神经阈值对亚临床糖尿病周围神经病变的诊断价值

目的:探讨神经阈值对亚临床糖尿病性周围神经病的诊断价值.方法:糖耐量异常患者、病程2年或2年以内的糖尿病患者(简称短病程糖尿病)、病程5～10年的糖尿病患者(简称长病程糖尿病)及健康对照组各20名,分别检测每位受试者双侧正中神经、双侧尺神经、双侧腓神经远端运动神经阈值和腓肠感觉神经阈值,测量所有患者血清糖化血红蛋白(HbA1c)值;使用统计学软件SPSS进行分析.结果:①方差分析显示左右正中神经、右腓神经远端运动神经阈值和左右腓肠神经感觉阈值四组间差异有统计学意义(P＜0.05),左右侧尺神经和左侧腓神经四组间差异无统计学意义;在糖耐量异常组和健康对照组之间,右侧正中神经、右侧腓神经远端运动神经阈值和左右腓肠神经感觉阈值两组间差异有统计学意义(P＜0.05);②Peason相关回归分析显示左侧正中神经、右侧尺神经、左右侧腓神经远端运动神经阈值和腓肠感觉神经阈值与血HbA1C水平呈正相关(P＜0.05),右侧正中神经、左侧神经远端运动神经阈值与血HbA1C无明显相关性(P＞0.05).结论:神经阈值测量可早期发现糖代谢异常患者周围神经兴奋性的变化,有助于评估周围神经功能和亚临床糖尿病神经病变的诊断.     

健康人周围神经刺激阈值的初步研究

目的探索建立健康人周围神经刺激阈值的正常值范围,初步探讨年龄、性别对周围神经刺激阈值的影响。方法选取符合纳入标准的健康志愿者120例,其中男性58例,女性62例;年龄20~79岁,平均年龄49.3岁。采用Keypoint workstation肌电图及诱发电位仪,带通20 Hz~10 kHz(运动传导检测)或1 Hz~2 kHz(感觉传导检测),扫描速度每格5 ms,灵敏度每格5 mV(运动传导检测)或每格20μV(感觉传导检测),刺激频率1 Hz,刺激时限0.2 ms。检查时室温27℃~30℃,保证健康志愿者皮肤温度在30℃以上。在神经传导检测的基础上采用双向测量法分别对正中神经、尺神经、腓神经及腓浅神经感觉支进行检测,得到各神经不同年龄组的神经刺激阈值,并对结果进行统计学分析。结果将健康志愿者按照年龄分为6组,即20~29岁组(A组)、30~39岁组(B组)、40~49岁组(C组)、50~59岁组(D组)、60~69岁组(E组)、≥70岁组(F组),每组20例。采用单因素方差分析,正中神经与尺神经刺激阈值F组与A组、B组、C组间差异有统计学意义;腓神经和腓浅神经感觉支刺激阈值F组与A组、B组间差异有统计学意义;其余各组间差异无统计学意义。正中神经、尺神经、腓神经及腓浅神经感觉支神经刺激阈值随年龄增长有逐渐增大趋势,尤其高龄组(≥70岁),其神经刺激阈值明显高于低龄组(20~40岁组)。不同性别间同名神经刺激阈值差异无统计学意义。上下肢比较发现,下肢神经刺激阈值明显高于上肢。结论采用双向测量法检测周围神经刺激阈值是可行的;年龄对神经刺激阈值的影响虽然微小但的确存在,尤其对于老年人;性别对于神经刺激阈值没有显著影响,这一点尚需深入研究进一步明确;上下肢神经刺激阈值的差异可能与其生理功能差异、神经纤维长度有关。     

慢性正已烷中毒121例的神经肌电图观察

目的：观察慢性正己烷中毒患者的神经电图和肌电图（EMG）改变的特点。方法：对121例慢性正己烷中毒患者进行神经电图及EMG检测。结果：正中神经、尺神经、腓肠神经、胫后神经感觉神经传导异常占72．5％，股外侧皮神经感觉神经传导异常占74．4％；正中神经、尺神经、腓总神经、胫神经运动神经传导电位异常占65．3％，股神经运动神经传导电位异常占45．5％；EMG异常占19．9％。结论：慢性正己烷中毒主要引起广泛性周围神经损害，肌肉受损程度较轻。神经电图检测对诊断有重要价值。     

