术中电生理检测在臂丛和其他周围神经损伤中的应用

探讨神经干动作电位（ＮＡＰ）、体感诱发电位（ＳＥＰ）和复合肌肉动作电位（ＣＭＡＰ）在臂丛和周围神经损伤术中的应用价值。方法１２０例臂丛和周围神经损伤，术中直接暴露神经刺激，记录ＮＡＰ和ＳＥＰ，对肘管综合征同时记录ＣＭＡＰ。根据术中电生理检测结果，结合临床综合分析，制订最佳手术方案。结果８０例外伤性臂丛根性完全损伤中，经术中电生理检测及手术探查证实，术前有９例将Ｃ５节前伴节后损伤误诊为节后损伤；２例将Ｃ６节后损伤误诊为节前损伤；２例将Ｃ７节前损伤误诊为节后损伤。另有３例术中Ｃ５、６根干部外观质地完全正常，但术中电生理检测证实为节前损伤（椎孔内撕脱）。４０例周围神经损伤中，术中ＮＡＰ和ＣＭＡＰ检测对早期神经再生的检测，神经瘤或吻合口部位神经功能及卡压神经松解疗效的评价均有良好作用。术中电生理诊断神经完全损伤而行神经切除术者，术后病理组织学检查证实无或仅含少量变性神经纤维。结论术中电生理检测能提高臂丛和周围神经损伤诊治水平，值得推广应用。

APPLICATION OF INTRAOPERATIVE ELECTROPHYSIOLOGICAL EXAMINATION TO BRACHIAL PLEXUS AND OTHER PERIPHERAL NERVE INJURIES

PURPOSE To introduce and evaluate the intraoperative application of nerve action potential (NAP), somatosensory evoked potential (SEP) and compound muscle action potential (CMAP) to brachial plexus and peripheral nerve injuries. METHODS Intraoperative NAP, SEP and CMAP examinations were performed on 80 cases of complete traumatic brachial plexus injuries and 40 cases of peripheral nerve injuries, including 20 cases of cubital tunnel syndrome. The optimal surgical management was carried out based on the electrophysiological evaluation of involved nerves combined with clinical assessment. RESULTS Among 80 cases of brachial plexus lesions, intraoperative electrophysiological examination (IEE) corrected preoperative misdiagnosis of 9 C5,2 C6 and 2 C7 root injuries, which were all confirmed by subsequent exploration. In another 3 cases, apparent normality of C5,6 root and trunk concelaed intraspinal preganglionic avulsion, which was testified by IEE. In 40 peripheral nerve injuries, IEE also manifested great value in early detection of nerve regeneration, assessment of neuroma, and evaluation of neurolysis effect of entrapped nerves. Histological examination confirmed IEE diagnosis of dysfunction of resected nerve segments, for no neurofibers or only a little degenerated neurofibers were observed in these specimens under microscope. CONCLUSIONS IEE is valuable and necessary in treatment of brachial plexus and peripheral nerve injuries, and it is worth wide using.