臂丛神经损伤的神经电生理诊断价值

目的：探讨电生理检查对臂丛神经损伤的诊断价值。方法：对26例臂丛神经损伤患者进行肌电图(EMG)、神经电图(NCV)及体感诱发电位(SEP)检查，并与手术探查中的发现相对比。结果：电生理检测结果与手术发现完全及基本符合率为92．3％。结论：电生理诊断对臂丛神经损伤的范围、性质、部位与程度均有重要价值。     

格林-巴利综合征患者的神经肌电图分析

目的:学习研究患者肌电图以及神经肌肉传导测定对格林-巴利综合征(GBS)患者的在临床实践中的全新价值和意义.方法:通过肌电图设备给60例GBS患者对感觉神经元传导速度、运动神经元传导速度及肌电图三项进行检测.结果:肌电图出现自发电位主要因为平均动作电位时限延长,运动神经传导战缓63％,然而感觉神经传导降低或测不出51％.结论:神经肌电电生理测试肌电图分析不但用于GBS患者的附带检查.还可以整体性来决定和评估GBS患者外周神经元由近到远损害的特征、面积、严重与否等,对GBS的诊治疗和预后分析评估均有重要的价值.     

臂丛根性损伤两种神经电图—肌电图检测方法的诊断符合率

目的比较两种神经电图－肌电图检测方法对臂丛根性损伤的诊断符合率。方法１９９７年前，对８２例臂丛根性损伤用上肢五大神经代表肌肉及肩胛带肌群肌电图（ＥＭＧ）、复合肌肉动作电位（ＣＭＡＰ）、运动神经传导速度（ＭＮＣＶ）、感觉神经诱发电位和传导速度（ＳＮＡＰ、ＳＮＣＶ）及体感诱发电位（ＳＥＰ）进行分析诊断。１９９７年起，对１１８例臂丛根性损伤加测颈椎旁肌ＥＭＧ、双侧膈肌的ＣＭＡＰ和斜方肌的ＥＭＧ、ＣＭＡＰ进行诊断。结果１９９７年至今，臂丛根性损伤神经电图－肌电图的诊断和术中发现相比，诊断完全符合率为８０％，完全及基本符合率为９５．４％，比１９９７年前分别提高１４．１％和１０．３％。结论臂丛神经根性损伤加测椎旁肌ＥＭＧ、膈神经、副神经肌电可提高臂丛根性损伤尤其是Ｃ５节后损伤的肌电诊断正确率。     

12例原发性醛固酮增多症患者的肌电观察

对１２例原发性醛固酮增多症患者行肌电图观察，结果发现手术前有１１例患者肌肉电位活动和运动神经传导均异常，手术后全部恢复正常，这两次肌电图检查结果与手术前后患者的血钾水平变化相一致，认为，肌电异常的原因是低血钾导致神经与肌肉的应激性受到抑制的结果。     

先天性马蹄内翻足的运动神经传导速度研究

目的采用对下肢运动神经传导速度的检测,研究先天性马蹄内翻足患者下肢神经和肌肉功能的变化,为有关该病病因学研究及其治疗方案的设计和疗效评价提供客观依据.方法用丹麦产维迪KEYPOINT 4C诱发电位仪,对53例,男39例,女14例,年龄0.5～15岁,平均(27.48±37.43)个月,临床确定为先天性马蹄内翻足的患者进行了运动神经传导速度检查.结果53例患儿75侧患肢运动神经传导速度检查发现,有47例68侧(88.7%)均有异常改变.只有6例7侧(11.3%)运动神经传导速度检查未发现明显异常.结论本研究发现支持有关先天性马蹄内翻足病因的神经肌肉学说,为该病诊断及治疗后效果评价提供了有价值的客观指标.     

术中电生理检测在外周神经损伤中的应用

目的 探讨电生理检测在外周神经手术中应用的临床价值。方法 对16例17条外周神经分三组行术中电生理检测，指导术中决策和判断预后，并与术前肌电图结果或核磁共振检查结果对比。结果臂丛损伤组9例，术中体感诱发电位与核磁共振对检查完全根性损伤的检出率，经，检验差异无显著性。对臂丛损伤的大体定位，术前结合体格检查、肌电图及核磁共振结果的诊断与术中电生理检测结果完全吻合。四肢外周神经损伤组5条神经，3条术前肌电图结果与术中检测完全相符，2条不符。神经肿物组3条神经，在摘除神经瘤体后，术中电生理检测提示1例好转，2例出现不同程度的神经受损改变，术后随访与术中电生理检测的提示相符。在本组所有17条神经中，共有5条神经因术中电生理检测结果而改变了手术方案。结论 外周神经术中电生理检测的准确性优于术前的肌电图检查及核磁共振检查，具有准确、简便、实时等特点，可直接指导术中手术方案的选择；对神经肿块等原因引起的神经压迫损害，术中电生理检测可评价手术疗效，判断预后。     