正常青年人群腕管正中神经MRI成像的断层解剖学测量

目的通过我国青年人群正中神经的断层解剖测量,为正中神经形态学研究和腕管综合征(CTS)的诊治提供参考。方法共采集28例志愿者56侧腕部MRI数据,测量计算正中神经横截面积(CSA)、扁平率(MNFR)和膨胀率(MNSR)并进行性别之间、双侧肢体间比较,再将上述指标分别与年龄、身高、体重进行相关分析。结果正中神经CSA、MNFR和MNSR在双侧肢体之间无统计学差异;CSA和MNSR在性别之间无统计学差异;而女性MNFR显著大于男性,差异具有统计学意义,而MNFR与身高存在着统计学负相关性。结论基于MRI(1.5T)正中神经的解剖测量具有可靠和精度高的特点;国人正中神经CSA存在着性别间差异,和西方人CSA相比差异较大,CSA和身高存在负相关性;CTS的MRI诊断标准应与国人解剖参数相结合。     

危重病性多发性神经病患者神经电生理分析

目的：分析10例危重病性多发性神经病患者的神经电生理特点,企为临床提供客观诊断依据。方法：回顾性分析10例确诊为危重病性多发性神经病患者的神经电生理检查结果。检测神经包括上肢正中神经、尺神经,下肢腓总神经、胫神经、腓肠神经,检测肌肉为第一骨间肌、拇短展肌、三角肌、胫前肌、股直肌、肋间内外肌。观察电生理参数：运动及感觉神经传导速度,运动及感觉神经诱发电位波幅,运动神经远端潜伏期,肌肉自发电位,运动单位电位时限及大力募集情况。结果：运动神经传导速度减慢8例,运动神经远端潜伏期延长3例,运动神经诱发电位波幅降低6例,感觉神经传导速度降慢4例,感觉神经诱发电位波幅降低2例,针肌电图可见神经原性损害4例,神经原性与肌原性混合损害2例。结论：危重病性多发性神经病的神经电生理表现具有多样性,重症患者早期及多次电生理检测对于疾病诊断、动态评估病情有重要意义。     

以上肢麻木不适为主要表现患者的周围神经高频超声和电生理研究

目的：探讨用高频超声和神经电生理方法来评估以上肢的麻木不适伴疼痛、肌无力、肌萎缩等为主要症状的患者周围神经病变的价值。方法：对具有上肢不适的患者37例（共74只上肢）（病例组）和健康志愿者26例（共52只上肢）（对照组）进行高频高分辨力超声和神经电生理的检查,超声重点测量正中神经、桡神经、尺神经上臂以及正中神经在腕管内的横截面积,电生理主要测定这三条神经的传导速度（NCV）。结果：病例组正中神经在上臂及腕管内的横截面积分别为上臂11．66（7．1～19．3）mm^2,桡尺关节平面处为11．94（5．3～18．2）mm^2,豌豆骨平面处为10．75（4．4～14．1）mm^2,钩骨钩平面处为12．51（6．2～18．9）mm^2,均大于对照组,（P〈0．01）;尺神经在肘管上缘的横截面积为7．85（3．3～22．8）mm^2,桡神经在上臂的横截面积为5．71（4．0～10．2）mm^2,与对照组比较差异不显著（P〉0．05）。超声和电生理检测得单纯正中神经损害率分别为62％和50％;正中神经、尺神经联合损害率分别为24％和19％;单纯尺神经的损害率分别为5．4％和8％,桡神经损害最少。正中神经损害最常见部位在腕管,但有35％的患者合并正中神经在上臂的增粗。尺神经最常损害部位在肘管。结论：高频超声和电生理检测都有助于明确上肢周围神经病变。出现上肢症状者正中神经损害最为常见,其次为正中神经尺神经联合病变,单独的尺神经异常不是太多,涉及桡神经的病变发生率最低。正中神经腕管内损害合并上臂的增粗应予以关注。     

