痉挛性斜颈患者瞬目反射的电生理研究

目的探讨痉挛性斜颈瞬目反射的电生理变化。方法 30例痉挛性斜颈患者及30例正常对照（颈部向左侧扭转）瞬目反射双侧R1、R2潜伏期、波幅高比较分析。结果病例组瞬目反射R1、R2潜伏期、R1波幅高正常,双侧R1、R2潜伏期、R1波幅高无统计学差异,斜颈同侧R2波幅高于对侧,有统计学差异;正常对照组颈部向左侧扭转时R1、R2潜伏期,R1、R2波幅高双侧比较无统计学差异。结论瞬目反射R1、R2潜伏期正常,提示该反射弧结构完整,斜颈同侧R2波幅高于对侧表明该侧上段延髓的外侧、桥脑中间神经元过度兴奋,痉挛性斜颈患者存在脑干功能失调。     

三叉神经-颈反射对运动神经元病球部损害的诊断价值

背景:运动神经元病的最早及好发部位为颈膨大,随病情发展,最早累及邻近的上部颈段及延髓区,三叉神经-颈反射受累较早。目的:建立三叉神经-颈反射的肌电检测方法,分析三叉神经-颈反射对运动神经元病球部损害的诊断价值。设计:病例-对照观察。单位:北京大学第三医院神经内科电生理检查室。对象:北京大学第三医院2002/2005就诊的运动神经元病患者主要为肌萎缩性侧索硬化症30例及健康志愿者70例。运动神经元病患者符合西班牙ElEscorial会议诊断标准。方法:受检测者取仰卧位,头部轻度抬高。使胸锁乳突肌轻度收缩。刺激一侧眶下神经,于双侧胸锁乳突肌记录峰潜伏期和波幅。所用检测仪器为Keypoint肌电图仪。所用电极均为Ag/Agcl表面电极。主要观察指标:正/负波潜伏期(P20/N30),波幅比率的平方根,即A值。结果:刺激对照者一侧的眶下神经,可于双侧胸锁乳突肌引出正/负波。运动神经元病组7例正常(23.3%),8例未引出(26.7%),11例潜伏期延长(36.7%),4例双侧反射超常不对称(13.3%)。运动神经元病组三叉神经-颈反射正波/负波的峰潜伏期(P20/N30)明显高于正常对照组,差异有显著性。波幅比的平方根(峰值与刺激前波幅比值的平方根即A值)明显低于正常对照组,差异有显著性。结论:三叉神经-颈反射能够可靠测定,可作为颈-球区病变的一种辅助检查手段,有助于运动神经元病的早期诊断。     

三叉神经-颈反射对运动神经元病球部损害的诊断价值

背景：运动神经元病的最早及好发部位为颈膨大，随病情发展，最早累及邻近的上部颈段及延髓区，三叉神经-颈反射受累较早。 目的：建立三叉神经-颈反射的肌电检测方法，分析三叉神经-颈反射对运动神经元病球部损害的诊断价值。 设计：病例-对照观察。 单位：北京大学第三医院神经内科电生理检查室。 对象：北京大学第三医院2002／2005就诊的运动神经元病患者主要为肌萎缩性侧索硬化症30例及健康志愿者70例。运动神经元病患者符合西班牙EI Escorial会议诊断标准。 方法：受检测者取仰卧位，头部轻度抬高。使胸锁乳突肌轻度收缩。刺激-侧眶下神经，于双侧胸锁乳突肌记录峰潜伏期和波幅。所用检测仪器为Keypoint肌电图仪。所用电极均为Ag／Agcl表面电极。 主要观察指标：正／负波潜伏期（P20／N30），波幅比率的平方根，即A值。 结果：刺激对照者一侧的眶下神经，可于双侧胸锁乳突肌引出正／负波。运动神经元病组7例正常（23．3％），8例未引出（26．7％），11例潜伏期延长（36．7％），4例双侧反射超常不对称（13．3％）。运动神经元病组三叉神经-颈反射正波／负波的峰潜伏期（P20／N30）明显高于正常对照组．差异有显著性。波幅比的平方根（峰值与刺激前波幅比值的平方根即A值）明显低于正常对照组，差异有显著性。 结论：三叉神经-颈反射能够可靠测定，可作为颈-球区病变的一种辅助检查手段，有助于运动神经元病的早期诊断。     

