小鱼际肌及前臂尺侧肌肉萎缩为著,主要见于亚裔青年男性^[2]。Singh等^[3]的研究发现,平山病患者以第一骨间背侧肌和小指展肌受累最为常见。发病年龄一般为20~30岁,男性多于女性,但也有儿童及中年发病的报道^[4]。平山病症状常为单侧,约10%的患者出现双侧对称受累,且临床症状较重^[5]。超过95%的患者可自觉寒冷环境中力弱加重^[6]。临床体征为C₇~T₁脊髓节段支配的前臂、手部肌肉进行性萎缩,手、前臂肌力减弱,但肱桡肌不受累,可勾勒出典型的掌侧及背侧前臂肌肉萎缩的斜行边界,较少伴有感觉异常或锥体束征^[2,7],受累肌肉收缩时可出现收缩震颤。患者肌肉牵张反射正常,锥体束征阴性,不伴有排尿异常及颅神经麻痹。Holla等^[8]报道了1例罕见的肩胛带肌受累病例,患者肌无力从双上肢远端逐渐发展至近端,出现无法穿衣、梳头等症状,查体可见翼状肩胛和菱形肌、冈上肌、冈下肌、胸大肌及前锯肌肌肉萎缩。平山病起病隐匿,与运动神经元病相似,但预后不同,提高对此病的诊断和治疗水平尤为重要。MRI检查及神经电生理检测技术有助于平山病的诊断和评估。目前平山病的治疗根据病情决定：病程短、症状轻的一般选择非手术治疗（颈托）;反之,则选择手术治疗。本文通过查阅近年平山病相关文献,分析其诊断及治疗方法,以期为平山病的诊治提供参考,现综述如下。     

平山病3例报告并文献复习

正平山病又称青少年上肢远端肌肉萎缩,于1959年由日本学者Hirayama等[1]首次报道,是一种主要累及下运动神经元的良性自限性疾病。平山病较罕见,多为散发,偶有家族发病,多数案例报道来自亚洲,尤其是日本及印度[2-3],北美及奥地利等亦有报道[4-5]。本院2011年8月—2014年2月确诊3例平山病,现结合文献就其临床表现、电生理学特征、影像学资料及治疗方案分析,报告如下。     

Giant lipomas of the upper extremity

Lipomas are slow-growing soft tissue tumours that rarely reach a size larger than 2 cm. Lesions larger than 5 cm, so-called giant lipomas, can occur anywhere in the body but are seldom found in the upper extremities. The authors present their experiences with eight patients having giant lipomas of the upper extremity. In addition, a review of the literature, and a discussion of the appropriate evaluation and management are included.     

Use of a microvascular coupler for repair of major distal upper extremity artery injuries

Background

Non-suturing alternatives to expedite a microanastomoses while still insuring maximum patency rates to date have best been achieved using everting ring-pin devices. Although these so-called couplers have heretofore primarily been used for the venous microanastomosis during free flap transfers, they have also had limited value for their arterial counterpart.

Methods

Applications for use of the microanastomotic coupler has been extended to repair solitary arterial injuries in the distal upper extremity. Over the past year, 4 patients specifically with hand or forearm arterial injuries alone, had rapid coupling of the injured vessels.

Results

Direct end-to-end repair of all hand or forearm arterial injuries using a microanastomotic coupler was possible in 3 of four cases. Because of the greater extent of injury, the exception required an interposition vein graft; but that too was coupled to each end of the divided artery in end-to-end fashion. In no case was there any compromise of vascular patency.

Conclusion

Although hand perfusion in no individual in this series was ever at jeopardy because of persistent collaterals, this demonstration of the efficiency and efficacy of this device may justify future use for critical limb revascularisation.     

班布特罗与当归补血汤对失神经肌肉萎缩防治作用的实验研究

目的：研究班布特罗及当归补血汤对防治失神经骨骼肌萎缩的作用效果及有无协同作用。方法 SD大鼠40只，随机分组，每组10只，建立失神经骨骼肌萎缩的实验模型。术后4周处死大鼠，双侧腓肠肌及心脏称重，测定肌肉SOD含量，测肌纤维直径，检测细胞凋亡情况。结果 各用药组与对照组肌总蛋白含量、SOD含量、肌纤维直径均无显著性差异（P〉0．05）。在排除个体体重差异后肌肉湿重亦无显著性差异。两种药物之间无协同作用。各组均可见凋亡细胞，荧光显微镜下肉眼观测凋亡细胞的数量无显著性差异。结论 班布特罗与当归补血汤在4周时无明显预防肌萎缩作用及协同作用；细胞凋亡在失神经肌萎缩中发挥一定的作用；本实验为探索药物长期应用防治失神经骨骼肌萎缩的研究提供借鉴。     

Advances in motion and electromyography based wearable technology for upper extremity function rehabilitation: A review

Study DesignScoping review.IntroductionWith the recent advances in technologies, interactive wearable technologies including inertial motion sensors and e-textiles are emerging in the field of rehabilitation to monitor and provide feedback and therapy remotely.Purpose of the StudyThis review article focuses on inertial measurement unit motion sensor and e-textiles–based technologies and proposes approaches to augment these interactive wearable technologies.MethodsWe conducted a comprehensive search of relevant electronic databases (eg, PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, The Cochrane Central Register of Controlled Trial, and the Physiotherapy Evidence Database). The scoping review included all study designs.ResultsCurrently, there are a numerous research groups and companies investigating inertial motion sensors and e-textiles–based interactive wearable technologies. However, translation of these technologies to the clinic would need further research to increase ease of use and improve clinical validity of the outcomes of these technologies.DiscussionThe current review discusses the limitations of the interactive wearable technologies such as, limited clinical utility, bulky equipment, difficulty in setting up equipment inertial motion sensors and e-textiles.ConclusionThere is tremendous potential for interactive wearable technologies in rehabilitation. With the evolution of cloud computing, interactive wearable systems can remotely provide intervention and monitor patient progress using models of telerehabilitation. This will revolutionize the delivery of rehabilitation and make rehabilitation more accessible and affordable to millions of individuals.     

Development of an upper extremity transplant program

Starting a hand transplant program poses tremendous challenges. Solid organ transplantation and hand replantation are time-tested procedures and are now standard of care. Hand transplantation is the amalgamation of the scientific principles of reconstructive surgery and the concepts of organ transplantation. Thus, for any hand transplant program to be successful, there must be collaboration within a multidisciplinary team comprising a core group of hand and transplant surgeons. Such a joint effort can overcome the challenges that are inherent in a complex therapeutic option that integrates different disciplines and organizations during the planning, procedural, and posttransplant phases.     

Management of upper extremity injuries in obese patients

Upper extremity injuries are more prevalent in obese people than in nonobese people after low-energy falls. Because splinting and casting are inefficient methods of stabilization in the setting of obesity, internal fixation provides stability for mobilization and realignment. Morbid obesity adversely affects positioning, surgical exposures, and complications associated with operative fixation. Avoiding short cuts and complications, morbidly obese patients should be able to return to normal functioning.