探讨肌电图联合高频超声检查在外伤性桡神经损伤程度和部位诊断中的应用

目的评估分析肌电图联合高频超声检查在外伤性桡神经损伤中的诊断价值。方法回顾总结2013年6月-2016年12月收治的37例桡神经损伤术前肌电图及高频超声检查诊断结果 ,对照术中发现的桡神经真实损伤程度及治疗后恢复结果 ,评价肌电图联合高频超声检查在桡神经损伤中的诊断价值。结果 37例桡神经损伤依据肌电图联合高频超声诊断采用标准化治疗方案。随访时间6～24个月,根据中华医学会手外科学分会上肢部分功能评定试用标准及英国医学研究会感觉功能测定标准评分,优18例,良16例,可3例,优良率91.9%。结论肌电图联合高频超声检查诊断外伤性桡神经损伤,可较好弥补受伤早期肌电图检查的不足,从形态上和功能上联合判断桡神经损伤的严重程度,可提高桡神经损伤的确诊率,对临床治疗方案的确定具有指导意义。     

臂丛MRI在臂丛神经节前损伤诊断中的临床效能分析

目的：探讨臂丛MRI在臂丛神经节前损伤诊断中的临床价值。方法45例临床诊断为臂丛神经损伤的患者,术前均采用1.5 T GE Signa EXCITE MRI扫描仪行双侧臂丛MRI扫描,同时所有患者均行锁骨上臂丛神经探查以及术中肌电图检查,将MRI扫描结果与手术所见及术中肌电图进行比较,分析臂丛MRI在节前损伤诊断中的准确率。结果45例共225根神经根,169根节前损伤,MRI共检出147根,MRI诊断总体准确率为86.2%,并且MRI检查距受伤时间与诊断准确率无明显相关性（P〉0.05）。结论臂丛MRI可以清晰地显示臂丛神经椎管内外的结构,对臂丛神经节前损伤可以提供准确而清晰的定位定性诊断,具有非常高的准确率,可以为临床诊断提供可靠参考,指导临床早期制定手术方案,有益于患者的预后。     

乳癌放疗后放射性溃疡的治疗

目的　探讨乳癌放射性治疗 (下简称放疗 )后放射性溃疡的治疗方法 ,阐述放疗后臂丛神经损伤的广泛性和严重性。方法　 1999年以来分别应用腹直肌肌皮瓣转移、皮肤软组织扩张、局部皮瓣转移和局部延迟皮瓣转移等方法修复乳癌放疗后放射性溃疡 16例 ,并常规行肌电图检查了解臂丛神经损伤的情况。结果　除 1例患者因创口感染而皮瓣部分坏死外 ,其余皮瓣成活良好 ,创面修复满意 ;10例行肌电图检查的患者中 ,有 7例合并有臂丛神经损伤。结论　乳癌放疗后引起的放射性溃疡常伴有臂丛神经损伤 ,这些损伤呈慢性、进行性和不可逆性改变 ;应用血运良好的皮瓣可有效地修复溃疡创面。     

肘管综合征的电生理诊断

肘管综合征是尺神经嵌压最常见的病征,常需籍电生理检测确诊,作者对25例(29条)尺神经肘管嵌压进行神经—肌电图检测其阳性率依次分别为运动神经传导速度(MCV,前管段—肘段)之差值42.9％;波幅衰减率60.9％;肌电图79.3％;MCV(肘段)     

Subpial spinal evoked potentials in patients undergoing junctional dorsal root entry zone coagulation for pain relief

Summary Seven patients with complete avulsion of the brachial plexus underwent junctional coagulation lesions of the dorsal root entry zone (DREZ) for relief of intractable pain in the paralyzed arm. Intra-operative monitoring by recording spinal cord somatosensory evoked potentials (SEP) resulting from tibial nerve stimulation was done using subpial recording electrodes situated dorsal to the posterior median sulcus at the C4 and T2 segment. SEP on the normal side showed an initial positive wave and two negative waves followed by a group of high frequency waves of relatively high amplitude which continued into high frequency, low amplitude potentials. The conduction velocity of the fastest spinal evoked potential components were, on average, 86 m/s. Recordings from the side of avulsion revealed a steep positive potential of high amplitude which appeared in five patients prior to the creation of the DREZ lesion. This effect was assumed to be secondary to spinal cord damage caused by avulsion. During the DREZ coagulation the SEP from the unaffected side did not change. On the side of DREZ coagulation the velocity of the fastest fibres decreased. Four patients reported sensory deficits after the operation, which were transient in three. In one of these patients, the first two negative potentials disappeared. In the fourth patient, who had permanent sensory deficits, the positive steep potential appeared after generation of the lesion. Our results point to the usefulness of the subpial SEPs monitoring during microneurosurgical procedures on the spinal cord to provide further insight into evoked electrical activity of the normal and injured spinal cord, and to minimize post-operative neurological morbidity.     