三叉神经-颈反射在多发性硬化中的诊断价值

目的 建立三叉神经-颈反射(TCR)的肌电检测方法，探讨其在多发性硬化中的诊断价值。方法受检测者取仰卧位，头部轻度抬高。刺激一侧眶下神经，于双侧胸锁乳突肌记录。结果刺激对照者一侧的眶下神经，可于双侧胸锁乳突肌引出正／负波。多发性硬化病人波形正常者8例(26.7％)，潜伏期延长者8例(26.7％)，双侧反射的超常不对称者14例(46．7％)。结论 TCR能够可靠测定，可作为多发性硬化的一种辅助检查手段。     

射频热凝术联合A型肉毒毒素注射治疗痉挛性斜颈疗效分析

痉挛性斜颈(spasmodic torticollis,ST)是颈肌受到中枢神经异常冲动造成不可控制的痉挛或阵挛,使头颈部向一侧痉挛性倾斜扭转,致使患者出现多种症状和姿势异常。以往采用口服药物、针灸及理疗等方法,效果不理想。近年来多采用手术治疗或     

三叉神经-颈反射检测方法的建立和正常值及在神经损伤时的评估作用

目的建立三叉神经-颈反射的肌电检测方法,测量国人正常值,探讨其临床应用。方法70例志愿者,取仰卧位,轻度收缩胸锁乳突肌,于眶下孔附近刺激,胸锁乳突肌记录。结果刺激正常受试者一侧的眶下神经,可引起双侧的正/负波。结论三叉神经-颈反射能够可靠测定,在下位脑干损伤的定位诊断中有一定作用。     

3例痉挛性斜颈患者的护理

<正>痉挛性斜颈(Spasmodic Torticollis,ST)指颈肌受到中枢神经异常冲动造成不可控制的痉挛或阵挛,导致特殊的头颈及肩部畸形,常伴有局部疼痛或压痛。斜颈主要累及颈部肌肉,以胸锁乳突肌、斜方肌、颈颊肌、斜角肌受累明显等颈部肌群自发性不自主收缩引起头部向一侧扭转或阵发性倾斜[1]。我院2012年3月收治3例痉挛性斜颈患者,经治疗和护理,获得了良好的效果,现报告如下。     

侧屈型痉挛性斜颈手术治疗分析（附45例）

目的 研究颈部神经及肌肉选择性切除术治疗侧屈型痉挛性斜颈。方法 我院1979年-2003年对45例侧屈型痉挛性斜颈，根据临床表现选择术式：1．副神经切断术(4例)；2．二联术-副神经切断加颈肌选择性切除术(28例)；3．三联术-二联术加做颈神经1-4后支切断术(13例)。结果全组45例，痊愈34例(76％)，显效9例(20％)，有效率96％，好转2例(4．4％)。无死亡，无致残。结论颈部神经及肌肉选择性切除术是治疗侧屈型痉挛性斜颈的安全、有效的、可供选择的方法。     

三叉神经体感诱发电位诊断三叉神经痛的临床应用价值

目的探讨原发性三叉神经痛患者三叉神经体感诱发电位（TSEP）的变化特征及临床应用价值。 方法对64例原发性三叉神经痛患者（TN组）进行患侧和健侧TSEP检测,对其结果进行对比分析,并与30例正常人（正常组）左右两侧TSEP进行比较。 结果TN组TSEP检测,患侧各波潜伏期延长,各波间期正常;部分伴有不同程度波幅下降;异常程度与病程长短有关。患侧与正常组比较,N13、P19波潜伏期差异具有统计学意义（P＜0.01）;N30波潜伏期差异具有统计学意义（P＜0.05）。TN组患侧和健侧各波潜伏期比较,差异具有统计学意义（P＜0.01）。 结论TSEP检测有助于了解三叉神经传导通路的功能状况;患侧各波峰值潜伏期顺应性的延长是诊断原发性三叉神经痛的有价值的电生理指标。     

