脊柱侧凸患者脊柱融合术后脊旁肌的肌电活动

研究脊柱侧凸患者脊柱融合术前后脊旁肌功能的变化。记录 18例特发性脊柱侧凸患者行脊柱融合术前后和 15例健康受试者行 3个动作 (前屈、左右侧屈 )的 8个导联的肌电图信号 ,计算均数的平方根 (RMS)和中位频率 (MF)。结果脊柱侧凸患者的胸段RMS术前增高、术后降低 ,腰段RMS术后增高 ;术前胸段MF降低、腰段MF增高 ,术后这一趋势减弱。这些提示脊柱融合术使患者的胸段脊旁肌活动减少 ,腰段脊旁肌活动增加 ,两侧脊旁肌活动不平衡减弱 ,但未回到正常水平 ,这些可用于指导物理治疗师对脊柱侧凸患者脊柱融合术后制定康复计划。     

腰骶神经根病肌肉异常与症状持续时间的关系

腰骶神经根病变患者脊旁肌(PSM)出现肌电图异常早于远端肌肉。本研究旨在确定PSM和其它主要的近远端肌肉异常是否与本病变持续时间相关。通过对139名肌电图确诊有腰骶神经根病的患者进行多变量逻辑分析,结果表明PSM及其它5块下肢肌肉EMG的异常与症状持续时间无显著相关性。这一结论告诉人们,临床医师在基于症状持续时间基础上解释EMG异常时应小心谨慎。     

胸锁乳突肌瓣转位修复晚期面瘫的解剖与临床

目的：为应用胸锁乳突肌瓣转位修复晚期面瘫提供解剖依据。方法：利用新鲜尸体和活体头颈部共计26侧,解剖观测胸锁乳突肌的起止、长度、血供及其神经的分支类型和入肌部位。结果：胸锁乳突肌全长为17．0～19．0cm,枕动脉与副神经伴行支于乳突尖部下方4．0～5．0cm入肌肉上段;勖神经分叉点至胸锁乳突肌胸骨端起点的长度为14．0～15．7cm,大于分叉点至口轮匝肌外上缘的距离11．0～14．3cm。结论：胸锁乳突肌瓣转位修复面瘫的长度足以满足治疗需要,并且不论肌外、肌内分叉均可以顺利转位,肌肉血供也没有影响。     

人性化护理在肌萎缩侧索硬化症患者肌电图检测中的应用

目的探讨人性化护理在肌萎缩侧索硬化症患者肌电图检测中的应用方法和效果。方法分析和总结48例肌萎缩侧索硬化症患者在行肌电图检测中应用人性化护理的经验。结果 48例肌萎缩侧索硬化症患者均顺利完成肌电图检测。患者颈段、胸段、上下肢肌肉广泛神经源性损害,81.3%-95.8%胸锁乳突肌、棘旁肌神经源性损害。结论将人性化护理应用于肌萎缩侧索硬化症患者肌电图检测中,增进了医护患间的沟通,密切了医护患关系,体现了人的尊严和医护的爱护,提高了患者对医护工作的信任度和满意度,提高检测结果的准确性,减少误差。     

肌间隙入路手术与传统入路手术治疗巨大甲状腺肿的疗效比较

目的 比较胸锁乳突肌内缘肌间隙入路与传统入路行巨大甲状腺肿切除手术的效果。方法 回顾性分析2018年1月至2022年7月郑州大学附属洛阳中心医院收治的21例经胸锁乳突肌与带状肌间隙入路完成的巨大甲状腺肿手术患者(观察组)与20例传统的离断颈前肌群的帘状开窗入路患者(对照组)的临床资料。比较两组手术情况、并发症发生情况以及术后生活质量。结果 与对照组比较，观察组手术时间更短，创伤更小，术后引流少，恢复快，颈前区不适感更轻，治疗效果满意。结论 胸锁乳突肌内缘肌间隙入路行巨大甲状腺肿切除安全可行。     

