胸廓出口综合征的神经-肌电图诊断方法

目的介绍胸廓出口综合征（ｔｈｏｒａｃｉｃｏｕｔｌｅｔｓｙｎｄｒｏｍｅ,ＴＯＳ）的神经－肌电图诊断方法。方法对胸廓出口综合征病例,常规检测上肢肌电图（ＥＭＧ）,正中神经及尺神经运动传导速度（ＭＮＣＶ）,感觉神经动作电位（ＳＮＡＰ）和感觉传导速度（ＳＮＣＶ）,感觉神经干动作电位（ＮＡＰ）,Ｆ反应及前臂内侧皮神经ＳＮＡＰ。在运算数据时,进行双侧对比,并必须排除腕管综合征、肘管综合征或其它神经源性病变后,才能最后确诊为ＴＯＳ。结果用该法确诊为ＴＯＳ的４３例中有下述异常发现,（１）尺神经腋部以下的ＳＮＡＰ或ＮＡＰ消失,或两者波幅较健侧衰减２５％以上;（２）手内在肌有失神经改变;（３）Ｆ波消失或其潜伏期较健侧延长１ｍｓ以上;（４）前臂内侧皮神经的ＳＮＡＰ消失,或其波幅较健侧衰减２５％以上。结论神经－肌电图检测结果,凡出现上述发现中两项者,即可确诊为典型的下干型ＴＯＳ。     

不同剂量异丙酚,咪唑安定和依托咪酯对上肢短潜伏其体感诱…

目的：观察３组不同剂量静脉麻醉药异丙酚、咪唑安定、依托咪酯对上肢短潜伏期体感诱发电位（ＳＬＳＥＰ）影响。方法：９０例择期手术患者，随机分成３组，每组再随机分为３个不同剂量组，分别单次静脉注射异丙酚１．５、２、３ｃｍ／ｋｇ，咪唑安定０．２、０．３、０．４ｃｍ／ｋｇ，依托咪酯０．１５、０．３、０．４ｃｍ／ｋｇ，观察用药后对ＳＬＳＥＰ的影响。结果：异丙酚组均对ＳＬＳＥＰ的Ｎ１４、Ｎ２０潜伏期在ＣＣＴ无明     

急性脊髓损伤后磁刺激运动诱发电位及体感诱发电位的诊断意义

目的 研究磁刺激运动诱发电位（ｍｏｔｏｒ ｅｖｏｋｅｄ ｐｏｔｅｎｔｉａｌｓ,ＭＥＰ）对脊髓损伤（ｓｐｉｎａｌ ｃｏｒｄ ｉｎｊｕｒｉｅｓ,ＳＣＩ）后运动传导功能的诊断价值。方法 采用Ｍａｇ－２型磁刺激仪对３２例ＳＣＩ患者进行经颅磁刺激ＭＥＰ检查,分别在双侧外展拇短肌（ａｂｄｕｃｔｏｒ ｐｏｌｌｉｃｉｓ ｂｒｅｖｉｓ,ＡＰＢ）和胫前肌（ａｎｔｅｒｉｏｒ ｔｉｂｉａｌｉｓ,ＡＴ）进行记录。同时检测Ｆ     

选择性腰骶神经后根切断术的电生理研究

探讨采用选择性腰骶神经后根切断术（ｌｕｍｂａｒ－ｓａｃｒａｌｓｅｌｅｃｔｉｖｅｐｏｓｔｅｒｉｏｒｒｈｉｚｏｔｏｍｙ,Ｌ－ＳＳＰＲ）治疗脑瘫下肢痉挛时,部分患者出现上肢痉挛缓解,斜视,流涎好转及发音变清晰等现象发生的机制。方法,采用体感诱发电位（ｓｏｍａｔｏｓｅｎｓｏｒｙｅｖｏｋｅｄｐｏｔｅｎｔｉａｌ,ＳＳＥＰ）,感觉神经传导速度（ｓｅｎｓｏｒｙｃｏｎｄｕｃｔｉｏｎｖｅｌｏｃｉｔｙ,ＳＣＶ）及运动神     