Evoked potentials in the investigation of traumatic lesions of the peripheral nerve and the brachial plexus

Nerve conduction studies using nerve action potential (NAP), sensory nerve action potential (SNAP), evoked muscle action potential (M-response), retrograde conduction in the motor axon (F-response), and cortical and subcortical somatosensory evoked potential (SEP) are useful tools for evaluation of the peripheral nervous system. SEP recording has the advantages of being applicable to severely damaged nerves because of its amplification mechanism and of disclosing proximal root lesions that would not be disclosed by other methods. When SEP recording is used in an operating theater, the amplification mechanism is suppressed by the effect of the anesthetic. Nevertheless, it is valuable for evaluating proximal root lesions in conjunction with NAP recording and M-response. Strong M-response of the serratus anterior and paraspinal muscles is a most encouraging finding if nerve repair is performed more than seven days after brachial plexus injury. SEP recording can clarify the functional continuity of the spinal root to the spinal cord. Thus the presence of SEPs becomes an important positive finding and implies the potential of nerve repair even when an M-response is not provoked by a situation such as prolonged conduction block.     

Functional diagnosis of brachial plexus injuries

We evaluated 10 patients with verified brachial plexus injuries and root avulsion. In 100%, dermatomal somatosensory evoked potentials (DSSEPs) were abnormal. Compound muscle action potentials (CMAPs) by magnetic stimulation revealed 90% abnormal findings on the affected side, but also revealed abnormality in adjacent segments. Dissociation of CMAPs and DSSEPs revealed the apparent continuity of motor and sensory nerves. The use of both techniques for the examination of the function of proximal peripheral nerve revealed increased latencies over the motor and/or sensory pathways in all patients. The technique of non-invasive stimulation of the motor pathway therefore provides an additional tools to detect and quantify subclinical and clinically apparent lesions in patients with defined brachial plexus injuries and root avulsions.     

Neurogenic motor evoked potentials: role in brachial plexus surgery. Case report

Peripheral nerve graft repair after severe brachial plexus injury is futile if there is degeneration of motor fibers in the proximal nerve stump to which the graft must be attached. Traditional intraoperative neurophysiological assessment methods like nerve action potential (NAP) and somatosensory evoked potential (SSEP) monitoring have been used to evaluate proximal nerve stump integrity, but these methods do not allow evaluation of the integrity of motor fibers back to the anterior horn cell. Consequently, the authors used transcranial electrical stimulation and recorded neurogenic motor evoked potentials (MEPs) directly from the brachial plexus in a patient undergoing surgical repair of a complete upper brachial plexus injury (Erb palsy) to assess the functional continuity of motor fibers. In addition, selected elements of the brachial plexus were directly stimulated, and NAPs were recorded. Finally, SSEPs were recorded from the scalp after stimulation of selected elements of the brachial plexus. Neurogenic MEPs were present from the medial cord of the brachial plexus, but not the middle or upper trunk; NAPs were present from the lateral and posterior cords after middle trunk stimulation, but absent after upper trunk stimulation; and SSEPs were present after medial cord stimulation but absent after stimulation of the upper and middle trunks. For the first time, neurogenic MEPs were coupled with NAPs and SSEPs to evaluate successfully the functional status of motor fibers back to the anterior horn cell for accurate localization of the lesion sites.     

Evaluation of traumatic cervical nerve root injuries by intraoperative evoked potentials

OBJECTIVE: To evaluate intraoperative evoked potentials as a diagnostic tool in traumatic brachial plexus injuries. METHODS: Thirteen patients with traumatic brachial plexus injuries were investigated by intradural nerve root inspection (n = 28 roots) via cervical hemilaminectomy to assess or rule out nerve root avulsion from the spinal cord. Two to 8 weeks later, evoked potentials from neck and scalp were recorded after direct electrical nerve root stimulation close to the vertebral foramen during operative brachial plexus repair via an anterior (supraclavicular and infraclavicular) approach. Recordings were performed without and after full muscle relaxation. RESULTS: There was a clear relationship between the state of the root as documented by intradural root inspection and the result of intraoperative recording of evoked potentials: the absence of evoked muscle action potentials from neck muscles demonstrated a 100% sensitivity for anterior root lesions, whereas sensory evoked potentials from the scalp demonstrated a 100% sensitivity for posterior root lesions. Moreover, roots could be identified with preserved continuity that did not conduct, suggesting a nerve lesion in continuity. CONCLUSION: Intraoperative evoked muscle action potentials and sensory evoked potentials after electrical nerve root stimulation allow selective functional evaluation of anterior and posterior nerve roots in patients with traumatic brachial plexus injuries. The high sensitivity and reliability of this test obviate the need for additional diagnostic surgery.     