神经电图与肌电图评估肌萎缩侧索硬化症与脊髓型颈椎病患者的神经电生理差异

背景：肌萎缩侧索硬化症早期症状往往局限于某部位，与脊髓型颈椎病临床表现极其相似，但两者的治疗方法和预后截然不同。此时肌电图和神经电图的多部位检查具有重要参考价值，特别是胸段棘旁肌肌电图可作为区别肌萎缩侧索硬化症与脊髓型颈椎病的客观指标。目的：探讨肌萎缩侧索硬化症与脊髓型颈椎病的电生理改变差异。设计：回顾性病例分析。单位：江西医学院第二附属医院的神经内科。对象：选择2001—12／2004—11江西医学院第二附属医院神经内科门诊和住院的肌萎缩侧索硬化症30例患者和脊髓型颈椎病30例患者。方法：对肌萎缩侧索硬化症患者30例和脊髓型颈椎病30例进行常规肌电图、神经电图检测。肌电图检测包括三肢体肌＋胸锁乳突肌＋胸段棘旁肌，观察静息状态时自发电位，测定运动单位电位的时限、波幅，大力收缩时的募集相。神经电图测定运动传导速度和感觉传导速度及动作电位的末端潜伏期、波幅。主要观察指标：①肌萎缩侧索硬化症与脊髓型颈椎病患者肢体肌、胸锁乳突肌与棘旁肌的肌电图检测结果。②肌萎缩侧索硬化症与脊髓型颈椎病患者神经传导速度检测结果。结果：60例患者全部进入结果分析。①肌电图检测结果：肌萎缩侧索硬化症与脊髓型颈椎病患者的肌电图均呈神经源性损害改变，而肌萎缩侧索硬化症的损害更为广泛，尤其胸段棘旁肌自发电位的异常率高达93．3％（28/30）；脊髓型颈椎病患者的胸段棘旁肌自发电位异常率仅占3．3％（1／30）（P〈0．001）。肌萎缩侧索硬化症患者运动单位电位平均时限、波幅增高异常与脊髓型颈椎病比较有明显的差异，但在两病的鉴别诊断中并不具有特征性。②运动神经传导速度：肌萎缩侧索硬化症患者运动神经传导速度的复合肌肉动作电位的波幅下降率明显低于脊髓型颈椎病患者（75．6％，86．7％；X^2=7．25，P〈0．01）。运动传导速度减慢率也低于脊髓型颈椎病患者（14.4％，23．9％，X^2=5．18,P〈0．05）。⑧感觉神经传导速度：肌萎缩侧索硬化症与脊髓型颈椎病患者的感觉神经传导速度未受到影响。结论：①两组患者的肌电图均呈神经源性损害改变，而肌萎缩侧索硬化症患者胸段棘旁肌自发电位异常率明显高于脊髓型颈椎病。②神经电图显示两者感觉神经传导速度均未受到影响。⑨神经电图还显示肌萎缩侧索硬化症患者运动神经传导速度减慢和波幅下降的运动神经数均少于脊髓型颈椎病患者。     

胸锁乳突肌淋巴瘤超声表现并穿刺活检一例

患者因发现颈部包块1月就诊,超声示右侧胸锁乳突肌增厚,肌肉纹理弥漫性增粗,肌束间隙回声减低,可见较丰富血流信号,于超声引导下右侧胸锁乳突肌穿刺活检,提示淋巴瘤,检索相关超声文献较少,予以报道,了解肌肉淋巴瘤超声表现能对平时诊断有帮助。     

胸锁乳突肌肌电图对肌萎缩侧索硬化与脊髓型颈椎病性肌萎缩鉴别诊断的临床意义

目的：探讨胸锁乳突肌(SCM肌)肌电图对肌萎缩侧索硬化(ALS)与脊髓型颈椎病性肌萎缩的鉴别诊断意义。方法：对13例ALS、12例脊髓型颈椎病性肌萎缩患者进行常规肢体肌电图及SCM肌肌电图检查。结果：13例ALS患者SCM肌肌电图异常率达100％，12例脊髓型颈椎病性肌萎缩SCM肌肌电图异常率为16．7％。结论：SCM肌肌电图对ALS与脊髓型颈椎病性肌萎缩诊断、鉴别诊断有重要作用。     