脑卒中患者双下肢H反射的变化及其与痉挛指数的相关性

目的：研究痉挛期脑卒中患者双下肢胫神经H反射的变化及其和痉挛指数的相关性，并探讨其发生机制。方法：32例恢复期脑卒中患者，均存在不同程度的患侧下肢伸肌痉挛。将患者双下肢分为患侧和非患侧，分别给予肌电图胫神经H反射检查和患侧综合痉挛量表（CSS）评定，比较双侧H反射的改变，分析患侧H反射潜伏期和H/M比值和CSS评分的相关性。结果：患侧H反射潜伏期平均26.18±1.64ms，H/M比值平均0.53±0.22，患侧下肢CSS评分平均9.88±1.59；非患侧H反射潜伏期平均28.30±1.69ms，H/M比值平均0.36±0.19。双侧H反射的潜伏期和H/M比值比较，患侧潜伏期缩短，H/M比值增大，有显著性差异；患侧CSS评分和H/M比值显著正相关，直线回归方程为y＝－0.54＋0.11x，相关系数r＝0.6329，（P＜0.001）。结论: 痉挛期脑卒中患者患侧H反射活跃，患侧H/M比值和CSS评分正相关，H/M比值是脑卒中后痉挛性偏瘫患者痉挛侧下运动神经元兴奋性评估的良好指标。     

Relationship between cytochrome P450 2C19*2 polymorphism and stent thrombosis following percutaneous coronary intervention in Chinese patients receiving clopidogrel

This study investigated the relationship between the cytochrome P450 2C19 (CYP2C19) *2 polymorphism (681A) and definite stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel (75 mg/day, orally). The CYP2C19*2 polymorphism status of 1738 Chinese patients with coronary artery disease was examined. The primary endpoint was the occurrence of definite ST during the 180-day follow-up period. The presence of at least one CYP2C19*2 allele was significantly associated with increased ST risk (19 CYP2C19*2/*2 or *1/*2 patients [2.4%] versus seven homozygous wild-type CYP2C19*1/*1 patients [0.75%]). The risk of definite ST was highest in patients with the CYP2C19*2/*2 genotype. The CYP2C19*2 genotype is associated with an increased risk of definite ST following coronary stent placement among Chinese patients with coronary artery disease receiving clopidogrel.     

Transcranial magnetic stimulation and silent period in spasmodic torticollis

OBJECTIVE: Our objective was to study the corticobulbar projections to neck muscles in cervical dystonia. DESIGN: We compared both the motor evoked potentials and the electromyographic silent period after transcranial magnetic stimulation from sternocleidomastoid and trapezius muscles in a group of 13 patients with spasmodic torticollis with those of 20 healthy volunteers. RESULTS: With the target muscle at rest, no changes of motor threshold, motor evoked potentials latency, and amplitude were observed in dystonic patients. With facilitation, the mean amplitude of the motor evoked potentials was increased in patients compared with controls, the significant difference being for the trapezius muscle, whereas the latency did not differ between groups. The cortical silent period was significantly shorter in dystonic patients than in healthy subjects in both muscles. The duration of the cortical silent period recorded from the sternocleidomastoid muscle showed a positive correlation with the degree of neurologic disability assessed by Tsui's scale. No abnormalities of both nerve conduction velocity and peripheral silent period by stimulation of accessory nerve were found. CONCLUSIONS: These results indicate an impairment of the mechanisms of inhibitory motor control in patients with spasmodic torticollis, which could be the result of a decrease of the basal ganglia inhibitory output over the motor cortex.     

关节镜下自体四股半腱肌重建膝关节前交叉韧带

[目的]探讨关节镜下自体四股半腱肌,重建膝关节前交叉韧带手术可行性。[方法]2003年5月至2008年10月,关节镜下自体四股半腱肌重建膝关节前交叉韧带35例,男26例,女9例。关节镜下均证实膝关节前交叉韧带断裂,取全长半腱肌,分四股,关节镜下行等长重建。参照敖英芳临床判断标准及Lysholm评分评价疗效。[结果]术后患者伤口均Ⅰ期愈合,8～12周膝关节屈伸功能恢复正常。获随访4个月至4．6年,平均2．5年。本组优20例,良11例,中2例,差2例。Lysholm评分术后92．48±10．53,与术前38．25±8．36比较,差异有统计学意义（P〈0．01）。[结论]关节镜下自体四股半腱肌重建膝关节前交叉韧带方法可行,疗效确切,且并发症少,值得临床广泛推广运用。     

