平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的神经电生理特点  

Electrophysiological characteristics of Hirayama disease, amyotrophic lateral sclerosis and distal cervical spondylotic amyotrophy

作　　者：金翔[1] 吕飞舟[1] 陈文钧[1] 夏新雷[1] 王立勋[1] 郑超君[1] 姜建元[1] 

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2013年第10期1004-1011,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81071438）;2010上海市卫生局重点项目（国人腰椎椎体间融合术后方入路解剖学及临床应用研究）

摘　　要：目的探讨平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的上肢神经电生理特点。方法回顾性分析87例平山病患者、83例肌萎缩性侧索硬化患者和28例远侧型肌萎缩型颈椎病患者的上肢神经电生理检测资料。其中87例平山病患者中，72例单侧上肢、15例双侧E肢出现肌肉萎缩；83例肌萎缩性侧索硬化患者中，30例单侧上肢、53例双侧七肢出现肌肉萎缩；28例远侧型肌萎缩型颈椎病患者中，20例单侧上肢、8例双侧上肢出现肌肉萎缩。结果平山病患者患肢尺神经刺激的复合肌肉动作电位（compound muscle actionpotential，CMAP）波幅明显低于正中神经刺激的CMAP波幅，肌萎缩性侧索硬化患者患肢正中神经CMAP波幅明显低于尺神经CMAP波幅，远侧型肌萎缩型颈椎病患者止中神经和尺神经CMAP波幅降低程度相同。平山病患者的平均尺神经／正中神经（U／M）CMAP比为0．58-＋0．40，肌萎缩性侧索硬化为2．28±1．25，远侧型肌萎缩型颈椎病为1．31±0．63，三者比较差异有统计学意义。在U／MCMAP比值〈0．6的患肢中，平山病有62例，肌萎缩性侧索硬化和远侧型肌萎缩型颈椎病分别只有3例和1例；在u／MCMAP比值〉1．7的患肢中，肌萎缩性侧索硬化有57例，平山病有12例，远侧型肌萎缩型颈椎病有4例。所有患者双侧的运动神经和感觉神经传导速度、感觉神经动作电位波幅均正常，健肢的CMAP波幅均正常。结论平山病患者小鱼际肌肉萎缩程度重于大鱼际肌，肌萎缩性侧索硬化患者与之相反，而远侧型肌萎缩型颈椎病患者大、小鱼际肌肉萎缩程度相似。Objective To explore the electrophysiological charaterstics of upper extremities nerves on the patients with Hirayama disease （HD）, amyotrophic lateral sclerosis （ALS）, and distal cervical spondylotic amyotrophy （DCSA）. Methods The data of electrophysiological examination of the upper limbs of 87 patients with HD, 83 with ALS and 28 with DCSA were re- viewed retrospectively. Seventy-two patients with HD among 87 had unilateral upper limb＇s amyotrophy and the other 15 ones had bilateral amyotrophy. There were 30 patients had unilater upper limb＇s amyotrophy and 53 ones had bilateral amyotrophy from the group of patients with AIRS; 20 patients with DSCA were affected unilaterally and 8 ones were bilaterally affected. Re- suits Compound muscle action potential （CMAP） evoked by ulnar stimulation had a lower ampititude compared with that evoked by median stimulation in HD patients. In ALS cases that was just the opposite. However, the CMAPs were similar in DCSA cases. The mean ratio of CMAP amplitude by ulnar stimulation to by median stimulation was 0.58＋0.40 in HD group; 2.28＋1.25 in AI,S and 1.31±0.63 in DCSA. The differences in the three groups were statistical significance. The U/M CMAP ratio was less than 0.6 in 62 patients with HD, 3 with ALS and 1 with DCSA, and more than 1.7 in 73 cases （57 ALS, 12 HD and 4 DCSA）. Conduction velocities （CV） of the sensory and motor nerves, the amplitude of the sensory nerve action potential in bilateral limbs, and the CMAP amplitude of the unaffected limb were normal in all cases. Conclusion This study could concluded that the severity of amyotropy in hypothenar mucles were higher than that in thenal muscles in patients with HD; there was just opposite in ALS cas- es and similar in DSCA.

关 键 词：颈椎病 肌萎缩 对比研究 

分 类 号：R746[医药卫生—神经病学与精神病学]