关节源性肌肉抑制的定量腱反射肌电图检查

目的 :膝关节骨关节炎 (kneeosteoarthritis,膝OA )可造成关节源性肌肉抑制 (arthrogenousmuscleinhibition ,AMI)和肌肉软弱。以往AMI的测定方法均有不足处。本研究旨在使用定量腱反射肌电图检查来诊断评价AMI。方法 :对 36例单侧膝OA患者进行股神经最大电刺激、定量的髌腱反射肌电图检查 ,比较健患侧电生理参数的差异。同时作股神经最大电刺激和定量髌腱反射时 ,肌电波幅减低程度之间的比较。另外 ,对 8例志愿者 (16个肢体 )作了定量腱反射的准确度检验。结果 :健侧与患侧相比 ,膝OA的股神经最大电刺激的肌电波幅与潜伏期无显著差别 ,但患侧定量髌腱反射肌电波幅却显著地低于健侧。另外 ,定量髌腱反射肌电波幅的减低程度显著地大于股神经最大电刺激肌电波幅的减低程度。 36例患者中 ,有 2 5例 (6 9 4% )表现出明显的肌肉抑制。在志愿者定量腱反射肌电图检查的准确度检验中 ,算出的平均变异系数为 0 0 71,且两侧反射波幅的差值基本在 10 %以内。小结 :在电刺激表明肌萎缩不明显的前提下 ,定量腱反射的肌电图检查显示膝OA的股四头肌有明显的AMI,此关节源性肌肉抑制为脊髓前角运动神经元的抑制。

Quantitative Electromyographical Test of Patella Tendon Reflex for Evaluation of Arthrogenous Muscle Inhibition

Objective Knee osteoarthritis (knee OA) may induce arthrogenous muscle inhibition (AMI) and muscle weakness.The previous evaluating methods of AMI were not satisfactory.The objectives of our research were to use quantitative electromyographical test of patella tendon reflex to evaluate AMI.Methods Maximal electrical twitch of femoral nerve and quantitative electromyographical test of patella tendon reflex were performed on 36 patients with unilateral knee OA.The differences of electrophysiologic parameters between the involved and the uninvolved limbs were studied.The decreased extent of amplitude of femoral nerve maximal electrical twitch and quantitative patella tendon reflex were compared.The accuracy of quantitative electromyographical test was examined in 8 volunteers (16 limbs).Results No statistical differences of amplitudes and latencies of the maximal electrical twitch of femoral nerve were found between involved and uninvolved limbs,but the amplitudes of quantitative patella tendon reflex of involved limbs were statistically lower than those of uninvolved limbs.The decreasing extent of amplitude of quantitative patellar tendon reflex was statistically larger than that of maximal electrical twitch of femoral nerve.25 of the 36 cases (69 4%) shown the evident muscle inhibition.The mean of coefficient of variation was 0 071.The difference between reflex amplitudes of two limbs was nearly under 10%.Conclusion Under the presupposition of no evident of muscle atrophy through maximal electrical twitch, quantitative electromyographical test of patellar reflex could discover the quadriceps AMI in patients with knee OA,which was known to be the inhibition of anterior horn motoneuron.