一种防御低氧兔脑损害高效剂的基础研究

在兔脑低氧模型上，以大脑皮层体感诱发电位ＳＥＰ为指标，按Ｌ９（３）４正交设计．随机对照研究ＶＩＳＡ高效剂抗低氧／复氧脑损害的作用。结果表明，ＶＩＳＡ高效剂不仅能增进常氧时大脑皮质电兴奋，而且低氧早期静注ＶＩＳＡ高效剂，低氧／复氧损害后，ＳＥＰ提前恢复，Ｐ２潜伏期，Ｎ１Ｐ２峰峰值显著大于对照值（Ｐ<０． ０１）。结论：ＶＩＳＡ高效剂具有防御低氧／复氧脑损害的作用，可供临床脑复苏借鉴。     

围脑干手术中体感诱发电位与心率监测的比较

目的：研究围脑干手术中体感诱发电位（ＳＥＰ）神经生理监测与ＨＲ监测的关系。方法：选择４３例全凭静脉麻醉的围脑干手术病例,对两侧正中神经分别进行刺激,记录相应ＳＥＰ的Ｎ２０波形,手术Ｎ２０发生明显变化（潜伏期延长超过１ｍｓ）或波辐降低超过５０％）,即通知术者调整操作,ＨＲ出现突然而明显的变化也及时通知术者。结果：３例术后出现神经病损者术中ＳＥＰ均表现为持续抑制,而其中１例ＨＲ并没有明显变化。术中ＳＥ     

咪唑安定对体感诱发电位的影响

目的：了解咪唑安定对体感诱发电位的影响。方法：选择３０例ＡＳＡＩ～Ⅱ级的脑外科手术病人，根据国际１０～２０系统，在Ｃ３或Ｃ４、ＦＰｚ（参考）和ＳＣ（第二颈椎棘突处）安放盘状记录电极，记录体感诱发电位。均分为三组按剂量（０．２ｍｇ／ｋｇ、０．３ｍｇ／ｋｇ和０．４ｍｇ／ｋｇ）静脉注射咪唑安定，连续观察皮层Ｎ２０、Ｐ２３和颈髓Ｎ１４电位的变化。结果：（１）用药后，皮层Ｎ２０和颈髓Ｎ１４电位的波幅降低，分别抑制到术前的６３．７５％和４８．７５％（Ｐ＜０．０５），苏醒后恢复到基础水平；（２）颈髓Ｎ１４、皮层Ｎ２０和Ｐ２３的潜伏期及中枢传导时间均无显著延长，（３）各剂量组间的ＳＥＰ变化无明显差别。结论：咪唑安定对ＳＥＰ一定程度的抑制作用临床意义不足，可用作ＳＥＰ监测时的静脉麻醉药。     

前列腺特异性抗原嘧度诊断前列腺偶发癌的临床价值

为探讨前列腺偶发癌早期诊断的有效指标，对１１例前列腺偶发癌和２０例前列腺增生症患前列腺特异性抗原嘧度进行了检测，结果前列腺偶发癌ＤＰＳＡ平均值为０．１５±０．１３ｎｇ（ｍｌ．ｃｍ＾３，（ＢＰＨ为０．０７±０．０６ｎｇ／（ｍｌ．ｃｍ＾３）。两进有非常显性差异。１１例ＤＰＡＳ〉０．１ｎｇ／（ｍｌ．ｃｍ＾３），９例为前腺偶发癌；２０例ＤＰＳＡ〈０．１ｎｇ／（ｍｌ．ｃｍ＾３），１８例为ＢＰＨ。而有     