痉挛性斜颈的CT表现及其诊断价值

目的：探讨痉挛性斜颈（ST）的多排螺旋CT（MSCT）检查方法及其对痉挛责任肌群的定位诊断价值。方法回顾性分析18例ST患者临床及CT资料,临床分型：旋转型10例,侧屈型8例;另选取年龄及性别匹配的健康志愿者18名作为对照组,均行颈部CT正位及斜位扫描。分别对两组左、右同名颈肌肌腹的横截面积进行测量及比较,分析不同类型ST痉挛肥大肌肉的分布特征。结果18例ST患者CT主要表现为颈部痉挛肌肉肌腹横截面积增大,且与斜颈临床分型相关,旋转型肥大肌群主要分布在头旋向侧的后1/4区及对侧前1/4区,正位CT显示痉挛肥大肌肉与对侧同名肌（胸锁乳突肌、头夹肌、肩胛提肌）肌腹横截面积均值差异有统计学意义（P＜0.05）;侧屈型肥大肌群主要分布在头屈向侧的后1/4区和前1/4区,正位CT显示痉挛肥大肌肉与对侧同名肌（胸锁乳突肌、肩胛提肌、斜方肌）肌腹横截面积均值差异有统计学意义（P＜0.05）。结论 MSCT能明确显示ST痉挛肥大肌肉形态改变及其分布规律,有助于确定痉挛责任颈肌并进行针对性治疗,是ST首选无创性检查方法。     

Long-term treatment with botulinum toxin: dosage, treatment schedules and costs

Local injection of botulinum toxin A (BTX) is considered as the treatment of choice for spasmodic torticollis (ST), blepharospasm (BS) and, with certain limitations, for hemifacial spasm (HFS). Long-term data from 89 patients with ST, 39 patients with BS and 15 patients with HFS were evaluated and subgroups of patients who received at least three (60 ST, 17 BS, 9 HFS), six (35 ST, 10 BS, 8 HFS) and nine (26 ST) re-injections were formed. These groups were investigated in regard of increases in the dosage of BTX and in regard of shorter treatment intervals in cases of repeated treatment. Annual drug costs were calculated from these data. Patients treated at least three times were asked to fill out a questionnaire concerning satisfaction and the quality of life after BTX treatment. Furthermore, the patients' "willingness to pay" for BTX treatment was investigated. Our calculations showed neither a significant increase in the dosage of BTX nor a significant reduction in the length of treatment intervals after 3 or 6 treatment sessions. Annual drug costs for BTX for the treatment of ST were 10,542 ATS, of BS 2847 ATS and of HFS 1029 ATS. 86.1% of patients with ST, 88.9% with BS and 100% with HFS were very satisfied or satisfied with the BTX treatment. In all 3 diagnostic groups, a significant mean improvement of quality of life was measured on a visual analogue scale (p < 0.001). We conclude that the injection of botulinum toxin A is a highly effective and cost effective treatment for ST, BS and HFS, and significantly increases the quality of life of all these patients.     

Reciprocal ST segment depression: impact on the electrocardiographic diagnosis of ST segment elevation acute myocardial infarction.