成人先天性肌性斜颈胸锁乳突肌单侧头与双侧头切断疗效比较

目的总结成人先天性肌性斜颈患者胸锁乳突肌单侧头切断及双侧头切断手术方式的优缺点。方法将2006年3月-2008年9月收治的35例成年先天性肌性斜颈患者分成两组,A组11例行胸锁乳突肌单侧头切断石膏外固定术,B组24例行胸锁乳头肌双侧头切断石膏外固定术。结果随访6～12个月,B组胸锁乳突肌松解明显优于A组,斜颈矫正程度也明显优于A组。结论成人先天性肌性斜颈行双侧头切断疗效优于单侧头切断。     

平山病长期误诊1例

患者,男,24岁,右利手,家族中无平山病病史。于就诊前7年学校体检时发现右手和前臂肌肉萎缩,无明显肌无力,无疼痛麻木及大小便功能障碍,伸握拳自如,走路稳,当时身高1．8m。在当地医院检查肌电图（EMG）示上肢肌肉有巨大电位,萎缩肌均有纤颤电位,少数可见束颤电位,胸锁乳突肌、椎旁肌肌电正常,符合前角细胞损害特征,颈部X线平片及颈段磁共振成像（MRI）检查未见异常病灶,拟诊断为运动神经元病,给予对症支持治疗,效果不明显。     

Identifying lumbosacral radiculopathies: an optimal electromyographic screen

OBJECTIVE: The objective of this study was to determine prospectively the optimal electromyographic screening examination of the lower limb that ensures identification of those lumbosacral radiculopathies that can be electrodiagnostically confirmed, yet minimizes the number of muscles studied. DESIGN: A prospective multicenter study was conducted from May 1996 to September 1997. Patients with suspected lumbosacral radiculopathy referred to participating electrodiagnostic laboratories were recruited and examined by needle electromyography using a standard set of muscles. Patients with electrodiagnostically confirmed lumbosacral radiculopathies were selected for analysis. Various muscle screens were tested against this group of patients with radiculopathies to determine the frequency with which each screen identified the patient with radiculopathy. RESULTS: There were 102 patients identified. When paraspinal muscles were one of the screening muscles, four-muscle screens identified 88-97% of the radiculopathies, five-muscle screens identified 94-98%, and six-muscle screens 98-100%. When paraspinal muscles were not part of the screen, identification rates were lower for all screens, and eight distal muscles were necessary to identify about 90% of the radiculopathies. CONCLUSIONS: Six-muscle screens with paraspinal muscles yielded consistently high identification rates. Studying additional muscles produced no improvements in identification.     

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。     

神经电图与肌电图评估肌萎缩侧索硬化症与脊髓型颈椎病患者的神经电生理差异

背景:肌萎缩侧索硬化症早期症状往往局限于某部位,与脊髓型颈椎病临床表现极其相似,但两者的治疗方法和预后截然不同.此时肌电图和神经电图的多部位检查具有重要参考价值,特别是胸段棘旁肌肌电图可作为区别肌萎缩侧索硬化症与脊髓型颈椎病的客观指标.目的:探讨肌萎缩侧索硬化症与脊髓型颈椎病的电生理改变差异.设计:回顾性病例分析.单位:江西医学院第二附属医院的神经内科.对象:选择2001-12/2004-11江西医学院第二附属医院神经内科门诊和住院的肌萎缩侧索硬化症30例患者和脊髓型颈椎病30例患者.方法:对肌萎缩侧索硬化症患者30例和脊髓型颈椎病30例进行常规肌电图、神经电图检测.肌电图检测包括三肢体肌+胸锁乳突肌+胸段棘旁肌,观察静息状态时自发电位,测定运动单位电位的时限、波幅,大力收缩时的募集相.神经电图测定运动传导速度和感觉传导速度及动作电位的末端潜伏期、波幅.主要观察指标:①肌萎缩侧索硬化症与脊髓型颈椎病患者肢体肌、胸锁乳突肌与棘旁肌的肌电图检测结果.②肌萎缩侧索硬化症与脊髓型颈椎病患者神经传导速度检测结果.结果:60例患者全部进入结果分析.①肌电图检测结果:肌萎缩侧索硬化症与脊髓型颈椎病患者的肌电图均呈神经源性损害改变,而肌萎缩侧索硬化症的损害更为广泛,尤其胸段棘旁肌自发电位的异常率高达93.3%(28/30);脊髓型颈椎病患者的胸段棘旁肌自发电位异常率仅占3.3%(1/30)(P＜0.001).肌萎缩侧索硬化症患者运动单位电位平均时限、波幅增高异常与脊髓型颈椎病比较有明显的差异,但在两病的鉴别诊断中并不具有特征性.②运动神经传导速度:肌萎缩侧索硬化症患者运动神经传导速度的复合肌肉动作电位的波幅下降率明显低于脊髓型颈椎病患者(75.6%,86.7%,x2=7.25,P＜0.01).运动传导速度减慢率也低于脊髓型颈椎病患者(14.4%,23.9%,x2=5.18,P＜0.05).③感觉神经传导速度:肌萎缩侧索硬化症与脊髓型颈椎病患者的感觉神经传导速度未受到影响.结论:①两组患者的肌电图均呈神经源性损害改变,而肌萎缩侧索硬化症患者胸段棘旁肌自发电位异常率明显高于脊髓型颈椎病.②神经电图显示两者感觉神经传导速度均未受到影响.③神经电图还显示肌萎缩侧索硬化症患者运动神经传导速度减慢和波幅下降的运动神经数均少于脊髓型颈椎病患者.     

