H反射在脑卒中后上肢偏瘫患者中的特征表现及分析

目的:通过研究脑卒中后上肢偏瘫患者H反射的特征表现,及其与偏瘫肢体肌张力的关系,探讨H反射在脑卒中后上肢偏瘫患者神经电生理评定中的应用价值。方法:选择符合本研究入选标准的脑卒中恢复期偏瘫患者42例。分别对患者双侧正中神经、尺神经、桡神经所支配的拇短展肌、小指展肌、指总伸肌进行H反射检查,并对患侧上肢给予改良Ashworth痉挛量表(MAS)评定,确定上述神经中哪些更容易引出H反射,并对其所引出的H反射结果及其与MAS的相关性进行比较和分析。结果:患者双侧正中神经、尺神经所支配的拇短展肌、小指展肌均较易引出H反射,引出率100%。桡神经所支配的指总伸肌不易(3例/42例,引出率7.14%)引出H反射。患侧正中神经和尺神经的H反射潜伏期分别为(25.89±3.66)ms、(25.71±3.26)ms;健侧正中神经和尺神经的H反射潜伏期分别为(26.60±3.11)ms、(26.44±2.87)ms。配对t检验分析,差异均有显著性意义(P<0.05);Hmax/Mmax比值均数用中位数表示,患侧正中神经和尺神经的Hmax/Mmax比值分别为0.185和0.217;健侧Hmax/Mmax比值分别为0.126和0.112,用Wilcoxon符号秩检验分析,患侧与健侧差异均有显著性意义(P<0.05)。用Kruskal-WallisH检验分析显示:患侧上肢正中神经、尺神经H反射潜伏期在MAS不同级别中没有差异,而Hmax/Mmax比值在MAS不同级别中有差异。Spearman秩相关检验结果显示:患侧上肢正中神经H反射潜伏期、Hmax/Mmax比值以及尺神经H反射潜伏期与MAS不相关;而患侧上肢尺神经Hmax/Mmax比值与MAS存在秩相关关系。结论:上肢H反射与MAS存在一定关系,其中Hmax/Mmax比值是评估下运动神经元兴奋性的较好指标,可以成为临床评价痉挛的客观神经电生理指标。     

脑卒中患者周围神经与肌肉神经电生理特征分析

目的:通过神经传导及同心圆针肌电图检测探讨脑卒中患者周围神经、肌肉的神经电生理变化特征,为脑卒中后神经肌肉功能评估和预后判断提供依据。方法:对符合入选标准的41例脑卒中患者进行双侧正中、尺、桡、肌皮、腋、肩胛上、胫、腓神经运动传导及双正中、尺、桡、胫、腓神经感觉传导检测,双拇短展肌、伸指总肌、肱二头肌、三角肌、冈上肌、胫前肌、比目鱼肌行同心圆针肌电图检测。采用Brunnstrom分期评价肢体功能。分析健、患侧肢体神经及肌肉的神经电生理指标差异及其与肢体功能的相关性。结果:(1)运动神经传导:与健侧比较,偏瘫侧正中、尺、桡、腋、肩胛上、胫、腓神经复合肌肉动作电位(compound muscle action potential,CMAP)波幅均显著降低(P0.05),腓总神经末端潜伏期延长及腓骨小头-踝传导速度减慢(P0.05),其他各神经末端潜伏期均无明显差异;病程3—6个月患者正中、尺、桡神经运动传导异常率均高于其他病程组;(2)感觉神经传导:偏瘫侧桡、腓浅神经SNAP波幅较健侧降低,尺、桡神经传导速度较健侧减慢(P0.05),且有9例患者健侧正中神经感觉传导速度减慢;病程3—6个月患者正中神经和腓浅神经感觉传导异常率高于其他病程组;(3)同心圆针肌电图:不同病程均有一定比例脑卒中患者上下肢肌肉可见纤颤电位、正锐波等异常自发电位;肢体远端肌肉,如拇短展肌、伸指总肌在各个病程中出现自发电位的比例均较高;病程6个月以上者,三角肌的自发电位发生率增高,而比目鱼肌在各个病程的患者中自发电位的出现率均较高;无主动收缩功能肌肉自发电位出现率显著高于有主动收缩功能肌肉(P=0.000);(4)患者手Brunnstrom分期与尺神经偏瘫侧/健侧CMAP波幅比呈正相关(r=0.426,P0.05)。结论:脑卒中患者偏瘫侧运动神经轴索变性及脱髓鞘伴部分感觉神经脱髓鞘和轴索变性,且以病程3—6个月患者最为多见;同时手功能Brunnstrom分期与尺神经运动传导CMAP波幅具有相关性;偏瘫侧肢体肌肉失神经支配改变以肢体远端肌肉和无主动收缩功能肌肉为主。     

