Xu Yingsheng, Chen Junyi, Zhang Shuo, Fan Dongsheng
Department of Neurology, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Peking University Third Hospital, Beijing, China.
Front Neurol. 2021 Feb 15;12:610786. doi: 10.3389/fneur.2021.610786. eCollection 2021.
We investigated upper motor neuron (UMN) signs in the cervical region in a Chinese clinic-based cohort of patients with flail arm syndrome (FAS) by clinical examination and neurophysiological tests such as triple stimulation technique (TST) and pectoralis tendon reflex testing. A total of 130 consecutive FAS patients from Peking University Third Hospital underwent physical examination and neurophysiological tests at baseline and 3 months, 6 months, 9 months, and 12 months later. Pyramidal signs, pectoralis tendon reflex and TST results were evaluated to estimate the function of cervical spinal UMNs. At the first visit, weakness of the bilateral proximal upper limbs was found in 99 patients, while weakness of a single proximal upper limb was found in 31 patients. There were 49 patients with tendon hyperreflexia, 42 patients with tendon hyporeflexia and 39 patients with tendon areflexia. All except 4 of the patients had brisk pectoralis tendon reflex. The UMN score of the cervical region was 1.7 ± 0.4, and the lower motor neuron score of that region was 3.5 ± 0.3. The TST/TST amplitude ratio was 65.7 ± 7.5%. The latency of quantitative detection of the pectoralis tendon reflex was 7.7 ± 1.2 ms. In the follow-up study, the UMN score and the TST/TST amplitude ratio decreased, while the lower motor neuron score increased, and the latency of quantitative detection of the pectoralis tendon reflex remained steady. Although the signs of cervical spinal UMN dysfunction in patients with FAS were often concealed by muscle atrophy in the progression of the disease, TST and pectoralis tendon reflex could reveal it.
我们通过临床检查以及三刺激技术（TST）和胸肌腱反射测试等神经生理学测试，对中国一组以临床为基础的连枷臂综合征（FAS）患者的颈部上运动神经元（UMN）体征进行了研究。北京大学第三医院共有130例连续的FAS患者在基线时以及3个月、6个月、9个月和12个月后接受了体格检查和神经生理学测试。评估锥体束征、胸肌腱反射和TST结果以估计颈段脊髓UMN的功能。首次就诊时，99例患者发现双侧近端上肢无力，31例患者发现单侧近端上肢无力。49例患者腱反射亢进，42例患者腱反射减弱，39例患者腱反射消失。除4例患者外，所有患者胸肌腱反射均亢进。颈部UMN评分为1.7±0.4，该区域的下运动神经元评分为3.5±0.3。TST/TST波幅比值为65.7±7.5%。胸肌腱反射定量检测的潜伏期为7.7±1.2毫秒。在随访研究中，UMN评分和TST/TST波幅比值下降，而下运动神经元评分增加，胸肌腱反射定量检测的潜伏期保持稳定。尽管FAS患者颈段脊髓UMN功能障碍的体征在疾病进展过程中常被肌肉萎缩掩盖，但TST和胸肌腱反射可以揭示这一点。