Upper extremity neuropathies after cardiac surgery

Although coronary artery bypass grafting is a common procedure, there can be significant postoperative morbidity. The occasional finding of unexplained postoperative neuropathy in these patients prompted this study. Fifty-three patients who had cardiac surgery that used the standard median sternotomy were studied prospectively. Detailed sensory and motor testing and intraoperative measurement of the distance of sternal retraction and duration of cardiopulmonary bypass were recorded. Twenty patients (37.7%) exhibited postoperative motor and sensory neuropathies, all of which involved the ulnar nerve. Five patients who were studied with electromyography and nerve conduction evaluations exhibited evidence of brachial plexus injury. The average duration of symptoms was 2.3 months, but several patients have long-term unresolved symptoms. Previous neuropathies, wide retraction of the sternum, and long cardiopulmonary pump runs seem to predispose to such injury, which appears to involve the brachial plexus. Anatomic reasons for such findings are offered.     

In situ strain and stress of nerve conduction blocking in the brachial plexus.

The objective of the present study was to determine the in situ strain and stress of nerve conduction blocking in the brachial plexus. The measurement of the in situ tension stress inducing functional failure of the brachial plexus consisted of two steps. Step I (in vivo): The brachial plexus of the rabbit was stretched laterally until electrophysiological conduction blocking occurred. The distance between two dye marks placed on the lower trunk was simultaneously recorded using a video dimensional analyzer system. Step II (in vitro): The lower trunk that was removed was loaded again, and the nerve tension was recorded. The load at complete conduction blocking was determined by a load-elongation curve. The results showed that when the in situ nerve strain reached 8.1 +/- 0.5%, the compound muscle action potential was not evoked. The in situ load and stress were 2.5 +/- 0.4 N and 0.89 +/- 0.14 MPa, respectively, at complete conduction blocking. These findings should be helpful in understanding the mechanism of brachial plexus traction injury.     

切断小斜角肌后臂丛神经功能改变的临床观察

目的 :观测小斜角肌在TOS患者术中的出现情况 ,分析切断小斜角肌的临床意义。方法 :回顾性分析下干型TOS共 3 3例 ,手术中探查切断小斜角肌 ,其中 4例进行术中肌电的监测 ,比较术前、切断前中斜角肌后、切断小斜角肌后上臂近段尺神经MNCV ,前臂内侧皮神经SNAP和尺神经F反应的变化。结果 :术中探查 3 3例下干型TOS中均有小斜角肌的存在 ,术后优良率为 78 8%。切断前中斜角肌后、切断小斜角肌后 ,上臂近段MNCV ,前臂内侧皮神经SNAP和尺神经F反应均较术前有改善。结论 :小斜角肌在绝大多数下干型TOS患者中均有出现 ;切断小斜角肌后下干型TOS患者臂丛神经功能的改善较明显 ;手术治疗中须探查松解小斜角肌     

Early microsurgical reconstruction in birth palsy

Most patients with birth palsy can be expected to recover spontaneously. But in some patients the recovery is unsatisfactory and the functional results are disappointing. One possible way to improve the prognosis for such patients is early surgical nerve reconstruction. In six infants, exploration of the brachial plexus was carried out at about six months after delivery, when there were no signs of recovery in shoulder and elbow joint movements. Preoperative metrizamide myelography, computerized tomography with intrathecal metrizamide (CT myelography), and axon reflex test (histamine test) were followed by intraoperative electrophysiologic examinations of root sensory evoked potential (SEP), nerve action potential (NAP), and evoked muscle response (M-response). Microsurgical nerve repair was performed on the basis of intraoperative diagnosis. Metrizamide myelography showed 13% false-positive root avulsion. Reliability of the histamine test was 80%. The intraoperative electro-diagnosis is essential for understanding the actual condition of the brachial plexus lesion and obtaining better results from microsurgical reconstruction in birth palsy. The surgical results, with an average follow-up evaluation of two years and four months, have been encouraging enough to continue this diagnostic and therapeutic program, though its superiority to natural recovery has not yet been clarified.