1例无周围神经损伤者的鱼际肌完全由尺神经支配

<正> 本文报告1例纯尺神经运动支配的一侧鱼际肌,其正中神经感觉支时程正常,且无周围神经损伤表现.病例:患者男性,39岁,公共汽车驾驶员。主诉右上肢偶有僵硬及不自主性震颤。所有神经系统检查,包括X 线均正常,双手无正中神经,尺神经支配的手内肌萎缩,上肢及手的肌张力正常。住院观察1周未见右上肢异常运动。排除右上肢正中神经运动支缺失。方法:经皮电刺激,标准表面电极记录双上肢正中神经、尺神经运动和感觉传导速度。刺激右上肢正中神经、尺神经,用针电极在对掌肌和小指外展肌记录M 波,刺激强度达35 mA 以免漏失M 波.     

肌内效贴对脑卒中患者肩关节半脱位后肩痛的疗效观察

目的:观察肌内效贴对脑卒中患者偏瘫侧肩关节半脱位后肩痛的疗效。方法:56例脑卒中肩关节半脱位后肩痛患者,按照随机数字表法分为治疗组与对照组(各28例),两组患者均实施常规康复治疗及宣教,治疗组在此基础上结合肌内效贴干预。分别于治疗前和治疗6周后通过X线测量法测量肩峰与肱骨头间距(AHI)、肩关节视觉模拟评分(VAS)疼痛、Fugl-Meyer上肢功能评分、肩痛侧腋神经及肌皮神经的运动神经传导测定,对两组治疗结果进行疗效评价。结果:治疗前,两组患者AHI值、VAS评分、Fugl-Meyer上肢功能评分无明显差异(P0.05),且检测所有患者肩痛侧腋神经(刺激部位:Erb点;记录部位:三角肌)及肌皮神经(刺激部位:Erb点;记录部位:肱二头肌)后发现两组中某些患者肌皮神经(30例,53.57%)、腋神经(31例,55.36%)波幅明显低于正常值,而潜伏期轻度延长或正常(提示轴索损伤)。两组治疗6周后,治疗组各项评分改善优于对照组(P0.05)且无不良事件发生。结论:在常规康复治疗的基础上,肌内效贴在脑卒中患者偏瘫侧肩关节半脱位后肩痛早期防治中,具有良好的疗效,其相应机制有待进一步研究。     

肌电图、神经传导速度在尺神经病变定位诊断中的应用

对23例尺神经病变患者31条尺神经、31条正中神经1条桡神经,小指展肌、第一骨间肌、拇短肌各31块行肌电图及神经传导速度(NCV)检查。结果2例尺神经在损伤的局部传导减慢,21例为肘部尺神经病变患者中,NCV均有异常改变;肌电图小指展肌及第一骨间肌均呈神经元性损害。提示在尺神经病变中肌电图、NCV可提供神经损伤的具体部位及程度,同时可预测预后。     

肌电图、神经传导速度在尺神经病变定位诊断中的应用

对23例尺神经病变患者31条尺神经、31条正中神经1条桡神经，小指展肌、第一骨间肌、拇短肌各31块行肌电图及神经传导速度(NCV)检查。结果2例尺神经在损伤的局部传导减慢，21例为肘部尺神经病变患者中，NCV均有异常改变；肌电图小指展肌及第一骨间肌均呈神经元性损害。提示在尺神经病变中肌电图、NCV可提供神经损伤的具体部位及程度，同时可预测预后。     