Acute myocardial infarction (AMI) is one of many causes of electrocardiographic ST segment elevation (STE) in ED chest pain (CP) patients; at times, the electrocardiographic diagnosis may be difficult. Coexistent ST segment depression has been reported to assist in the differentiation of non-infarction causes of STE from AMI-related ST segment elevation. The objective was to determine the effect of AMI diagnosis on the presence of STD among ED CP patients with electrocardiographic STE. Adult CP patients with electrocardiographic STE in at least 2 anatomically distributed leads were reviewed for the presence or absence of ST segment depression in at least 1 lead and separated into 2 groups, both with and without ST segment depression. A comparison of the 2 groups was performed in 2 approaches: all STE patients and then only with STE patients who lacked confounding electrocardiographic pattern (bundle branch block [BBB], left ventricular hypertrophy [LVH], or right ventricular paced rhythm [VPR]). All patients in the study underwent prolonged observation in the ED (at least 8 hours) with 3 serial troponin T determinations and 3 electrocardiograms (ECG). AMI was diagnosed by abnormal serum troponin T values (>0.1 mg/dL); electrocardiographic STE diagnoses of non-AMI causes were determined by medical record review. There were 171 CP patients with STE were entered in the study with 112 (65.5%) individuals show ST segment depression. When considering all study patients, ST segment depression was present at statistically equal rates in AMI and non-AMI situations (P = NS). The sensitivity, specificity, positive predictive value, and negative predictive value for the electrocardiographic diagnosis of AMI were 63%, 34%, 30%, and 67%, respectively. Patients with confounding patterns (LVH 46, BBB 19, and VPR 6) were removed from the analysis group, leaving 100 patients for analysis; 38 of these patients had ST segment depression. When considering this group of study patients, ST segment depression was present significantly more often in AMI patients (P <.0001). The sensitivity, specificity, positive predictive value, and negative predictive value for the electrocardiographic diagnosis of AMI were 69%, 93%, 93%, and 71%, respectively. Clinical diagnoses were as follows: 56 AMI, 50 USAP, and 65 noncoronary syndrome. When all CP patients with electrocardiographic STE are considered, the presence of ST segment depression is not helpful in distinguishing AMI from non-AMI. If one considers only patterns which lack electrocardiographic ST segment depression caused by altered intraventricular conduction, the presence of ST segment depression strongly suggests the diagnosis of AMI. In these cases, reciprocal ST segment depression is of considerable value in establishing the electrocardiographic diagnosis of STE AMI.     

Selective peripheral denervation for torticollis: preliminary results

Herein we report the preliminary results in nine patients who have undergone selective peripheral denervation for spasmodic torticollis and have been followed up for at least 13 months. All patients had improvement immediately after surgical intervention, and the results have been maintained in five patients. In one patient who had recurrent torticollis, a second procedure in conjunction with injection of botulinum toxin has produced substantial improvement; however, follow-up was brief (6 months). No surgical complications occurred. We believe that selective peripheral denervation is safe and that it can benefit patients with torticollis who have not responded to other types of therapy. These favorable results confirm other published reports on the efficacy of selective peripheral denervation. Long-term follow-up, however, is necessary for determining the role of this procedure in the management of torticollis.     

星状神经节阻滞治疗痉挛性斜颈

目的：观察星状神经节阻滞（ＳＧＢ）治疗痉挛性斜颈（ＳＴ）病人的临床效果。资料及方法：３例病程４个月～２年的ＳＴ患者,１例为头颈部持续向右旋转,２例为了阵挛性转头动作。其中２例经多得药物治疗或针灸治疗未能控制。用２％利多卡因（５ｍｌ／次）行ＳＧＢ治疗,每日１次连续２周,然后隔日１次连续２周;最后,１周２次连续２周。用Ｔｓｕｉ评分价疗效。结果：３例病人经ＳＧＢ治疗后症状逐渐好转,两周后症状明显改善,１     

局部注射A型肉毒毒素后远隔部位F波的改变

目的探讨局部注射A型肉毒毒素(BTX-A)后其远隔部位F波的改变及其可能机制。方法对19例偏侧面肌痉挛(HFS)患者、5例Meige综合征患者及2例痉挛性斜颈(TS)患者行BTX-A注射，并在注射前、注射后1周及注射后12～24周时分别检测其尺神经及胫神经F波的各项参数变化。结果①注射后1周，有3例患者共5条尺神经未引出肯定波形。②与注射前比较，尺、胫神经F波平均潜伏期以及尺神经F波时限在注射1周后显著延长，且这种改变与注射剂量无明显相关性；注射12～24周时，上述两参数与注射前比较，差异均无显著性意义。结论F波平均潜伏期和时限是评价BTX-A远隔效应的敏感指标；BTX-A的远隔效应似与检查部位和注射部位间的距离有关，而与注射剂量无明显相关性。