针极肌电图联合神经传导速度检测在原发性桡神经沙漏样狭窄中的应用价值  

Effect of needle electromyography combined with nerve conduction velocity detection in primary hourglass-like stenosis of radial nerve

作　　者：王娆[1] 诸寅[1] 赵睿 杨卓[1] 王丽华[1] 杨昀[1] 张珍珍[1] WANG Rao;ZHU Yin;ZHAO Rui;YANG Zhuo;WANG Lihua;YANG Yun;ZHANG Zhenzhen(Electromyogram Room,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院肌电图室

出　　处：《实用医学杂志》2019年第23期3685-3689,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目（编号：81501064）

摘　　要：目的通过与术中探查对比,评价针极肌电图联合神经速度传导检测对原发性桡神经沙漏样狭窄的诊断和预后预测价值。方法纳入2013年1月至2016年12月因原发性桡神经沙漏样狭窄行桡神经松解术的患者30例。所有患者术前均行针极肌电图、神经传导检测与超声检查。采用加权Kappa法对肌电图、超声检查与手术判断进行一致性分析。分析神经传导速度指标与患者预后之间的相关性。结果(1)神经损伤严重程度为肌电图检测显示Ⅰ型共2例,Ⅱ型共24例,Ⅲ型共3例,Ⅳ型仅有1例;超声检查显示Ⅰ型共3例,Ⅱ型共27例;术中探查显示Ⅰ型共4例,Ⅱ型共24例,Ⅲ型共2例。(2)采用加权Kappa法进行一致性检验,以术中探查为金标准,肌电图与手术间Kappa=0.790(95%CI:0.648~0.899),超声与手术间Kappa=0.813(95%CI:0.662~0.0.931),说明肌电图或超声检查与术中探查结果之间均具有较强一致性。(3)预后为优的患者初始运动神经传导速度为(50.05±4.76)m/s,表面点击检测感觉神经传导速度(sensory nerve conduction velocity,SCV)为(51.07±5.21)m/s,均显著高于预后为可的患者;预后为良的患者SCV为(43.28±3.06)m/s,显著高于预后为可的患者。结论在桡神经沙漏样狭窄的诊断方面,针极肌电图联合神经传导检测与术中探查金标准具有较好的一致性,并且神经传导速度检测结果可以提示桡神经沙漏样狭窄患者手术预后。Objective To evaluate the diagnostic and prognostic value of electromyography(EMG)combined with nerve velocity conduction(VEC)in primary hourglass-like stenosis of radial nerve.Methods Thirty patients with primary hourglass stenosis of the radial nerve who underwent radial nerve lysis from January 2013 to December 2016 were enrolled.Needle electromyography,nerve conduction test and ultrasonography were performed for all patients before operation.Weighted Kappa method was used to analyze the consistency of electromyography,ultrasonography and surgical judgement.The correlation between nerve conduction velocity and prognosis was analyzed.Results(1)The severity of nerve injury was detected by electromyography in 2 cases of typeⅠ,24 cases of typeⅡ,3 cases of typeⅢand only 1 case of typeⅣ.Ultrasonography revealed that there were 3 cases of typeⅠand 27 cases of typeⅡ.Intraoperative exploration revealed that there were 4 cases of typeⅠ,24 cases of typeⅡand 2 cases of typeⅢ.(2)Weighted Kappa method was used to check the consistency.The gold standard was intraoperative exploration.The consistency between electromyography and intraoperative Kappa was 0.790(95%CI:0.648~0.899)and that between ultrasound and intraoperative Kappa was 0.813(95%CI:0.662~0.0.931).It showed that there was a strong consistency between electromyography or ultrasonography and intraoperative exploration.(3)The initial Motor nerve conduction velocity(MCV)and Sensory nerve conduction velocity(SCV)of patients with good prognosis were(50.05±4.76)m/s and(51.07±5.21)m/s,which were significantly higher than those with acceptable prognosis.The SCV of patients with good prognosis was(43.28±3.06)m/s,which was significantly higher than those with acceptable prognosis.Conclusions Needle electromyography combined with nerve conduction detection can be in consistent with intraoperative exploration gold standard on the diagnosis of hourglass-like stenosis of radial nerve,and the results of nerve conduction velocity test can indicate the prognosi

关 键 词：针极肌电图 神经传导速度检测 桡神经 沙漏样狭窄 神经传导速度 

分 类 号：R74[医药卫生—神经病学与精神病学]