Swiss Paraplegic Center, Nottwil, Switzerland.
Institute of Clinical Sciences, Department of Orthopedics at the University of Gothenburg, Gothenburg, Sweden.
J Neurotrauma. 2020 Feb 1;37(3):441-447. doi: 10.1089/neu.2019.6444. Epub 2019 Aug 1.
The differentiation between an upper motoneuron (UMN) lesion and lower motoneuron (LMN) lesion of forearm muscles in patients with tetraplegia is critical for the choice of treatment strategy. Specifically, the M. pronator teres (PT), M. flexor digitorum profundus III (FDPIII), and M. flexor pollicis longus (FPL) were studied since they represent key targets in nerve transfer surgery to restore grasp function. Forearm muscles of 24 patients with tetraplegia were tested bilaterally with electrical stimulation (ES) to determine whether UMN or LMN lesion was present. For detecting and testing the nerve stimulation points, a standardized mapping was developed and clinically applied. The relationship between the anatomical segmental spinal innervation and the innervation pattern tested by ES was determined. The data of 44 arms were analyzed. For PT, 19 arms showed an intact UMN, 18 arms an UMN lesion, and seven arms partial denervation. For FDPIII, three arms demonstrated an intact UMN, 26 arms an UMN lesion, 10 arms partial denervation, and five arms denervation. For FPL, two arms presented an intact UMN, 16 arms an UMN lesion, 12 arms partial denervation, and 14 arms denervation. A total of 20.1% ES tested muscles were partially denervated. In four patients, only one arm could be tested because of surgery-related limitations. According to the level of lesion and the segmental spinal innervation, most denervated muscles were present in the patient group C6 to C8. The ES, together with the developed mapping system, is reliable and can be recommended for standardized testing in surgery and rehabilitation. It offers the possibility to detect if and to what extent UMN and LMN lesions are present for the target muscles. It allows for refined pre-operative diagnostics and prognostics in spinal cord injury neurotization surgery.
四肢瘫痪患者前臂肌肉的上运动神经元（UMN）损伤与下运动神经元（LMN）损伤的鉴别对于治疗策略的选择至关重要。具体来说，研究了 M. 旋前圆肌（PT）、M. 指深屈肌 III（FDPIII）和 M. 拇长屈肌（FPL），因为它们是神经转移手术恢复抓握功能的关键靶标。对 24 例四肢瘫痪患者的双侧前臂肌肉进行了电刺激（ES）测试，以确定是否存在 UMN 或 LMN 损伤。为了检测和测试神经刺激点，开发并临床应用了标准化图谱。确定了解剖节段性脊髓神经支配与 ES 测试神经支配模式之间的关系。分析了 44 只手臂的数据。对于 PT，19 只手臂显示 UMN 完整，18 只手臂 UMN 损伤，7 只手臂部分去神经支配。对于 FDPIII，3 只手臂显示 UMN 完整，26 只手臂 UMN 损伤，10 只手臂部分去神经支配，5 只手臂去神经支配。对于 FPL，2 只手臂显示 UMN 完整，16 只手臂 UMN 损伤，12 只手臂部分去神经支配，14 只手臂去神经支配。共有 20.1%的 ES 测试肌肉部分去神经支配。由于手术相关的限制，有 4 名患者只能测试一只手臂。根据损伤水平和节段性脊髓神经支配，大多数去神经支配的肌肉存在于 C6 至 C8 患者组中。ES 与开发的图谱系统相结合是可靠的，可推荐用于手术和康复中的标准化测试。它提供了检测目标肌肉 UMN 和 LMN 损伤是否存在以及存在程度的可能性。它允许对脊髓损伤神经化手术进行更精细的术前诊断和预后。