AO带锁型钢板螺钉在脊髓型颈椎病的应用

本文报告了应用 Ａ Ｏ 带锁型钢板螺钉（ Ｃｅｒｖｉｃａｌ ｓｐｉｎｅ ｌｏｃｋｉｎｇ ｐｌａｔｅ, Ｃ Ｓ Ｌ Ｐ）治疗脊髓型颈椎病（ Ｃｅｒｖｉｃａｌｓｐｏｎｄｙｌｏｔｉｃ ｍ ｙｅｌｏｐａｔｈｙ, Ｃ Ｓ Ｍ ）２８ 例的结果,对 Ｃ Ｓ Ｌ Ｐ的特点及应用指征、手术方法加以探讨。全部病例获得随访３～１２ 个月（平均７．５ 个月）。 Ｊ Ｏ Ａ 术前得分平均：９．６±２．８ 分,术后随访得分平均：１６．４±１．０ 分。恢复率：８８．９±９．６％ ,优良率：９６．３％ ,表明这一技术在 Ｃ Ｓ Ｍ 治疗中具有重要临床价值。     

普鲁卡因对上肢短潜伏期体感诱发电位的影响

目的：探讨静滴普鲁卡因对短潜伏期体感诱发电位（ＳＬＳＥＰ）的影响。方法;对上肢感觉传导无异常的病人１５例,分别观察静脉滴注普鲁卡因前以及滴注１％普鲁卡因２０ｍｇ．ｋｇ＾０－１．ｈ＾－１１０分钟、４０ｍｇ．ｋｇ＾－１、ｈ．＾－１５分钟和６０ｍｇ．ｋｇ＾－１．ｈ＾－１５分钟的上肢ＳＬＳＥＰ,比较Ｎ１４,Ｎ２０,Ｐ２３各波的潜伏期,Ｎ１４－Ｎ２０波间潜伏期（ＣＣＴ）以及Ｎ２０Ｐ－Ｐ２０的峰间值。结果：Ｓ     

前臂内侧皮神经后支与肘管综合征手术切口的解剖关系

目的 观察肘部前臂内侧皮神经(medial antebrachial cutaneous nerve,MACN)后支的解剖特征,探讨在肘管综合征松解手术中防止其医源性损伤的方法.方法 解剖10具(20侧)成人上肢标本,并对12例肘管综合征手术患者,在肱骨内上髁远、近各8 cm范围内,观察NACN后支的数目、横跨角度并测定其与手术切口(内上髁前1 cm)的交汇部位.结果 32侧肢体共记录到62支MACN 后支,平均每侧肢体为1.9支.其中1支者8侧(25.0%,均位于内上髁远侧),2支者19侧(59.4%),3支者4侧(12.5%),4支者1侧(3.1%).位于内上髁下方者37支(59.7%),内上髁上方者25支(40.3%).这些后支与切口线的交角均大于45°,即皮神经是横向跨过切口线的.所有标本(100%)均至少有1支后支从内上髁远侧跨过切口线,其距内上髁的平均距离为[(2.9±2.3)cm,x-±s,下同];在68.8%的标本中至少有1支后支从内上髁近侧跨过切口线,其距内上髁的平均距离为(2.1±1.8)cm.结论 MACN后支至少有1支横跨肘管综合征的手术切口线,了解其位置关系并在皮下组织中仔细解剖分出保护,有助于避免误伤.     

颈5～7神经根性撕脱后神经电生理表现及临床意义

目的 分析臂丛颈5～7神经根性撕脱伤后相应皮区感觉神经动作电位(sensory nerve action potential,SNAP)、体感诱发电位(somatosensory evoked potential,SEP)的神经电生理表现及其临床意义.方法 随机选择20例经手术探查证实为臂丛颈5～7神经根撕脱的患者,回顾性统计分析术前神经电生理检测所得颈5(三角肌皮区)、颈6(拇指及前臂背外侧、桡骨上至虎口区)、颈7(示指)皮区SNAP和SEP的指标.结果 20例臂丛颈5皮区SNAP均未引出.臂丛颈5.6皮区SNAP、SEP检测结果 显示:SNAP、SEP均未引出各3例;臂丛颈6皮区SNAP、SEP均可引出10例,其SEP潜伏期较健侧延长14.3%,波幅较健侧降低54.4%.臂丛颈7皮区SNAP、SEP均可引出8例,其SEP潜伏期较健侧延长13.1%,波幅较健侧降低51.8%;臂丛颈6皮区SNAP可引出,SEP未引出7例.臂丛颈7皮区9例.结论 三角肌皮区的SNAP未引出可定性为臂丛颈5神经根性完全损伤,需综合其他神经根性损伤证据共同判别颈5神经根性撕脱与否.SNAP、SEP均未引出提示神经损伤均较为严重,可伴有神经节的损毁或臂丛神经多平面损伤.臂丛颈6、7皮区SNAP、SEP均可引出的患者中,SEP潜伏期较对侧延长大于15%或波幅下降大于55%可作为判别神经根节前损伤的佐证.只有不到50%的患者出现SNAP可引出、SEP未引出的典型电生理表现.对臂丛颈6神经根,拇指或前臂背外侧、桡骨上至虎口区中任有一项表现为SNAP可引出、SEP未引出,即有判断神经撕脱的指征.     

