腕管综合征:比较在鱼际区记录的尺神经和正中神经刺激下的复合肌肉动作电位。

Carpal tunnel syndrome: comparison of the compound muscle action potentials recorded at the thenar region from ulnar and median nerve stimulation.

作者信息

Wee A S

机构信息

Electromyography Laboratory, Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.

出版信息

Electromyogr Clin Neurophysiol. 2006 Mar-Apr;46(2):123-6.

DOI:
Abstract

Thenar muscles are primarily innervated by the median nerve. However, compound muscle action potentials (CMAPs) evoked by ulnar nerve stimulation can be recorded at the thenar region due to proximity of some ulnar-innervated muscles, and from volume conduction events. This study was to determine if loss of thenar muscle mass from carpal tunnel syndrome (CTS) could alter the size of ulnar CMAPs obtained at the thenar region, because of changes in the physical surroundings and electrical conductivity. Supramaximal CMAPs were recorded over the thenar eminence to electrical stimulation of the ulnar nerve at the wrist and median nerve at the palm in 102 hands with CTS. Needle EMG was done in the thenar muscles. Severity of needle EMG abnormality was negatively correlated with median-evoked CMAP amplitude (r = -0.76), but not with ulnar-evoked CMAP amplitude (r = -0.12). There was no correlation between the absolute amplitudes of the median and ulnar CMAPs (r = -0.13). Needle EMG abnormality had modest negative correlation (r = -0.43) with median/ulnar CMAP amplitude ratio. Mean median/ulnar CMAP amplitude ratios for normal EMG and for mild, moderate, and severe needle EMG abnormalities were 3.72, 3.31, 1.56, and 0.37, respectively. The absolute amplitude of the ulnar CMAP recorded at the thenar area does not seem to be influenced significantly by the degree of thenar muscle loss (atrophy) from median nerve pathology. However, if the median/ulnar CMAP amplitude ratio falls below 0.5, the study suggests severe loss of motor units in the thenar muscles.

摘要

鱼际肌主要由正中神经支配。然而,由于一些尺神经支配的肌肉位置靠近以及容积传导事件,在尺神经刺激时诱发的复合肌肉动作电位(CMAPs)可在鱼际区域记录到。本研究旨在确定腕管综合征(CTS)导致的鱼际肌质量丢失是否会因物理环境和电导率的变化而改变在鱼际区域获得的尺神经CMAPs的大小。对102例患有CTS的手,在腕部对尺神经以及在手掌对正中神经进行电刺激时,在鱼际隆起处记录超强CMAPs。对鱼际肌进行针极肌电图检查。针极肌电图异常的严重程度与正中神经诱发的CMAP波幅呈负相关(r = -0.76),但与尺神经诱发的CMAP波幅无关(r = -0.12)。正中神经和尺神经CMAPs的绝对波幅之间无相关性(r = -0.13)。针极肌电图异常与正中神经/尺神经CMAP波幅比值呈中度负相关(r = -0.43)。正常肌电图以及轻度、中度和重度针极肌电图异常的平均正中神经/尺神经CMAP波幅比值分别为3.72、3.31、1.56和0.37。在鱼际区域记录到的尺神经CMAP的绝对波幅似乎不受正中神经病变导致的鱼际肌丢失(萎缩)程度的显著影响。然而,该研究表明,如果正中神经/尺神经CMAP波幅比值低于0.5,则提示鱼际肌运动单位严重丢失。

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