连枷臂综合征的临床和神经电生理研究  

作　　者：徐迎胜[1] 樊东升[1] 

机构地区：[1]北京大学第三医院神经内科,100191

出　　处：《中华医学杂志》2013年第1期23-25,共3页National Medical Journal of China

基　　金：国家自然科学基金（81100895）;国家自然科学基金重点项目（81030019）;北京市自然科学基金（7102161）

摘　　要：目的探讨连枷臂综合征（FAS）的临床和神经电生理特点。方法回顾分析2006年7月至2012年7月北京大学第三医院FAS患者、上肢起病的经典肌萎缩侧索硬化（ALS）患者、上臂丛神经病患者，对其临床表现和神经电生理特点进行分析、比较。神经电生理研究主要包括四肢神经传导和延髓、颈、胸、腰骶4区肌肉的肌电图检测。结果共人组138例患者，其中FAS组56例，ALS组60例，上臂丛神经病22例。FAS患者中男：女=5：1，主要表现为双上肢近端肌无力、肌萎缩；上肢运动神经复合肌肉动作电位（CMAP）波幅下降，各区域肌肉肌电图不同程度的神经源性损害，其三角肌和肱二头肌运动单位动作电位（MUAP）波幅高于ALS组[（1531±76）灿V比（898±57）μV；（1433±57）μV比（872±75）μV]（F=13．25，6．33，均P〈0．05）；其第一骨间肌、三角肌和肱二头肌肌电图MUAP波幅高于臂丛神经病组[（1263±24）μV比（507±42）μV；（1531士76）μV比（564±27）μV；（1433±57）μV比（593±36）μV）]（F=12．32，16．71，8．35，均P〈0．05）。结论连枷臂综合征患者男性较多见，主要累及双上肢近端，不同区域肌电图呈程度不同的神经源性损害，上肢运动神经CMAP波幅明显下降。Objective To explore the clinical and neuroelectrophysiological characteristics of flail arm syndrome (FAS).Methods The clinical and neuroelectrophysiological characteristics were analyzed retrospectively from July 1,2006 to July 1,2012 in FAS patients (n =56),those with upper limb onset amyotrophic lateral sclerosis (ALS) (n =60) and those with upper brachial plexus neuropathy (n =22)from our hospital.Nerve conduction study of musculocutaneous,axillary,median,ulnar,radial,tibial,peroneal and sural nerves and electromyogram (EMG) of bulbar,cervical,thoracic and lumbosacral regions were conducted.Results In FAS patients,the ratio of male-to-female was 5:1 and they were characterized by symmetric,proximal wasting and weakness of upper extremities,the involved muscles demonstrated neurogenic damage on EMG and the amplitude of compound muscle action potential (CMAP) of arms decreased.Compared with ALS patients,the amplitude of motor unit action potential (MUAP) of deltoid muscle and biceps muscle was higher in FAS patients ((1531 ±76) vs (898 ±57) μV; (1433 ±57) vs (872 ± 75) μV) (F =13.25,6.33 ; P ＜ 0.05).Compared with upper brachial plexus neuropathy patients,the amplitude of MUAP of first dorsal interosseous,deltoid and biceps muscles was higher in FAS patients ((1263±24) vs(507 ±42)μV; (1531 ±76) vs (564 ±27) μV; (1433 ±57) vs (593 ±36) μV) (F=12.32,16.71,8.35; P＜0.05).Conclusion The clinical manifestations of FAS are symmetric,proximal wasting and weakness of arms.And the involved muscles show denervation on EMG and the amplitudes of CMAPs decrease in motor nerves of upper extremities.

关 键 词：肌萎缩侧索硬化 臂丛神经病 肌电描记术 

分 类 号：R744[医药卫生—神经病学与精神病学]