腕管综合征术前、后感觉神经动作电位与复合肌肉动作电位检测结果的比较

目的　比较腕管综合征术前和正中神经松解术后 (术中 )两者感觉神经动作电位 (sensorynerveactionpotential ,SNAP)与复合肌肉动作电位 (compoundmuscleactionpotential,CMAP)检测结果的差异。方法　对 2 0例腕管综合征患者 ,术中在切开屈肌支持带及正中神经松解术后 ,分别测定 (1)拇短展肌的CMAP ;(2 )刺激示、中指 ,于腕部记录正中神经的SNAP ;(3 )刺激环指 ,于腕部分别记录正中神经和尺神经的SNAP。将三者结果与术前的相应数据行统计学分析。结果　 (1)术前拇短展肌CMAP的潜伏期小于4 3ms ,术后其潜伏期、波幅与术前相比差异无统计学意义 (P >0 0 5 )。 (2 )术后 2～ 4指SNAP的潜伏期比术前平均缩短 5 %、波幅增加 13 %左右 ,两者相比差异均有统计学意义 (P <0 0 1)。结论　腕管综合征手术中 ,在正中神经松解术后行SNAP检测较CMAP检测的结果更为敏感和准确。     

拇短展肌针极肌电图检查在轻、中度腕管综合征中的应用

目的 评价拇短展肌针极肌电图(electromyography, EMG)检查在轻、中度腕管综合征中的应用价值。方法 前瞻性研究2016年1月至2021年12月就诊于秦皇岛市第一医院的102例轻度和中度腕管综合征患者,其中男36例,女66例;平均年龄57岁(32～86岁)。根据正中神经运动神经远端潜伏期(distal latency, DL)分为两组,其中DL正常组50例,男14例,女36例,平均年龄56.5岁(39～79岁);DL异常组52例,男22例,女30例,平均年龄57.5岁(32～86岁);DL异常组又分为EMG正常组和EMG异常组。记录各组患者的正中神经运动神经DL和肌肉复合动作电位(compound muscle action potential, CMAP)波幅,并进行统计学分析。结果 DL异常组患者的正中神经运动神经CMAP波幅低于DL正常组(P<0.05);DL正常组和DL异常组患者的拇短展肌EMG异常率分别为12.0%和32.7%(P<0.05)。DL异常组中,EMG异常患者的正中神经运动神经CMAP波幅低于EMG正常患者(P<0.05)。结论 ...     

单纤维肌电图在诊断腕管综合征中的表现和评价

目的 分析、评价单纤维肌电图(single fiber electromyography,SFEMG)在诊断腕管综合征中的表现和作用.方法 将临床确诊的14例腕管综合征患者(共20侧)根据常规电生理神经传导检测数据分为两组:患侧跨腕段SNCV(感觉神经传导)均减慢,但拇短展肌CMAP(复合肌肉动作电位)潜伏期正常者为腕管Ⅰ组(10侧),拇短展肌CMAP的潜伏期4.3ms者为腕管Ⅱ组(10侧).各组均行SFEMG检测,得到拇短展肌的纤维密度(fiber density,FD)和单纤维动作电位间间隔的连续差均值(mean of consecutive difference,MCD).10例(10侧)健康志愿者为对照组,同法测取FD、MCD值.结果 术前各组SFEbfG检测结果 :拇短展肌MCD平均值,腕管Ⅰ组为67.86μs,较对照组延长了27.47μs;腕管Ⅱ组为83.36μs,较对照组延长了42.97μs.拇短展肌FD平均值,腕管Ⅰ组较对照组增加了0.46,腕管Ⅱ组较对照组增加了0.60.腕管Ⅰ、Ⅱ组的MCD、FD明显高于对照组,Ⅱ组MCD又明显高于Ⅰ组,而Ⅰ组、Ⅱ组FD则无明显差异.结论 单纤维肌电图检测为腕部正中神经卡压,特别是早期卡压的诊断提供了一项新的更为直接的客观指标.     

腕管综合征两种减压手术后肌电图检测结果的分析比较

目的 通过分析比较中、重度腕管综合征传统与内窥镜微创减压手术后中远期肌电图检测结果的差异,探讨两种方法治疗腕管综合征后肌电指标改善的程度.方法 选择中、重度腕管综合征患者共46例59腕,按手术方法的不同分为两组,其中传统切开减压组22例27腕、内窥镜微创减压组24例32腕,于术后1年进行肌电图检测,对复合肌肉动作电位(compound muscle action potential,CMAP)潜伏期、感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉传导速度(sensory nerve conduction velocity,SNCV)的随访数据进行分析比较.结果 术后1年拇短展肌CMAP 潜伏期及SNCV组间比较差异有统计学意义(P＜0.05),而SNAP波幅组间比较差异无统计学意义(P＞0.05).结论 神经电生理检测提示传统切开减压治疗中、重度腕管综合征的中远期随访的肌电指标改善程度优于内窥镜微创治疗.     