颈5～7神经根性撕脱后神经电生理表现及临床意义

目的 分析臂丛颈5～7神经根性撕脱伤后相应皮区感觉神经动作电位(sensory nerve action potential,SNAP)、体感诱发电位(somatosensory evoked potential,SEP)的神经电生理表现及其临床意义.方法 随机选择20例经手术探查证实为臂丛颈5～7神经根撕脱的患者,回顾性统计分析术前神经电生理检测所得颈5(三角肌皮区)、颈6(拇指及前臂背外侧、桡骨上至虎口区)、颈7(示指)皮区SNAP和SEP的指标.结果 20例臂丛颈5皮区SNAP均未引出.臂丛颈5.6皮区SNAP、SEP检测结果 显示:SNAP、SEP均未引出各3例;臂丛颈6皮区SNAP、SEP均可引出10例,其SEP潜伏期较健侧延长14.3%,波幅较健侧降低54.4%.臂丛颈7皮区SNAP、SEP均可引出8例,其SEP潜伏期较健侧延长13.1%,波幅较健侧降低51.8%;臂丛颈6皮区SNAP可引出,SEP未引出7例.臂丛颈7皮区9例.结论 三角肌皮区的SNAP未引出可定性为臂丛颈5神经根性完全损伤,需综合其他神经根性损伤证据共同判别颈5神经根性撕脱与否.SNAP、SEP均未引出提示神经损伤均较为严重,可伴有神经节的损毁或臂丛神经多平面损伤.臂丛颈6、7皮区SNAP、SEP均可引出的患者中,SEP潜伏期较对侧延长大于15%或波幅下降大于55%可作为判别神经根节前损伤的佐证.只有不到50%的患者出现SNAP可引出、SEP未引出的典型电生理表现.对臂丛颈6神经根,拇指或前臂背外侧、桡骨上至虎口区中任有一项表现为SNAP可引出、SEP未引出,即有判断神经撕脱的指征.     

颈5～7神经根性撕脱后神经电生理表现及临床意义

目的 分析臂丛颈5～7神经根性撕脱伤后相应皮区感觉神经动作电位(sensory nerve action potential,SNAP)、体感诱发电位(somatosensory evoked potential,SEP)的神经电生理表现及其临床意义.方法 随机选择20例经手术探查证实为臂丛颈5～7神经根撕脱的患者,回顾性统计分析术前神经电生理检测所得颈5(三角肌皮区)、颈6(拇指及前臂背外侧、桡骨上至虎口区)、颈7(示指)皮区SNAP和SEP的指标.结果 20例臂丛颈5皮区SNAP均未引出.臂丛颈5.6皮区SNAP、SEP检测结果 显示:SNAP、SEP均未引出各3例;臂丛颈6皮区SNAP、SEP均可引出10例,其SEP潜伏期较健侧延长14.3%,波幅较健侧降低54.4%.臂丛颈7皮区SNAP、SEP均可引出8例,其SEP潜伏期较健侧延长13.1%,波幅较健侧降低51.8%;臂丛颈6皮区SNAP可引出,SEP未引出7例.臂丛颈7皮区9例.结论 三角肌皮区的SNAP未引出可定性为臂丛颈5神经根性完全损伤,需综合其他神经根性损伤证据共同判别颈5神经根性撕脱与否.SNAP、SEP均未引出提示神经损伤均较为严重,可伴有神经节的损毁或臂丛神经多平面损伤.臂丛颈6、7皮区SNAP、SEP均可引出的患者中,SEP潜伏期较对侧延长大于15%或波幅下降大于55%可作为判别神经根节前损伤的佐证.只有不到50%的患者出现SNAP可引出、SEP未引出的典型电生理表现.对臂丛颈6神经根,拇指或前臂背外侧、桡骨上至虎口区中任有一项表现为SNAP可引出、SEP未引出,即有判断神经撕脱的指征.     

