Machetanz J, Röricht S, Gress S, Schaff J, Bischoff C
Department of Neurology, University of Greifswald, Greifswald, Germany.
Arch Phys Med Rehabil. 2001 Mar;82(3):353-9. doi: 10.1053/apmr.2001.19741.
To compare clinical, electrophysiologic, and computed tomography (CT) imaging correlates of reinnervation in replanted limbs.
Patients were assessed between 8 and 194 months after replantation of completely severed hands.
University hospital, departments for neurology and for plastic and reconstructive surgery.
Thirteen patients, 10 with total and 3 with subtotal type V amputation, whose hands had been reattached.
Clinical assessment of function of hand and finger muscles; electromyographic tests of sensory nerve action potentials (SNAPs) of median, ulnar, and radial nerves; and compound motor action potentials (CMAPs) of abductor pollicis brevis, first dorsal interosseus, and abductor digiti minimi muscles. CT assessment of motor unit action potentials. Measurements of both replanted and normal hands.
Medical Research Council scale of force; sensory functions of anatomic areas of nerves; SNAP and CMAP amplitudes; CT area, mean absorption, standard deviation (SD) from mean absorption, and root mean square SD of absorption.
Correlates of reinnervation were evidenced by all methods, except by surface recordings of SNAPs, which could not be elicited even in hands with good sensory function. CMAP amplitudes were the electrophysiologic parameter that correlated best with the clinical restoration. Of the CT measures, the cross-sectional area was the most useful parameter for the detection of denervation, but no CT parameter was sufficiently sensitive to detect reinnervation. In cases with good functional recovery, CMAP amplitudes were superior to clinical rating in showing incomplete reinnervation.
The combination of clinical and electrophysiologic methods supplied sufficient data for a reliable evaluation of reinnervation. Usually, CT parameters did not add useful information.
比较再植肢体中神经再支配的临床、电生理及计算机断层扫描（CT）影像学相关指标。
对完全离断手再植术后8至194个月的患者进行评估。
大学医院的神经科以及整形与重建外科。
13例患者，其中10例为Ⅴ型完全离断，3例为Ⅴ型不完全离断，其手部均已再植。
对手部和手指肌肉功能进行临床评估；对正中神经、尺神经和桡神经的感觉神经动作电位（SNAP）进行肌电图测试；对拇短展肌、第一背侧骨间肌和小指展肌进行复合运动动作电位（CMAP）测试。对运动单位动作电位进行CT评估。对再植手和正常手均进行测量。
医学研究委员会肌力分级；神经解剖区域的感觉功能；SNAP和CMAP波幅；CT面积、平均吸收值、平均吸收值标准差（SD）以及吸收值的均方根标准差。
除SNAP的表面记录外，所有方法均证实了神经再支配的相关性，即使在感觉功能良好的手部也无法引出SNAP的表面记录。CMAP波幅是与临床恢复相关性最佳的电生理参数。在CT测量指标中，横截面积是检测失神经支配最有用的参数，但没有CT参数对检测神经再支配足够敏感。在功能恢复良好的病例中，CMAP波幅在显示不完全神经再支配方面优于临床评级。
临床和电生理方法的结合为可靠评估神经再支配提供了充分的数据。通常，CT参数并未提供有用信息。
