运动诱发电位诊断胸廓出口综合征的实验研究  

Diagnosis of thoracic outlet syndrome with motor evoked potential: an experimental study

作　　者：徐雷[1] 徐建光[1] 顾玉东[1] 张凯莉[1] 朱艺[1] 

机构地区：[1]复旦大学华山医院手外科,上海200040

出　　处：《中华手外科杂志》2002年第1期55-58,共4页Chinese Journal of Hand Surgery

基　　金：上海市领先学科基金资助项目 (95 Ⅲ 1 )

摘　　要：目的　研究运动诱发电位 (motorevokedpotentialMEP)在胸廓出口综合征电生理检查中的应用价值。方法　建立大鼠胸廓出口综合征的卡压模型 ,用经颅电刺激MEP技术在神经卡压后 2、4、8、12、16、2 0周等 6个时间段进行同体对照检测。分别测定冈下肌、三角肌、二头肌 (上干型TOS)、拇短展肌、小指展肌 (下干型TOS)MEP的潜伏期和波幅 ,并将其与从外周刺激的复合运动动作电位 (CMAP)进行相关性分析。结果　 (1)术后 8、12周 ,MEP的潜伏期较对照侧分别延长 [(2 5± 1.5 ) % (P <0 .0 5 ) ]和 [(4 5±1.6% ) (P <0 .0 1) ] ,两组差异有显著性意义和非常显著性意义。CMAP的潜伏期较对照侧分别延长[(10± 1.6) % (P >0 .0 5 ) ]和 [(15± 1.8) % (P >0 .0 5 ) ] ,两组差异无显著性意义。 (2 )术后 12、16周 ,MEP的波幅分别较对照侧衰减 [(3 0± 3 .6) % (P <0 .0 5 ) ]和 [(5 0± 3 .4) % (P <0 .0 1) ] ,且波形离散、出现双峰波 ,两组差异有显著性意义和非常显著性意义。CMAP波幅分别较对照侧衰减 [(2 0± 3 .5 ) %(P >0 .0 5 ) ]和 [(3 0± 3 .6) % (P <0 .0 5 ) ] ,后者两侧的差异有显著性意义。 (3 )术后 16、2 0周 ,MEP和CMAP的潜伏期和波幅均延长衰减。 (4 )同侧MEP和CMAP的波幅比值 ,实验侧在术后 12周开?Objective To study application value of motor evoked potential (MEP)in electrophysiological diagnosis of thoracic outlet syndrome (TOS). Methods Compression model of TOS in the rat was set up. Latency and amplitude of MEP at bilateral side in infraspinous muscle, deltoid, biceps(superior trunk type of TOS),abductor pollicis brevis, abductor digiti minimi(inferior trunk type of TOS)were detected by MEP technique at 2, 4, 8, 12, 16 and 20 weeks postoperatively, and the correlation analysis was done between MEP and CMAP. Results (1) Compared to the control side, latency of MEP was elongated (25 ± 1.5) % and (45 ± 1.6) % at postoperative 8 and 12 weeks, respectively. There was statistical significant difference between two sides. Latency of CMAP was elongated to (10 ± 1.6) % and (15 ± 1.8) % at postoperative 8 and 12 weeks respectively, there were no statistical significant difference. (2) Compared to the control side, amplitude of MEP was declined (30 ± 3.6) % and (50 ± 3.4) % at postoperative 12 and 16 weeks, with disperse wave form and double spike potential. There was statistical significant difference. Amplitude of CMAP was declined (20 ± 3.5) % and (30 ± 3.6) % ,respectively. There was no statistical significant differences. (3) Latency and amplitude of MEP and CMAP were elongated and decreased at postoperative 16 and 20 weeks.(4) The ratio of amplitude of MEP and CMAP at the ipsilateval side began to decline at experimental side at postoperative 12 weeks, with (0.76 ± 0.03) in the upper trunk type and (0.70 ± 0.04) in the inferior trunk type. There was statistical significant difference between two groups.Conclusion For diagnosis in TOS, not only was MEP more sensitive and accurate than CMAP but also useful for early diagnosis.

关 键 词：胸廓出口综合征 运动诱发曜闰 动物实验 复合运动动作电位 电生理诊断 神经根卡压损伤 

分 类 号：R651.3[医药卫生—外科学]