前臂皮神经,皮神经营养血管与浅静脉的关系和临床意义？…

目的 为设计皮神经营养血管皮瓣和对该类皮瓣与某些局部移转的静脉的的关系的认识提供学基础。方法 用显微解剖法,标本双色透明法观测前臂内侧皮神经血供、贵要静脉与前臂内侧皮神经及其营养血管的关系和前臂外侧皮神经的血供、头静脉与前外侧皮神经及其营养血管的关系。结果 前臂内、外侧皮神经的血供形式不相同,前者由神经旁血管供养,后者由主要动脉和神经旁血管共同供养。头静脉与前外侧皮神经及其营养血管,贵要静脉与前后     

Effects of hypothermia on median nerve somatosensory evoked potentials during spontaneous circulation

Perioperative-induced hypothermia is a common means of reducing ischemic injury in neurosurgical procedures and cardiac surgery, and it may occur accidentally. Somatosensory evoked potentials (SSEPs) are used frequently for neurophysiologic monitoring of these procedures. The effects of hypothermia on SSEPs have been studied widely in humans with cardiopulmonary bypass (CPB) during nonpulsatile flow. However, changes of latency and amplitude of early SSEP components during spontaneous circulation have not yet been studied. Median nerve SSEPs were recorded in 21 patients during rewarming from 32 to 36 degrees C core temperature. Latencies and amplitudes of N9, N13, N20, and central conduction time were registered at 32, 34, and 36 degrees C. Latencies of N9, N13, and N20 were prolonged at 32 degrees C compared with 36 degrees C (N9: 13.4 +/- 1.4 msec versus 11.8 +/- 1.4 msec, P <.05; N13: 17.6 +/- 1.9 msec versus 15.4 +/- 1.4 msec, P <.01; N20: 26.5 +/- 1.8 msec versus 22.4 +/- 1.6 msec, P <.001). Amplitude of N20 was higher at 32 degrees C compared with 36 degrees C (2.86 +/- 1.94 microV versus 2.07 +/- 1.47 microV, P < .05). Central conduction time decreased by 27%, and peripheral latency of N13 decreased by 14%. The increase in SSEP latency (N9, N13, and N20) and central conduction time during moderate hypothermia of 32 degrees C and spontaneous circulation are comparable with those during nonpulsatile flow on CPB. In contrast to nonpulsatile flow, the amplitude of N20 was increased significantly (P < .05) during moderate hypothermia and pulsatile circulation. These results suggest to be cautious about generalizing the effects of hypothermia on SSEP during CPB to spontaneous circulation.     

Posterior interosseus nerve vs. medial cutaneous nerve of the forearm: differences in digital nerve reconstruction