健康成人远端复合肌肉动作电位时限及时间离散度分析

目的 探讨健康成人远端复合肌肉动作电位时限（DCMAPD）及时间离散度（TD）的定量检测,为周围神经脱髓鞘病变诊断提供依据。方法 选取120例健康志愿者,其中男56例,女64例,年龄20～84岁。将其按年龄20～29岁、30～39岁、40～49岁、50～59岁、60～69岁及>70岁分为6组。依次对所有志愿者的胫神经、腓总神经、正中神经、尺神经进行常规运动神经传导检测,分析不同年龄段和不同性别间远端复合肌肉动作电位时限（DCMAPD）和时间离散度（TD）的差异。结果 四条神经中仅腓总神经DCMAPD在不同年龄组差异具有统计学意义（P<0.05）,其余三条神经DCMAPD在不同年龄组间差异均无统计学意义（P>0.05）;正中神经、尺神经、胫神经和腓总神经DCMAPD和TD在不同性别间差异均无统计学意义（P>0.05）。结论健康成人DCMAPD值在正中神经、尺神经、胫神经中可不分年龄及性别采用统一的参考值,而腓总神经则按照50岁前后来区分参考值比较合理,TD值可不分年龄及性别采用统一参考值。     

慢性酒精中毒患者周围神经亚临床损害的神经电生理研究

目的:探讨神经传导速度(NCV)和F波在检测慢性酒精中毒患者周围神经亚临床损害中的意义.方法:检测40例无周围神经损害症状和体征的长期大量饮酒者(病例组)和48例对照组的正中神经和胫神经的F波,以及正中神经、尺神经、腓肠神经和胫神经的NCV,并对两组结果进行分析对照.结果:病例组NCV 640条神经中异常79条,异常率为12 3%,对照组768条神经中异常8条,异常率为1 04%,差异显著(P<0.01).病例组下肢NCV异常率明显高于上肢(P<0.01);病例组F波异常率与对照组比较差异则无显著意义(P>0.05).结论:NCV检测对早期慢性酒精中毒性周围神经病的诊断有参考价值.     

47例腕管综合征患者的临床及神经电生理改变特征

目的：分析腕管综合征（CTS）患者临床及神经电生理改变特征,以提高临床诊断准确性。方法：对47例临床症状、体征均符合CTS患者的正中神经和尺神经各55条分别进行运动神经传导速度（MCV）和感觉神经传导速度（SCV）测定,其结果与正常参考值作比较;对拇短展肌和某些病例的掌长肌作针极肌电图（EMG）,观察失神经电位以作鉴别诊断。结果：本组正中神经肘-腕MCV有6条未引出动作电位,41条正常,8条减慢,平均MCV较正常参考值减慢,差异有显著意义（P％0．05）;正中神经远端潜伏期（DML）异常率为96％,平均DML较正常参考值延长,经比较差异有显著意义（P〈0．05）;尺神经肘-腕MCV均在正常范围,其DML异常率为2％,与正常参考值比较差异无统计学意义;正中神经SCV异常率为98％;尺神经SCV异常率为2％;47例共55块拇短展肌EMG有49％见失神经电位。结论：结合临床及神经电生理改变特点,可对CTS作出明确诊断,为治疗提供依据。     

高频超声对正常正中神经显像及其临床意义

目的 通过高频超声探查上肢正中神经全程并熟练掌握正中神经的超声探查手法,选取超声易于辨识的解剖位点测量正中神经的横截面积（CSA）并探讨其与周围组织的关系,提供正常参考值范围并为临床诊断外周神经疾病提供依据。 方法 对240例健康志愿者沿正中神经走行进行高频超声探查,依次测量5个位点 ［腕管（腕横纹处）、前臂中点、正中神经穿出旋前圆肌处、肱骨髁上处及肱骨中点处］的CSA,每个位点重复测量３次取其均值,并进行CSA与身高、体重的相关性分析。 结果 高频超声显示,正常人正中神经横截面呈筛网状低回声图像,在不同部位分别显示为圆形、椭圆形或三角形,纵截面上成束状平行排列的低回声被断续的条带状高回声分割。探查得出,正中神经在上述5个位点的CSA均值以及双侧上肢之间同一位点处正中神经的CSA差异无统计学意义。 结论 正中神经在高频超声下全程可探及,显示率为100％;在不同部位的正常值及超声声像图略有差异,差异有统计学意义;正中神经的CSA在上臂段最粗,腕管处次之,前臂段最细。     

