术中肌电检测判断外伤性神经瘤残存功能的探讨  

Assessment of neurofiber function within neuroma using intraoperative compound muscle action potential test

作　　者：陈正永[1] 徐建光[2] 沈丽英[1] 张凯莉 朱艺 顾玉东[2] 

机构地区：[1]上海医科大学华山医院手外科临床电生理研究室,200040 [2]上海医科大学华山医院手外科

出　　处：《中华骨科杂志》2000年第10期601-603,共3页Chinese Journal of Orthopaedics

基　　金：上海市医学领先基金资助课题(95-Ⅲ-001)

摘　　要：目的探讨术中神经瘤近端 /远端复合肌肉动作电位 (compound muscle action potential,CMAP)波幅比值 (proximal-to-distal amplitude ratio,PDAR)与神经瘤松解术后疗效的关系。方法选择 30例外伤性周围神经损伤、术前肌力 2～ 3级、术中发现局部有神经瘤形成的患者。行神经瘤周围松解术后，分别刺激神经瘤的近端和远端神经干，记录靶肌肉的 CMAP，测量其波幅，并计算 PDAR。术后进行临床和电生理追踪，研究不同 PDAR值与神经瘤松解术后疗效的关系。随访时间为 6～ 13个月，平均 8.5个月。结果 PDAR大于 30％者，神经瘤松解术后疗效优良率 (肌力达 4级以上 )为 89.5％ (17/19)； PDAR小于 30％者疗效优良率仅为 18.2％ (2/11)，两者差异有非常显著性意义 (P< 0.01)。结论应用术中 PDAR可较准确预测神经瘤松解术后肌肉功能恢复水平。 PDAR大于 30％者，建议行神经瘤松解术； PDAR小于 30％者，建议行神经瘤切除术。Objective To investigate the value of proximal-to-distal amplitude ratio (PDAR) in evaluating the neurofiber function within neuroma in traumatic peripheral nerve injury. Methods 30 cases of traumatic peripheral nerve injury were selected for the study according to the following criteria: 1)the injury was located in the upper limb; 2) preoperative muscle strength innervated by involved nerves was grade 2 to 3; 3) neuroma was found intraoperatively in the involved nerve. After neurolysis, the involved nerve was stimulated both proximally and distally to the neuroma, and compound muscle action potential (CMAP) was recorded in the target muscle of the tested nerves. The amplitude of CMAP was measured and the PDAR was calculated. Clinical and physiological follow-up was performed. The relationship between different value of PDAR and the treatment outcome after neurolysis of neuroma was studied. The follow-up period ranged from 6 to 13 months, with an average of 8.5 months. Results The satisfactory rate of treatment outcome (MCR≥ grade 4) was 89.5％ (17/19) for the patients with PDAR >30％ , and 18.2％ (2/11) for the patients with PDAR< 30％ . There is statistically difference between the two rates (P< 0.01). Conclusion PDAR could reliably predict the postoperative nerve function after neurolysis of neuroma. The treatment outcome was satisfactory in the patients with PDAR >30％ , and poor in those with PDAR< 30％ . Resection of neuroma was recommended if PDAR was < 30％ .

关 键 词：神经瘤 电生理学 创伤和损伤 

分 类 号：R651.3[医药卫生—外科学]