Digital nerve defects are common in hand trauma and for primary or secondary nerve reconstruction, the autologous nerve graft remains the gold standard. This study compares the regeneration results and donor side morbidity of either the posterior interosseus nerve (PIN) graft or the medial antebrachial cutaneous nerve (MACN) graft. 16 patients (group A, age 43 ± 13 years) with digital nerve defects were treated with a PIN graft and 12 patients (group B, age 40 ± 15 years) received a MACN graft. The average nerve gap was 22 mm in each group. After a follow-up of 15 ± 8 months in group A, S4-sensibility were measured in 9 cases, S3+ in 5 cases and in 1 case S2 and S0. Up to an inconspicuously scar in projection of the fourth extensor-tendon compartment, there was no significant donor side morbidity. In group B, a S4-senibility has been obtained in 4 cases, S3+ in 5 cases, S3, S2 and S0 in each 1 case after a follow-up of 16 ± 11 months. Regarding the donor side morbidity, almost all patients complained about a disturbing scar formation and unpleasant paresthesia at the forearm down to the rascetta. Neuroma-associated pain has been detected in 4 cases. Although there has been no significant difference in terms of nerve regeneration, we recommend the use of the PIN graft for digital nerve reconstruction, since harvesting this nerve is fast and easy and without any donor side morbidity compared to the MACN graft.     

Research on the effectiveness of intermittent cervical traction therapy, using short-latency somatosensory evoked potentials

Short-latency somatosensory evoked potentials (SSEPs) were measured before and after intermittent cervical traction therapy to serve as objective indicators of therapy effectiveness. The subjects were 29 patients with myelopathy, 23 with cervical radiculopathy, 28 with cervical sprain, and 26 healthy individuals. SSEPs were recorded by stimulating the median nerve, and the negative potentials elicited from the brachial plexus (N9), neck (N11, lcN13, ucN13), and somatosensory area (N18) were measured to determine interpeak latencies and then corrected latency. As to the changes in SSEPs following traction, the N11-lcN13 and lcN13-ucN13 interpeak latencies for patients with type I and II myelopathy decreased, and the severity of myelopathy was inversely related to the degree of decrease. The ucN13-N18 interpeak latency for some patients with severe myelopathy increased. The N9-N11 and N11-lcN13 interpeak latencies for patients with cervical radiculopathy decreased, and the ucN13-N18 for patients with cervical sprain accompanied by autonomic nervous symptoms also decreased. Traction therapy might improve conduction disturbance primarily by increasing the amount of blood flow from the nerve roots to the spinal parenchyma. Received: April 16, 2001 / Accepted: November 12, 2001     

Effects of ketamine on somatosensory evoked potentials during nitrous oxide anesthesia in humans

The effects of ketamine with 60% nitrous oxide were studied on subcortical sensory evoked potentials recorded at Erb's point (N9), neck (N13) and on cortical potentials recorded at the scalp (N20) following median nerve stimulations in 7 neurologically normal patients. Latencies and amplitudes of the potentials were measured and compared with postinduction control values taken during inhalation of 60% nitrous oxide. Ketamine 2 mg.kg-1 (iv) was administered initially and incremental dose was 50 micrograms.kg-1.min-1. N20 latency decreased at 15, 30 minutes after ketamine administration from a control value of 18.7 +/- 0.9 msec to 18.2 +/- 1.1, 18.2 +/- 1.1 msec respectively, and N13-N20 interpeak latency decreased from 6.0 +/- 0.4 msec to 5.5 +/- 0.7, 5.4 +/- 0.7 msec (mean +/- SD). The author concluded that during nitrous oxide-based anesthesia, ketamine did not inhibit specific thalamoneocortical pathways.     

Electrophysiological diagnosis in ulnar nerve entrapment at elbow

Using "inching technique" we recorded antidromic sensory nerve action potentials from the little finger and compound muscle action potentials from the abductor digiti minimi, first dorsal interosseous and flexor carpi ulnaris muscles in 30 entrapped ulnar nerves. In cubital tunnel syndrome, localized conduction delay occurred most commonly at a point 2 to 4 cm distal to the medial epicondyle. In other ulnar neuropathies, with the exception of cubitus valgus deformity, conduction block or delay was noted at a site just distal to the medial epicondyle. These conduction abnormalities were most commonly observed in the abductor digiti minimi and first dorsal interosseous. In contrast, conduction abnormality in tardy palsy secondary to the valgus deformity reflected mainly in the flexor carpi ulnaris. This method provides useful information in diagnosing the early involvement and precise localization of nerve entrapment, and differentiation of cubital tunnel syndrome from other ulnar nerve entrapment.