脑卒中恢复期正中神经电生理变化及其与功能的相关性研究

目的:观察脑卒中恢复期偏瘫上肢正中神经电生理变化及其与偏瘫侧肢体功能的相关性。方法:选取符合纳入标准的脑卒中恢复期患者30例,分别于T1(8～12周)、T2(16～20周)对其偏瘫侧和非偏瘫侧正中神经进行运动神经传导和感觉神经传导检查,以及双侧拇短展肌(APB)行同心圆针肌电图检查,采用Brunnstrom分期评估偏瘫侧手功能。分析脑卒中恢复期内不同时期正中神经电生理的差异及其与手功能Brunnstrom分期的相关性。结果:T1、T2正中神经偏瘫侧复合肌肉动作电位(CMAP)波幅和感觉神经电位(SNAP)波幅均较非偏瘫侧明显减低(P0.05),偏瘫侧T2拇短展肌的自发电位分级较T1显著减少(P0.05),偏瘫侧T2的手功能Brunnstrom分期较T1显著提高(P0.05),偏瘫侧T1、T2自发电位分级与手功能Brunnstrom分期均呈负相关(T1:rs=-0.616,P0.05;T2:rs=-0.781,P0.05)。结论:中枢神经损伤继发的周围神经损伤以神经轴索损害为主,脑卒中恢复期偏瘫侧自发电位分级与手功能Brunnstrom分期具有相关性。     

平山病的电生理研究

目的分析总结平山病神经电生理检查结果的特点,探讨电生理检查对平山病的诊断意义。 方法对18例临床确诊为平山病的患者（男16例,女2例;年龄19~58岁,平均24.9岁;病史1~40年,平均5.2年;10例为单侧发病,3例双侧发病,5例疑似双侧发病）进行神经电生理检测。所有病例均检测：患侧正中神经、尺神经的运动传导速度（MCV）和感觉传导速度（SCV）,以及小指展肌、拇短展肌、指总伸肌、肱桡肌、肱二头肌、胸锁乳突肌的肌电图;下肢一侧（与上肢患侧同侧）腓总神经MCV、SCV,以及胫前肌的肌电图。双侧或疑似双侧发病共8例患者检测对侧尺神经MCV、SCV,以及小指展肌、指总伸肌、肱桡肌肌电图。正中神经、尺神经MCV采用由远端至近端分段刺激,记录复合肌肉动作电位（CMAP）,并判断是否存在神经传导阻滞。 结果①18例患者正中神经、尺神经检测均无神经传导阻滞表现。②18例患者正中神经、尺神经SCV及感觉神经动作电位（SNAP）均无异常。③上肢MCV减慢总阳性率为43.2％（19/44）,不同神经阳性率由高至低依次为：患侧尺神经72.2％（13/18）、患侧正中神经33.3％（6/18）、对侧尺神经0（0/8）。④上肢CMAP波幅降低总阳性率为81.8％（36/44）,不同神经阳性率由高至低依次为：患侧尺神经100.0％（18/18）、患侧正中神经77.8%（14/18）、对侧尺神经50.0％（4/8）。⑤18例患者腓总神经MCV、SCV及胫前肌的肌电图均无异常。⑥上肢肌电图检查：神经性损害表现总阳性率为47.0％（62/132）,不同检测肌肉神经性损害阳性率由高至低依次为：患侧小指展肌100.0％（18/18）、患侧拇短展肌100.0％（18/18）、患侧指总伸肌88.9％（16/18）、对侧小指展肌62.5％（5/8）、对侧指总伸肌37.5％（3/8）、患侧肱桡肌5.6％（1/18）、患侧肱二头肌5.6％（1/18）;对侧肱桡肌以及患侧胸锁乳突肌的肌电图均未检出神经性损害表现。 结论平山病神经电生理学特点为单侧上肢神经源性损害、或为单侧表现明显的双侧上肢神经源性损害;根据异常肌电图分布范围提示患侧C7~T1脊髓前角细胞损害,C6及C6以上节段少有累及。平山病的神经电生理学特点可为该病提供有助于定位诊断和鉴别诊断的依据。     

综合康复治疗脑卒中偏瘫患者肩关节半脱位的疗效

目的 观察综合康复治疗脑卒中偏瘫患者肩关节半脱位的疗效。方法 对20例脑卒中偏瘫后肩关节半脱位患者进行良肢位摆放、保持肩关节被动活动度、肩胛肌群抗阻训练、戴肩吊带等综合康复治疗，6周后评定疗效。结果 20例患者经康复治疗后，肩关节半脱位恢复，患肢运动功能与治疗前比较有显著性差异（P〈0．05～0．01）。结论 综合康复治疗能有效改善脑卒中偏瘫患者肩关节半脱位及所致的功能障碍。     