掌部小切口治疗腕管综合征

目的介绍应用新型掌部小切口行腕管松解术。方法对确诊为腕管综合征的68例(89侧)患者采用新型掌部小切口行腕管松解术,该切口为纵行、位于鱼际纹尺侧2～3mm、长约2.0～2.5cm,近端不超过远侧腕横纹。结果经术后6个月随访,所有患者症状均消失,拇短展肌肌力、握力、捏力、皮肤感觉功能均明显改善,术前术后差异在统计学极具显著意义(P<0.001)。本组无任何神经血管并发症,无1例出现腕掌部瘢痕疼痛。结论本切口具有安全、损伤小、直视下松解腕管并同时可行正中神经内松解和尺管松解、手术瘢痕小等诸多优点,是腕管松解术的一种新型、可靠的手术入路。     

异丙酚复合芬太尼对患者拇短展肌运动诱发电位的影响

目的 探讨异丙酚复合芬太尼对患者拇短展肌运动诱发电位(MEP)的影响.方法 择期普通外科手术患者11例,ASA Ⅰ或Ⅱ级,年龄26～48岁.以第6颈椎棘突为刺激线圈的中点进行磁刺激,周期20s.试验Ⅰ:经30 s匀速静脉注射异丙酚2mg/kg.记录给药即刻至患者出现睁眼或体动反应期间右拇短展肌MEP波幅的基础值、最低值和最后值,及其对应的潜伏期,以及波幅下降至最低值的时间(时程).试验Ⅱ:试验Ⅰ结束后30 min,经大隐静脉依次匀速注射异丙酚2 mg/kg和芬太尼5 μg/kg,每种药物注射时间为30 s.记录给药即刻开始拇短展肌MEP波幅的基础值、最低值和最后值,及其对应的潜伏期,以及时程,记录时间为360 s.结果 与基础值比较,两试验拇短展肌MEP波幅的最低值和最后值降低(P<0.01);与试验Ⅰ比较,试验Ⅱ拇短展肌MEP波幅的最后值降低(P<0.05).结论 与静脉注射异丙酚比较,异丙酚复合芬太尼对患者拇短展肌MEP的抑制作用更强.     

腕管综合征主要症状体征敏感性与特异性的比较

目的　比较腕管综合征 (carpaltunnelsyndrome ,CTS)主要症状、体征的敏感性与特异性。方法　对 10 1例 ( 162只手 )进行症状严重程度与功能状况的询问 ,感觉、运动功能的检查 ;其中 62只手在术后 6周再次测定。结果　 162只患手中 15 8只具有典型症状 ( 98% )。Phalen征、前臂正中神经加压征、Semmes Weinstein单丝纤维测试阳性率分别为 98%、96%、82 %。 87%的患手出现肌力下降 ,拇短展肌肌力测定 (定量法 )结果显示 ,与徒手法相比 ,不同性别间、术前与术后的差异均具非常显著意义 (P <0 .0 1)。结论　典型症状、Phalen征、前臂正中神经加压征、拇短展肌肌力变化的敏感性与特异性最高 ,拇短展肌肌力定量法测定是判断腕管综合征严重程度、评定疗效的一个良好的客观指标。     

正中神经返支卡压征二例

病例1男,16岁.因双手拇指无力,大鱼际肌萎缩4个月而来我院就诊.专科检查:右手大鱼际肌萎缩(++),左手大鱼际肌萎缩(+),双手拇指外展、对掌受限,双手拇指及大鱼际痛温觉正常.神经电生理检查:双侧拇短展肌肌电图为神经性损害,正中神经远端运动潜伏期(LAT)延长,复合肌肉动作电位(CMAP)波幅降低,正中神经感觉传导速度(SCV)、感觉神经动作电位(SNAP)正常.     