Anatomic basis of vascularised nerve grafts: the blood supply of peripheral nerves

The present study was carried out on 30 cadavers (5 fresh, 20 preserved adult and 5 fresh stillborn) following injection of red latex through the subclavian and common iliac arteries. The blood supply to the peripheral nerves was studied in general, together with the vascular pedicles to the ulnar, saphenous, sural, deep and superficial peroneal nerves, and the superficial branch of the radial nerve. The nutrient arteries supplying the peripheral nerves came from either the adjacent axial artery or the fasciocutaneous or muscular arteries. They formed anastomotic channels in the epineurium and penetrated it to form a continuous longitudinal artery. Based on the presence of absence of dominant arterial pedicles, five patterns of blood-supply to the nerves could be identified. I: no dominant arterial pedicle; II: only one dominant artery (e.g. artery with a diameter more than 0.8 mm and accompanying the nerve for most of its length); III: only one dominant vessel that divided into ascending and descending branches to supply the nerve; IV: multiple dominant pedicles; V: multiple dominant arterial pedicles forming a continuous artery that accompanied the nerve. The arterial pedicles to the ulnar, saphenous and deep peroneal nerves and the superficial branch of the radial n. had mean diameters of over 0.8 mm, thus being suitable for microvascular anastomosis. Those to the sural nerve were not present in two thirds of the dissected cadavers. In 10% of the cadavers the superficial peroneal nerve had an arterial pedicle that accompanied the nerve for less than two cm with a mean diameter less than 0.8 mm. The ulnar nerve could be very suitable as a donor vascularized nerve graft as it had a dominant vascular pedicle in all the cases studied; however, its use should be restricted to C8 and T1 root damage of the brachial plexus. The superficial branch of the radial n. might be suitable for vascularized nerve grafting, but this is difficult in practice since the radial artery is a major limb artery. The saphenous nerve had a dominant arterial pedicles in all the cadavers dissected and could be the most suitable as a donor vascularized nerve graft, unlike the sural nerve which did not have a dominant arterial pedicle in two-thirds of the specimens. The deep and superficial peroneal nerves may also be unsuitable since the former is accompanied by a major limb vessel while the latter had a dominant vascular pedicle that accompanied the nerve for only a short distance in 10% of the dissected cadavers.     

日韩健康人运动神经传导的比较

目的：检测健康的日本人和韩国人的末梢神经传导以研究不同国家的国民之间的传导差异,进而探讨各国民族生活习惯对末梢神经传导指标的影响。方法：以40名日本志愿者和30名韩国志愿者为对象,检测正中、尺、胫及腓神经的复合肌肉动作电位（CMAP）和F波,比较日本人和韩国人的神经传导检测结果。结果：经比较,正中、尺、胫及腓神经CMAP的远端波幅（DAmp）平均值,日本组高于韩国组（P〈0．05）;尺神经运动传导速度（MCV）日本组快于韩国组;F波最短潜伏期（F-Lat）日韩两组均有延长现象。腓神经D—Lat和F-Lat,日本组较韩国组延长;日本组中,腓神经DLat大于（x±s）的神经组的DAmp和F-Lat低下或延长。结论：正中、尺、胫及腓神经CMAP的DAmp,日本组高于韩国组;提示日韩两组均有腕肘部潜在性尺神经损伤;日本组中,可观察到踝前部的潜在性腓神经损伤。推测日常生活中的频繁而反复的轻微外伤以及日本人的正坐习惯是导致腕肘部及踝前部的潜在性神经损伤的根源。     