Describing paraspinal EMG findings: inadequacy of the single 0-4+ score

OBJECTIVE: Clinical electrodiagnostic textbooks instruct that lumbar radiculopathies typically have paraspinal abnormalities and that these abnormalities should be recorded using a single 0-4+ scale. Recent work demonstrates that that the innervation of the paraspinal muscles is segmental, not homogenous, and that asymptomatic persons may have reproducible ("1+") positive waves or fibrillation potentials. DESIGN: To assess current use of the 0-4+ scale, a retrospective study of EMG scores in persons diagnosed with radiculopathy at a university laboratory was performed. No specific paraspinal EMG technique was used. Included were 117 consecutive, qualified S-1 radiculopathies and 33 L-5 radiculopathies. RESULTS: When radiculopathy was defined by "more than one limb muscle abnormal," paraspinal scores were recorded as 0 to 1+ in 83% of L-5 and 63% of S-1 cases (chi2, L-5 vs. S-1, not significant). For more severe radiculopathies (at least one limb muscle with a "2+" score), 0-1+ paraspinal scores were recorded in 76% of L-5 and 57% of S-1 cases (chi2, not significant). A total of 82% of S-1 radiculopathies with no overlapping L-5 innervation had 0-1+ scores. CONCLUSIONS: These data demonstrate the common use of equivocal paraspinal scores in patients whom electromyographers believe have radiculopathies. Standardized exploration techniques and a more detailed scoring system for the paraspinal muscles may eliminate this discrepancy.     

Identification of cervical radiculopathies: optimizing the electromyographic screen

OBJECTIVE: To determine the optimal electromyography screening examination of the upper limb that ensures detection of those cervical radiculopathies, which can be electrodiagnostically confirmed, yet minimizes the number of muscles studied. DESIGN: A prospective multicenter study was conducted from May 1996 to September 1997 at five institutions. Patients who were referred to participating electrodiagnostic laboratories with suspected cervical radiculopathy were recruited. A standard set of muscles were examined by needle electromyography. Patients with electrodiagnostically confirmed cervical radiculopathies, based on electromyography findings, were selected for analysis. Muscle screens were tested against this group to determine whether the screen identified the patients with radiculopathy. RESULTS: There were 101 patients with cervical radiculopathies representing all cervical root levels. When paraspinal muscles were one of the screening muscles, five muscle screens identified 90% to 98% of radiculopathies, six muscle screens identified 94% to 99%, and seven muscle screens identified 96% to 100%. When paraspinal muscles were not part of the screen, eight distal limb muscles recognized 92% to 95% of radiculopathies. CONCLUSION: This study demonstrated that six muscle screens including paraspinal muscles yielded consistently high identification rates. Studying additional muscles led to marginal increases in identification.     