正中神经返支卡压征二例

病例1男,16岁.因双手拇指无力,大鱼际肌萎缩4个月而来我院就诊.专科检查:右手大鱼际肌萎缩(++),左手大鱼际肌萎缩(+),双手拇指外展、对掌受限,双手拇指及大鱼际痛温觉正常.神经电生理检查:双侧拇短展肌肌电图为神经性损害,正中神经远端运动潜伏期(LAT)延长,复合肌肉动作电位(CMAP)波幅降低,正中神经感觉传导速度(SCV)、感觉神经动作电位(SNAP)正常.     

正中神经返支卡压征二例

病例1男,16岁.因双手拇指无力,大鱼际肌萎缩4个月而来我院就诊.专科检查:右手大鱼际肌萎缩(++),左手大鱼际肌萎缩(+),双手拇指外展、对掌受限,双手拇指及大鱼际痛温觉正常.神经电生理检查:双侧拇短展肌肌电图为神经性损害,正中神经远端运动潜伏期(LAT)延长,复合肌肉动作电位(CMAP)波幅降低,正中神经感觉传导速度(SCV)、感觉神经动作电位(SNAP)正常.     

Endoscopic carpal tunnel release and nerve conduction studies

We investigated the outcome of endoscopic carpal tunnel release (ECTR) for patients with carpal tunnel syndrome (CTS) in comparison with the results of preoperative nerve conduction studies. The compound muscle action potential (CMAP) of the abductor pollicis brevis muscle (APB) and the second lumbrical muscle (L2) was recorded following median nerve stimulation at the wrist. A total of 38 hands in 35 patients were classified into four categories. Hands with a similarly prolonged distal motor latency for the APB and L2 were classified as type I (n=25), while those with a more prolonged distal motor latency for the APB than for the L2 (>0.7 ms) were classified as type 2 (n=10). Hands with a CMAP for the APB, but not L2, were classified as type 3 (n=1), and hands with no CMAP for either the APB or L2 were classified as type 4 (n=2). After ECTR, all of the type 1 and 2 hands were improved. Patients with type 3 and type 4 hands did not show satisfactory improvement, which may have been due to anatomical variation of the recurrent motor branch of the median nerve.     

Time-dependent changes in median nerve sensory amplitude after local anesthetic administration and tourniquet application

Indirect visualization, as used in several newer mini-open and endoscopic carpal tunnel release (CTR) procedures, may increase the possibility of nerve injury in some cases. Intraoperative neural monitoring may be used to evaluate nerve location and integrity. In the study reported here, we assessed the feasibility of intraoperative neural monitoring by systematically exploring the effect of local anesthetic and tourniquet on median sensory amplitude. Results for 30 median nerves (7 symptomatic) showed that sensory amplitude decreased, on average, 54% with lidocaine injection, 15% with tourniquet application, and 47% with the combination. Sensory amplitudes of 9 of 10 nerves were still above 1.0 microV 15 minutes after anesthetic administration and tourniquet application. Study results demonstrate that intraoperative monitoring, using the amplitude of the median sensory nerve response, is viable under CTR conditions.     

骨间前神经卡压征的电生理研究

目的分析总结骨间前神经卡压征的神经电生理特点,探讨其对骨间前神经卡压征的诊断意义。方法对12例骨间前神经卡压征患者进行神经电生理检测：（1）惠侧及对侧骨间前神经运动潜伏期及复合肌肉动作电位波幅：（2）患侧正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅：（3）患侧拇短展肌、指浅屈肌、旋前方肌、拇长屈肌肌电图。结果10例骨间前神经运动潜伏期延长;12例骨间前神经复合肌肉动作电位波幅降低;12例正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅正常：12例旋前方肌、10例拇长屈肌肌电图示神经性损害;12例拇短展肌、指浅屈肌肌电图正常。结论骨间前神经卡压征的神经电生理表现特点为：骨间前神经运动传导潜伏期延长及复合肌肉动作电位波幅降低,其支配肌肉肌电图示神经性损害,而正中神经运动及感觉传导正常．其支配肌肉肌电图正常。骨间前神经卡压征的神经电生理表现可为该病提供客观、准确的诊断与鉴别诊断依据。     

Dose-responsiveness of electrophysiologic change in a new model of acute carpal tunnel syndrome

This study was done to determine the dose-responsiveness during the development of acute pressure-induced median neuropathy in rabbits and to develop a new animal model of acute carpal tunnel syndrome. Twenty-three rabbits were used. Carpal tunnel syndrome was induced by infusing a controlled saline solution into the carpal tunnel of rabbits using a 21-gauge needle under general anesthesia to elevate the carpal tunnel pressure. The changes in the amplitude and latency of the compound muscle action potential obtained by abductor pollicis recording were observed after a complete conduction block, and after the release of pressure at various pressure levels. Pressures greater than 30 mm Hg applied to the carpal tunnel caused a remarkable electrophysiologic change. A higher pressure level resulted in a shorter time required for a complete conduction block and also for recovery after the release of pressure. Complete conduction block occurred between 40 and 50 minutes at a pressure of 100 mm Hg. The degree of recovery after a conduction block was related inversely to the pressure-time integrals. Our animal model reflects the pathophysiology of acute carpal tunnel syndrome and shows a regular dose-responsiveness during the development of acute pressure-induced neuropathy.     