带腓肠外侧皮神经及其营养血管筋膜皮瓣的应用解剖

目的 为带腓肠外侧皮神经及其营养血管筋膜皮瓣的临床应用提供解剖学基础.方法 在32例成人下肢标本上,对腓肠外侧皮神经及其营养血管进行解剖观测.结果 腓肠外侧皮神经在腓骨头平面上方 7.1±2.4cm处起于腓总神经,分布于小腿后外侧上半或上2/3的皮肤.其营养动脉主要为:腓肠外侧皮动脉:起自腘动脉,在腓骨头平面上方5.0±1.5cm处浅出,外径为0.9±0.3mm;肌间隔筋膜皮支:起自胫后动脉和腓动脉,分别在腓骨头平面下方9.2±3.8cm和15.8±3.8cm处浅出,外径为0.7±0.3mm和0.9±0.4mm.该营养动脉除在腓肠外侧皮神经周围或其内呈链式吻合外,还发出筋膜皮支与邻位的皮动脉连接.静脉血可沿伴行静脉或小隐静脉及其属支回流至深静脉.结论 以腓肠外侧皮神经及其营养血管为蒂,可设计成顺行或逆行转位筋膜皮瓣,修复邻近部位的软组织缺损.     

Tibial and peroneal nerve conduction studies in ankle sprain

BACKGROUND: Lower limb injuries and ankle sprain occur frequently among football players, due to the high incidence of physical contact. As a result, lower limb nerves are subject to injury. This project aims to evaluate the lower limb nerve conduction among students playing football to investigate the probable relationship between ankle sprain in football and nerve conductivity. MATERIALS AND METHODS: Fifty volunteer students aged between 19 and 25 were studied. They fell into three groups; one comprising of 20 healthy football players whose football experience exceeded three years, the second group with 15 football players who had suffered ankle sprain and the last group with 15 healthy non- sports students. Initially, the surface temperature of the foot skin was recorded. Then, the latency and the conduction velocity of deep peroneal and tibial nerves were recorded, statistical data analysis was conducted using statistical tests, i.e., "Independent sampleT", and "Paired T test". RESULTS: In the football player group, student with Hx of ankle sprain, the deep peroneal and tibial nerves distal latencies were significantly longer than the other two groups (P < or = 0.05). In addition, the nerve conduction velocity of the deep peroneal motor and tibial nerves showed a significant decrease in comparison with the other two groups (P < or = 0.05). CONCLUSION: Harming the lower limb nerves, football may increase the nerve latencies and hence decrease the conductivity in lower limbs. Therefore, in electrophysiologic tests of the football players lower limb nerves, especially those with lower limb injuries, one has to consider the fact that the decrease in the clinical neuroconductivity may be preexistent. Thus care should be taken in diagnosing neuropathy, in this group.     

Nerve conduction velocity distribution in normal subjects and in diabetic patients without clinical neuropathy. I. Motor nerve.

A computer-assisted collision method to evaluate motor conduction velocity distribution of the ulnar and external peroneal nerves in normal subjects and in insulin-dependent and non-insulin-dependent diabetics without clinical signs of neuropathy is described. Distribution curves were sigmoidally (bimodally) shaped in normal and in insulin- and non-insulin-dependent subjects. In insulin-dependent patients, motor conduction velocity of the peroneal nerves was globally impaired, whereas of the ulnar nerves it was normal. In non-insulin-dependent patients, slower conduction velocity was involved in both nerves.     

脑卒中瘫肢正中神经结构和功能的研究

目的:观察脑出血大鼠瘫肢正中神经超微结构的变化和脑卒中偏瘫患者患肢正中神经传导功能的变化。方法:动物实验:Wister大鼠60只,模型组及假手术各30只,通过胶原酶加肝素联合注射法建立大鼠脑出血动物模型。造模成功后第3 d、14 d取材,观察正中神经镜下变化(光镜、电镜)。临床研究:于2009年7月～2011年12月随机选择淮北市人民医院神经内科经CT或MRI确诊的首次住院的脑卒中偏瘫患者60例,应用肌电图技术测试其患侧和健侧正中神经的传导功能变化。结果:无论是模型组还是假手术祖,大鼠正中神经有髓神经髓鞘及轴索无明显异常变化。脑卒中患者瘫肢正中神经运动神经传导速度(MCV)和感觉神经传导速度(SCV)与对照组(健侧)比较无显著差异(P>0.05)。结论:结果表明脑出血偏瘫大鼠瘫肢周围神经结构无明显损害。脑卒中急性期患者瘫肢正中神经传导功能无异常变化。     