肌电诱发神经肌肉电刺激治疗脑卒中肩关节半脱位

目的:观察肌电诱发的神经肌肉电刺激疗法在脑卒中肩关节半脱位中的临床疗效。方法:脑卒中肩关节半脱位患者60例,随机分为A、B、C组各20例。3组均给予常规康复治疗,B组加用神经肌肉电刺激疗法,C组加用肌电诱发的神经肌肉电刺激疗法。治疗前后分别采用双侧肩关节X线片及肩关节指诊评价复位情况;采用运动功能评定量表(FMA)中上肢部分评定上肢功能恢复情况。结果:治疗6周后,C组复位率明显高于A、B组(45%、15%、25%,P<0.05);3组FMA的分值均较治疗前明显提高,C组更高于A、B组(P<0.05)。结论:肌电诱发的神经肌肉电刺激治疗脑卒中肩关节半脱位优于单纯常规治疗方法和神经肌肉电刺激疗法。     

连枷臂综合征的临床及神经电生理特点分析

目的:探讨连枷臂综合征(FAS)的临床及神经电生理特点。方法:选取13例诊断明确的FAS患者及31例由上肢起病的肌萎缩侧索硬化(UL-ALS)患者,收集上述患者临床查体及神经电生理数据,包括正中神经、尺神经、腋神经复合肌肉动作电位(CMAP)波幅并计算分裂手比值SI值(SI值＝正中神经CMAP波幅/尺神经CMAP波幅)...     

Electrodiagnostic localization of traumatic upper trunk brachial plexopathy

Eighteen patients having traumatic upper trunk brachial plexopathy ("the stinger"), a common football injury, were investigated electrodiagnostically. Proximal nerve conduction was determined by stimulating the supraclavicular fossa and at the C5 root and recording from muscles supplied by the long thoracic, suprascapular, musculocutaneous, axillary, lateral pectoral and thoracodorsal nerves. The accessory nerve was stimulated in the lateral posterior triangle and the evoked potential recorded from the upper trapezius muscle. Median and ulnar nerves were also tested, sensory and motor fibers being stimulated peripherally and proximally. Conduction slowing was observed in 16 patients mainly in the proximal segments of the axillary, musculocutaneous, suprascapular and accessory nerves. The most commonly observed electromyographic abnormalities were an increase in polyphasic waves and decreased recruitment. Spontaneous activity was sparse. These abnormalities appear to result most likely from compression of the most superficially located fibers of the brachial plexus at Erb's point. As a significant etiologic factor, the impact of ill-fitting shoulder pads against the neck during a football tackle is suggested. This empirical observation was supported by the decrease of "stingers" after the improvement of the shoulder gear.     

Arthrographic and clinical findings in patients with hemiplegic shoulder pain

OBJECTIVES: To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN: Case series. SETTING: Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS: Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS: Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS: After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.     

Reflex sympathetic dystrophy in hemiplegia

There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (P<0.01). Additionally, the presence of flaccidity was also a significant factor in the development of reflex sympathetic dystrophy. Glenohumeral subluxation was present in 37 patients (38.9%) in our study group and the presence of this complication was related to the occurrence of reflex sympathetic dystrophy. The presence of glenohumeral subluxation was significantly higher in patients with reflex sympathetic dystrophy (21/29, 72.4%) when compared to the patients without reflex sympathetic dystrophy (16/66, 24.2%) (P<0.001). Also, hemiplegic patients with more severe shoulder subluxation were significantly more likely to develop reflex sympathetic dystrophy. These results suggest that lower recovery stages, reduced tonus and glenohumeral subluxation significantly contribute to the occurrence of reflex sympathetic dystrophy in the hemiplegic patient. We believe that preventive and treatment measures should consider these factors as they seem to have in common a higher risk of traumatizing the paralyzed upper limb and causing reflex sympathetic dystrophy.     

脑卒中恢复期软瘫患者上肢周围神经损伤与运动功能的相关性

目的 通过神经电生理检查,评估脑卒中恢复期软瘫患者上肢周围神经损伤发生率,探讨上肢周围神经损伤与上肢运动功能之间的相关性,指导临床治疗及康复。方法 2015年12月至2019年10月,符合条件的脑卒中患者77例患侧上肢行运动神经传导、F波、皮肤交感反应(SSR)、针极肌电图(EMG)检查,采用简式Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。根据神经传导结果分为正常组和损伤组。结果 损伤组共41例(53.25%)。损伤组FMA-UE评分低于正常组(t = 2.193, P < 0.05);F波振幅和出现率降低( t > 2.002, P < 0.05),SSR振幅和潜伏期明显下降( t > 3.140, P < 0.01),但损伤组F波出现率、SSR潜伏期均处正常参考值范围内。神经损伤数与FMA-UE评分负相关( r= -0.858, P < 0.001);线性回归分析显示,尺神经、桡神经、肌皮神经振幅是FMA-UE评分的影响因素(B > 0.317, P < 0.05)。 结论 脑卒中恢复期患者患侧上肢出现软瘫后,有可能出现上肢周围神经损伤,且与运动功能恢复有关;应尽量避免、及时治疗周围神经损伤。     

