儿童及青少年尺神经病变的电生理特征

Electrophysiologic features of ulnar neuropathy in childhood and adolescence.

作者信息

Karakis Ioannis, Liew Wendy, Fournier Heather Szelag, Jones H Royden, Darras Basil T, Kang Peter B

机构信息

Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurology, Lahey Clinic, Burlington, MA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.

Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurology, KK Women's & Children's Hospital, Singapore.

出版信息

Clin Neurophysiol. 2017 May;128(5):751-755. doi: 10.1016/j.clinph.2017.01.024. Epub 2017 Feb 20.

DOI:10.1016/j.clinph.2017.01.024

PMID:28319875

Abstract

OBJECTIVE

To analyze patterns of nerve injury in pediatric ulnar neuropathy (PUN).

METHODS

Retrospective analysis of 49 children with PUN.

RESULTS

Sensory loss in digit V was the prevailing complaint (89%). Predominant localization was at the elbow (55%). Diminished ulnar SNAP was the most common abnormality (71%) with median axon loss estimate (MAXE) of 62%. Dorsal ulnar cutaneous (DUC) sensory nerve action potential (SNAP) was reduced in 55% with MAXE of 43%. Abductor digiti minimi (ADM) and first dorsal interosseous (FDI) compound muscle action potential (CMAP) were reduced half of the time, with MAXE of 30% and 28% respectively. There was high correlation between ulnar sensory MAXE and ADM MAXE (r=0.76, p<0.0001), FDI MAXE (r=0.81, p<0.0001) and DUC MAXE (r=0.60, p=0.0048). Neurogenic changes were seen in the ADM, FDI, flexor carpi ulnaris (FCU) and flexor digitorum profundus IV (FDP IV) in 79%, 77%, 25% and 35% respectively. Pathophysiology was demyelinating in 27%, axonal in 59% and mixed in 14%.

CONCLUSIONS

In proximal axonal lesions, sensory fibers to digit V and motor fibers to distal muscles are predominantly affected, whereas in demyelinating lesions, slowing occurs twice as frequently as conduction block.

SIGNIFICANCE

There is frequent axonal and fascicular injury in PUN.

摘要

目的

分析小儿尺神经病变（PUN）的神经损伤模式。

方法

对49例小儿尺神经病变患儿进行回顾性分析。

结果

第五指感觉丧失是最常见的主诉（89%）。主要病变部位在肘部（55%）。尺神经感觉神经动作电位（SNAP）降低是最常见的异常（71%），轴突损失估计中位数（MAXE）为62%。55%的患儿尺背侧皮神经（DUC）感觉神经动作电位降低，MAXE为43%。小指展肌（ADM）和第一背侧骨间肌（FDI）复合肌肉动作电位（CMAP）有一半时间降低，MAXE分别为30%和28%。尺神经感觉MAXE与ADM MAXE（r = 0.76，p < 0.0001）、FDI MAXE（r = 0.81，p < 0.0001）和DUC MAXE（r = 0.60，p = 0.0048）之间存在高度相关性。分别有79%、77%、25%和35%的患儿在ADM、FDI、尺侧腕屈肌（FCU）和第四指深屈肌（FDP IV）中出现神经源性改变。病理生理学表现为脱髓鞘型占27%，轴索性占59%，混合型占14%。