膈神经副神经肌电图检查对提高臂丛神经根性损伤诊断符合率的机制和意义  

The mechanism and significance of increased diagnostic rate of brachial plexus root injuries using electromyographic examinations of phrenic and accessory nerves

作　　者：陈正永[1] 沈丽英[1] 马建军[1] 张凯莉[1] 朱艺 

机构地区：[1]上海医科大学华山医院手外科

出　　处：《中华手外科杂志》1998年第3期161-163,共3页Chinese Journal of Hand Surgery

基　　金：美国中华医学基金;国家自然科学基金;卫生部重点科研基金;上海市医学领先学科基金

摘　　要：目的阐明膈神经、副神经肌电图检查对提高臂丛神经根性损伤诊断符合率的机制和意义。方法对１００例术中证实为全臂丛或上中干根性损伤的术前肌电图资料（包括膈神经、副神经和臂丛神经）进行分析，总结Ｃ５神经根性损伤中节前、后的发生率，术前诊断符合率及膈神经、副神经的功能。结果１００例臂丛神经根性损伤中，Ｃ５神经根性损伤的诊断符合率为８７％，比过去提高３１．９％；节后损伤的诊断符合率为８１．９％，提高３０．８％。膈神经、副神经完全损伤者Ｃ５神经根均为节前损伤。膈神经完全损伤１３例，不全损伤７例中５例（７１．４％）为节前损伤；副神经完全损伤５例，不全损伤１４例中８例（５７．１％）为节前损伤。结论对膈神经、副神经进行肌电图检测，可提高Ｃ５神经根性损伤的术前诊断符合率；并可判断膈神经。Objective To illustrate the mechanism and significance of increased diagnostic rate of brachial plexus injuries using electromyographic examination of phrenic and accessory nerves. Methods Preoperative electromyographic examination data of phrenic nerve, accessory nerve and brachial plexus of 100 cases of brachial plexus root injuries, which were confirmed by open exploration and intraoperative electromyographic examinations, were analyzed. Incidence of C 5 pre or post ganglionic root lesion, preoperative diagnostic rate of EMG and function of phrenic and accessory nerves were summerized. Results Of the 100 cases of brachial plexus root injuries, the diagnostic rate of EMG for C 5 root injury and C 5 postganglionic injury were 87% and 81.9% respectively, which were 31.9% and 30.8% higher than those of the past respectively. Complete dysfunction of phrenic and accessory nerve was found in 13 and 5 cases respectively. Preganglionic injury of C 5 nerve root was diagnosed in all these cases. Of 7 incomplete phrenic nerve injury, 5 (71.4%) were C 5 root avulsion. Of 14 cases of incomplete accessory nerve injury, 8 (57.1%) were C 5 root avulsion. Conclusions Electromyographic examinations of phrenic and accessory nerves can increase the diagnostic rate of C 5 root lesion, and judge whether the nerves can be used as donor nerves in neurotization.

关 键 词：膈神经 副神经 臂丛神经根损伤 诊断 肌电描记术 

分 类 号：R651.304[医药卫生—外科学]