正中神经SEP与偏瘫手功能相关研究

目的通过检测偏瘫患者正中神经体感诱发电位(SEP),并评估患侧手Brunnstrom分级,观察正中神经SEP作为评测偏瘫手功能客观指标的可靠性,为临床判断偏瘫手功能提供客观依据.方法27例住院偏瘫患者,测定双侧正中神经SEP,根椐Kovindha标准将正中神经SEPN20进行分级.按Brunnstrom分级对偏瘫手进行评定.将患侧正中神经SEPN20分级与患侧手Brunnstrom分级进行Spearman等级相关分析.结果正中神经SEP等级分级与手Brunnstrom评定分级呈正相关,相关系数r＝0.6295,P＜0.01有相关性意义.结论正中神经SEP可以作为临床判定手功能的一个敏感的电生理指标.SEP为偏瘫手功能的评定及康复治疗提供了有价值的依椐.     

Standardized nerve conduction studies in the upper limb of the healthy elderly.

Nerve conduction studies are increasingly being performed on elderly individuals; however, no standardized data for the elderly population exists to provide an accurate interpretation of electrodiagnostic findings. The purpose of this study was to provide standardized data in the healthy elderly for the nerves of the upper limb that are routinely chosen for study by electromyographers. Nerve conduction studies were performed prospectively in one upper limb of 155 carefully screened healthy elderly individuals between the ages of 60 and 95 years. Upper limb temperature was controlled to limit the influence of temperature on the measured conduction parameters. Standard nerve conduction techniques using constant measured distances were applied to evaluate the median, ulnar and radial nerves. A normative electrodiagnostic database for elderly individuals was established in this study. The mean nerve conduction parameters of this healthy elderly population compared favorably with existing literature values for younger populations. However, age had a statistically significant but low strength effect on all ulnar nerve conduction velocities and distal latencies as well as the distal sensory amplitudes of all three nerves. Gender had a greater effect than age on these parameters as well as on median sensory distal latency. Other median motor and sensory conduction parameters along with radial sensory distal latency were not significantly related to age or gender based on two-way analysis of variance.     

正常人周围神经传导速度40例分析

目的:研究健康成人周围神经运动传导速度(motor-nerveconductionve-locity,MCV)和感觉传导速度(sensory-nerveconductionvelocity,SCV)的正常值,为诊断周围神经疾病提供依据。方法:健康志愿者40例,年龄22～53岁,男女各20例。分别检测双侧正中神经、尺神经、胫神经及腓神经MCV和双侧正中神经、尺神经及胫神经SCV。分析指标包括潜伏期、波幅及神经传导速度(nerveconductionvelocity,NCV)。结果:NCV在正常人男女之间、左右侧肢体之间的差异在统计学上无显著性意义(P>0.05),并且随着年龄的增加而逐渐减慢。结论:NCV检测是周围神经病的重要诊断技术之一,而正常值的确定是临床诊断的前提。不同年龄组应采用各自的正常值。     

Quantification of Upper Limb Motion During Gait in Children with Hemiplegic Cerebral Palsy

Movements of the lower limbs during gait have been widely investigated using gait analysis, while data on upper limb movements are scanty. The aim of the present study was to quantify upper limb motion during gait in children with hemiplegic cerebral palsy (CP). Gait of 13 children with hemiplegic CP was acquired using a full-body marker set to obtain the arm kinematics. Our results demonstrated that movement of the plegic arm was characterized by an abducted intra-rotated shoulder and a more flexed elbow position with reduced range of motion during the entire gait cycle compared to controls. The controlateral non-plegic side also showed abnormalities, in particular at the shoulder joint, which was abducted at the beginning of gait cycle. These data showed that gait of children with hemiplegic CP is generally characterized by abnormal upper limb position not only on the plegic side but also on the non-plegic side.