神经肌电图对特发性面瘫治疗及预后评估的研究

目的探讨神经肌电图(神经电图electroneurography,ENG和肌电图electromyography,EMG)在特发性面瘫治疗及预后评估中的价值。方法采用丹麦生产的keypointⅣ肌电图仪对96例确诊为特发性面瘫的患者进行患侧与健侧ENG、EMG检测,分别记录患侧面神经颞支、颧支、颊支的运动传导潜伏期、波幅以及所支配的额肌、眼轮匝肌、口轮匝肌的肌电图情况,并与自身健侧作对比。结果特发性面瘫患者患侧面神经运动传导潜伏期延长、M波波幅降低,与自身健侧相比,差异有统计学意义(P<0.05)。波幅下降<70%、NCV(神经传导速度)减慢<20%、EMG大致正常的轻度患者,3个月内面肌完全恢复,治愈率100%;波幅下降70%～90%、NCV减慢20%～50%、EMG呈部分神经源性损害的中度患者,3个月内大部分可完全恢复,治愈率87.8%;波幅下降>90%、NCV减慢>50%、EMG呈部分或完全神经源性损害的中重度患者,3个月内面肌完全恢复者为50%;诱发电位消失、NCV引不出、EMG呈完全神经源性损害的重度患者,3个月内面肌完全恢复者为25%。结论 ENG和EMG检测对特发性面瘫的神经损伤、面肌恢复等预后评估有重要价值,能对临床治疗提供客观依据。

Study of EMG on the treatment and prognosis of idiopathic facial paralysis

Objective To investigate the value of the neuro-EMG(electroneurography,ENG and electromyography,EMG) on the treatment and prognosis in idiopathic facial paralysis.Methods The keypoint Ⅳ EMG made in Denmark was used to detect the ENG and EMG of ipsilateral and contralateral facial nerve of the 96 cases of patients with clinical diagnosis of idiopathic facial paralysis.The motor conduction latency period and amplitude of facial nerve temporal branch,zygomatic branch and buccal branch and the EMG in frontal muscle,orbicularis muscle and orbicularis oris muscle were recorded,and then compared with the patient’s own contralateral ones.Results It was statistically significant(P<0.05) that facial nerve motor conduction latency were longer and M-wave amplitude lowered than its own contralateral side in patients with idiopathic facial paralysis.The facial muscle of mild patients with generally normal EMG and amplitude dropt less than 70% and nerve conduction velocity dropt less than 20% was fully recovered within three months and the cure rate was 100%.Most of the patients with amplitude dropt to 70%~90% and nerve conduction velocity dropt to 20%~50%,or moderate part neurogenic damage EMG,was fully recovered within three months and the cure rate was 87.8%.The facial muscle of the moderate and severe patients with amplitude dropt to more than 90% and nerve conduction velocity dropt to more than 50% and partial or complete neurogenic damage was fully recovered and the cure rate was 50%.The patients with facial muscle of 25% patients with evoked potentials disappeared,NCN absented and completely damaged EMG showed fully recovered in three months.Conclusion It is important to test the ENG and EMG on the prognostic assessment of nerve injury and recovery of facial muscle in idiopathic facial paralysis,which provides an objective basis for clinical treatment.