Power spectrum analysis of compound muscle action potential in carpal tunnel syndrome patients

The objective of using wave-form analysis to assess compound muscle action potential (CMAP) in entrapment neuropathy had not been fully developed. We applied the power spectrum analysis to patients with carpal tunnel syndrome (CTS) for this purpose. 24 patients with CTS were divided into three stages according to Mackinnon s classification, and 50 normal volunteers were examined. CMAP was obtained from the abductor pollicis brevis with supramaximal stimulation to median nerve. Mean and peak frequencies were measured by power spectrum analysis. The distal latencies of CMAP and the sensory nerve conduction velocities showed some prolongation in CTS patients. Integral values of CMAP were also decreased in CTS patients. Mean and peak frequencies of power spectrum of CMAP in volunteers were 134 Hz and 98 Hz, respectively. These values shifted into lower frequencies in CTS patients, namely 102 Hz and 61 Hz. Regardless of clinical stage, distal latency of CTS patients correlated with mean frequency.     

Two cases of endoscopic management of carpal tunnel syndrome in macrodactyly patients.

Some cases of carpal tunnel syndrome in macrodactyly patients have been reported. We performed endoscopic carpal canal release on two unilateral macrodactyly patients suffering from bilateral carpal tunnel syndrome. We measured carpal canal pressure before performing endoscopic surgery using the Universal Subcutaneous Endoscope system to confirm median nerve compression. We diagnosed median nerve compression in each patient due to the high preoperative carpal canal pressure. Carpal canal pressure immediately decreased to within normal range following release of both the flexor retinaculum and the distal holdfast fibres of the flexor retinaculum. One patient recovered to within normal in terms of sensory disturbances and abductor pollicis brevis muscle strength. The other patient showed improvement in terms of sensory disturbance, however, muscle power did not recover because this patient had suffered from carpal tunnel syndrome for ten years. Endoscopic carpal canal release and decompression surgery was effective for carpal tunnel syndrome in both macrodactyly patients.     

Flexor superficialis abductor transfer with carpal tunnel release for thenar palsy

PURPOSE: In patients with advanced chronic carpal tunnel syndrome (CTS) the ability of the thumb to abduct and perform functional opposition is impaired greatly, primarily because of denervation and paralysis of the abductor pollicis brevis muscle. The purpose of this study was to evaluate the results of transfer of the flexor digitorum superficialis to the abductor pollicis brevis for restoration of thumb abduction in thenar paralysis caused by advanced chronic CTS. METHODS: Fifty patients (51 hands) with advanced CTS and loss of thumb abduction had a flexor digitorum superficialis transfer (37 small, 10 ring, 4 middle finger donors) to the abductor pollicis brevis with simultaneous carpal tunnel release (49 of 51 endoscopic). Thirty patients (60%) were women with an average age of 70 years (range, 35-90 y). Forty-three patients (84%) were in their sixth through eighth decades. We analyzed retrospectively preoperative and postoperative abduction, abduction strength, thenar muscle recovery and function, and patient satisfaction and complications. RESULTS: All patients reported improved thumb and hand function. Thumb abduction increased almost 20 degrees and 3 British Medical Research Council strength grades. Abduction was improved by the transfer in all patients, with some thenar recovery found in 35 of 40 cases followed-up longer than 12 months. Harvest of the flexor digitorum superficialis from the ring and middle fingers was associated with donor finger proximal interphalangeal joint contracture, although harvest from the small finger was not. CONCLUSIONS: Carpal tunnel release with simultaneous flexor digitorum superficialis-to-abductor pollicis brevis transfer provides satisfactory results for patients with profound CTS and thenar paralysis. The use of the small finger superficialis as the donor motor has minor morbidity compared with other methods and has predictable improvement and patient satisfaction. This transfer method is combined easily with endoscopic carpal tunnel release (as in 49 of our 51 cases), 2-portal, or open method releases.