Spinal nerve stimulation in the diagnosis of lumbosacral radiculopathy

Direct spinal nerve stimulation was compared with needle electromyography (EMG) in 40 patients who were suspected of having an L5 or S1 radiculopathy. For spinal nerve stimulation, we adapted a monopolar needle electrode inserted deep into the paraspinal muscle. The minimal latency, amplitude, and negative phase area of compound muscle action potential from myotomal muscles were recorded with computer assistance. Abnormality was considered to be significant when the value fell outside of 2 SD of control mean values. Among 17 patients with clinical evidence of radiculopathy, needle EMG was abnormal in 10 patients (58.8%), whereas in the nerve stimulation test the abnormalities were shown in 16 patients (94.1%); in amplitude difference and the abnormal area, differences were shown in 12 patients (70.6%). Among 23 patients with only subjective symptoms of radiculopathy, needle EMG was abnormal in nine patients (39.1%), whereas the abnormal amplitude differences were shown in 18 patients (78.3%) and 15 patients (65.2%) with abnormal area difference by spinal nerve stimulation, respectively. Direct spinal nerve stimulation is recognized as an objective and sensitive test in the diagnosis of lumbosacral radiculopathy.     

深层椎旁肌肌电图在脊神经根受损中的定位价值

目的 探索脊神经受损定位诊断中的精确定位检测指标。方法 对200例脊神经根受损患者先行传统定位检查,在此基础上,根据肢体异常肌 群的对照检查。结果 200例473块患侧椎帝肌100％阳性,健侧10块对照肌100％阴性。凡肢体异常肌群呈根性分布均在相应深层椎旁肌上得到了阳性验证,其中18例轻症仅表现为患侧53块椎旁肌阳性和4个H反身的延长,而无其他指标的改变。结论 深层椎旁肌肌电图的阳性改变在脊神经根受损的诊断中是一个最早出现的精确定位检测指标,具有极 敏感性和特异性。     

Symptom duration and spontaneous activity in lumbosacral radiculopathy

OBJECTIVES: A long-held notion in the electrodiagnostic literature is that paraspinal muscles tend to show spontaneous activity (fibrillations and positive sharp waves) on needle electromyography, early on in a lumbosacral radiculopathy, and that more distal muscles become abnormal later in the disease process. The purpose of this study was to determine whether paraspinal muscle and other major proximal and distal muscle spontaneous activity is related to a lumbosacral radiculopathy symptom duration. METHODS: A multicenter, prospective study that collected standard information on history, physical examination, and electrodiagnostic findings in patients with electrodiagnostically confirmed lumbosacral radiculopathies was undertaken. RESULTS: Multivariate probit analyses of 96 patients identified with a lumbosacral radiculopathy showed no evidence of correlation between spontaneous activity in the paraspinal muscles and symptom duration. Symptom duration was also nonsignificant in nine of the remaining ten lower limb muscles analyzed. CONCLUSION: These findings emphasize the limitations of using symptom duration when interpreting electrodiagnostic findings in lumbosacral radiculopathy.     

Motor Training of the Lumbar Paraspinal Muscles Induces Immediate Changes in Motor Coordination in Patients With Recurrent Low Back Pain

Recurrent low back pain (LBP) is associated with altered motor coordination of the lumbar paraspinal muscles. Whether these changes can be modified with motor training remains unclear. Twenty volunteers with unilateral LBP were randomly assigned to cognitively activate the lumbar multifidus independently from other back muscles (skilled training) or to activate all paraspinal muscles with no attention to any specific muscles (extension training). Electromyographic (EMG) activity of deep (DM) and superficial multifidus (SM) muscles were recorded bilaterally using intramuscular fine-wire electrodes and that of superficial abdominal and back muscles using surface electrodes. Motor coordination was assessed before and immediately after training as onsets of trunk muscle EMG during rapid arm movements, and as EMG amplitude at the mid-point of slow trunk flexion-extension movements. Despite different intentions of the training tasks, the pattern of activity was similar for both. After both training tasks, activation of the DM and SM muscles was earlier during rapid arm movements. However, during slow trunk movements, DM and SM activity was increased, and EMG activity of the superficial trunk muscles was reduced only after skilled training. These findings show the potential to alter motor coordination with motor training of the lumbar paraspinal muscles in recurrent LBP.     

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.