挠神经/骨间后神经沙漏样狭窄患者的电生理分析  

Electrophysiological analysis of the patients with hourglass-like constriction of radial nerve/posterior interosseous nerve

作　　者：许娅莉[1] 田野[1] 张栋栋 邵新中[1] Xu Yadi;Tian Ye;Zhang Dongdong;Shao Xinzhong(Department of Hand Surgery,the Third Hospital cf Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院手外科,石家庄050051

出　　处：《中华手外科杂志》2020年第1期23-26,共4页Chinese Journal of Hand Surgery

基　　金：2018年度河北省医学适用技术跟踪项目(G2018043)。

摘　　要：目的分析橈神经(radial nerve,RN)/骨间后神经(posterior interosseous nerve,PIN)沙漏样狭窄患者的电生理特点并探讨其可能的病因。方法回顾性分析我院自2011年1月至2018年11月收治的18例RN/PIN沙漏样狭窄患者的术前电生理结果,统计病变累及的范围及程度。结果18例患者电生理检测前的病程为3周至13个月,完全损伤者14例(77.8%),不全损伤者4例(22.1%)。电生理结果与术中所见符合率94.4%。除与沙漏狭窄直接相关的异常之外,88.9%的刖沙漏患者和11.1%的PIN沙漏患者合并其他神经异常。其中,8例RN沙漏患者合并患狈IJ正中神经(50%)、尺神经(50%)、肌皮神经(37.5%)、腋神经(25%)、肩胛上神经(25%)、肱三头肌肌支(75%)以及对侧.上肢(25%)、对侧膈神经(12.5%)和四肢神经(12.5%)的异常。主要表现为异常插入电位、静息自"发纤颤电位、轻收缩时限延长、用力收缩单纯相以及感觉和运动神经传导的诱发电位波幅减低,神经传导速度无明显异常。结论RN/PIN沙漏样狭窄常合并其他神经异常;沙漏病变位置越高,累及范围越广。其与周围神经卡压的电生理特征不同,可能存在神经痛性肌萎缩。Objective To analyze the electrophysiological characteristics of the patients with houi^lasslike constriction of radial nerve(RN)/posterior interosseous nerve(PIN)and explore the possible causes.Methods From January 2011 to November 2018,18 patients with hourglass-like constriction of RN/PIN were treated in our hospital.The electrophysiological results of them were analyzed retrospectively.The extent and degree of lesion involvement were evaluated.Results The course of disease was 3 weeks to 13 months before electrophysiological examination in 18 patients.14 patients(77.8%)suffered from complete injury and 4 patients(22.1%)suffered from incomplete injury.The coincidence rate between electrophysiological results and intraoperative findings was 94.4%.In addition to the abnormalities directly related to hourglass-like constriction,88.9%of RN hourglass-like constriction patients and 11.1%of PIN hourglass-like constriction patients were associated with other neurological abnormalities.Among them,8 patients with RN houi^lass-like constriction were complicated with the abnormalities of median nerve(50%),ulnar nerve(50%),musculocutaneous nerve(37.5%),axillary nerve(25%),suprascapular nerve(25%),triceps brachii branch(75%),and the nerves of contralateral upper extremity(25%),contralateral phrenic nerve(12.5%)and the nerves of four extremities(12.5%).The main manifestations were abnormal insertion potential,resting spontaneous fibrillation potential,prolongation of light contraction time limit,simple phase of forced contraction and decrease of amplitude of motor evoked potential in sensory and motor nerve conduction.There was no obvious abnormality in nerve conduction velocity.Conclusion The houi^lass-like constriction of RN/PIN is often associated with other neural abnonnalities.The higher the location of houiglass-like constriction,the wider tlie range of involvement.It is different from the electrophysiological characteristics of peripheral nerve entrapment,indicating possible presence of neuralgic amyotrophy.

关 键 词：电生理学 視神经 骨间后神经 沙漏样狭窄 

分 类 号：R6[医药卫生—外科学] R74[医药卫生—临床医学]