神经传导速度和H反射对酒精中毒性周围神经病的诊断价值

目的:探讨神经传导速度(NCV)和H反射对慢性酒精中毒性周围神经病(CAPN)的诊断价值。方法:用肌电图检测CAPN患者50例和对照者50例。检测正中、尺、腓、胫神经的NCV,并在胭窝引出H反射。结果:CAPN组的NCV及H反射异常率分别为70%和92%,与对照组比较差异有极显著意义,下肢NCV异常率(82%)高于上肢的异常率(77%),感觉神经传导速度(SCV)异常率(84%)高于运动神经传导速度(MCV)的异常率(76%)。结论:NCV及H反射检测可作为酒精中毒性周围神经病变的检测手段之一。     

吉兰-巴雷综合征患者的肌电图测试与分析

目的:探讨神经传导速度、F波和针极肌电图对吉兰-巴雷综合征的诊断价值。方法:检测32例吉兰-巴雷综合征患者的正中神经、尺神经、腓总神经、胫神经、腓浅神经和腓肠神经的传导速度以及正中神经和胫神经F波的潜伏期测定,小指展肌、拇短展肌、肱二头肌、股直肌和胫前肌的针极肌电图检测。结果:吉兰-巴雷综合征的运动神经传导速度异常率为72.6%,感觉神经传导速度的异常率为57.8%,F波潜伏期的异常率为85.9%,结论:肌电图的测定可为吉兰-巴雷综合征的诊断提供客观依据,并可发现亚临床周围神经病变,神经电生理的检查对吉兰-巴雷综合征的诊断具有重要的参考价值。     

Effects of one year of near-normoglycemia on peripheral nerve function in type 1 (insulin-dependent) diabetic patients

Summary Ninety poorly controlled C-peptide negative type 1 (insulin-dependent) diabetic patients with chronic complications were allocated to intensified insulin treatment with either continuous subcutaneous insulin infusion or multiple insulin injections; 83 were studied over 1 year (seven patients dropped out of the study). Peripheral nerve function was assessed by clinical examination, malleolar vibration perception threshold, and motor and sensory nerve conduction velocities (MNCV; SNCV) in the median, ulnar, peroneal, and sural nerves. In order to assess the effect of metabolic control on peripheral nerve function, the results in patients with normal mean HbA₁ levels during months 3–12 of the study <8.6% (tight control (tc);n=50) were compared with those with abnormal mean HbA₁ 8.6% (poor control (pc);n=33). Mean blood glucose was significantly higher in pc than in tc at months 2–9 and 11 (P<0.05). In pc median and ulnar SNCV were significantly lower at 6 and 12 months, and ulnar and peroneal MNCV at 12 months than in tc (P<0.05). No significant differences between the groups were observed for median MNCV, sural SNCV, and vibration sensation. Further analysis revealed that in well-controlled patients who showed abnormal peripheral nerve tests at baseline, median, and ulnar MNCV and SNCV but not peroneal MNCV, sura SNCV, and vibration sensation were significantly improved after 12 months as compared with poorly controlled patients with initially abnormal tests (P<0.05). There were no differences in nerve function between well- and poorly-controlled patients who had normal nerve tests at baseline. These results provide evidence that near-normoglycemia over 1 year does not have uniform effects on peripheral nerve function in type 1 diabetic patients. Impaired motor and sensory nerve conduction seems to be more susceptible to improvement under strict glycemic control in the upper than in the lower extremities.Abbreviations at Abnormal tests - CSII Continuous subcutaneous insulin infusion - GM Geometrical mean - ICT Intensified conventional therapy - MNCV Motor nerve conduction velocity - pc Poor control - SEF Standard error factor - SNCV Sensory nerve conduction velocity - tc Tight control - VPT Vibration perception threshold Members of the Study Group: H. Berger, I. Cicmir, K. Dannehl, K. Dopstadt, F.A. Gries (coordinator), A. Hübinger, Th. Koschinsky, P. Mayer, W. Schäfer, B. Schleppinghoff, M. Toeller, D. Tschöpe, K. Wiefels, and D. Ziegler