Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
Department of Neurosciences, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
Muscle Nerve. 2023 Jun;67(6):469-473. doi: 10.1002/mus.27817. Epub 2023 Mar 26.
INTRODUCTION/AIMS: Lower limb sensory nerve action potentials are an important component of nerve conduction studies. Most testing of the sural and superficial fibular nerves involves antidromic techniques above the ankle, which result in a falsely unobtainable response in 2%-6% of healthy people. Cadaver, surgical, and more recent ultrasound series suggest this may relate to the site of fascia penetration of the nerve, and it is hypothesized that a modified technique may be more likely to produce reliable responses and reduce false-negative errors.
This article evaluates a variety of recording distances for both nerves in 100 healthy controls, including varying recording electrode positions and techniques, to provide the optimal electrodiagnostic information in healthy control subjects.
Shorter stimulation distances produce higher-amplitude responses but become confounded by increasing stimulation artifact at very short distances, with the best balance found at around 10 cm. In both sural and superficial fibular nerves, amplitude increases by approximately 10%/cm compared with the standard 14 cm distance. The Daube superficial fibular technique produced a higher amplitude than the Izzo Intermediate technique (by 22.46%, p < .001). The calculated upper limit of normal for side-to-side variation in amplitude was around 50% in the sural nerve but over 70% in the superficial fibular nerve.
It is proposed that the 10 cm recording distance for both nerves is optimal, with minimal false-negatives and a higher amplitude elicited than with existing techniques.
简介/目的：下肢感觉神经动作电位是神经传导研究的重要组成部分。大多数对腓肠神经和腓浅神经的测试都涉及到踝关节上方的逆行技术，这导致 2%-6%的健康人出现无法获得的假阴性反应。尸体、手术和最近的超声系列表明，这可能与神经筋膜穿透部位有关，并且假设改良技术可能更有可能产生可靠的反应并减少假阴性错误。
本文评估了 100 名健康对照者的两种神经的各种记录距离，包括改变记录电极的位置和技术，以在健康对照者中提供最佳的电诊断信息。
较短的刺激距离会产生更高幅度的反应，但在非常短的距离下，刺激伪影会增加，从而使结果变得复杂，最佳平衡距离约为 10cm。在腓肠神经和腓浅神经中，与标准的 14cm 距离相比，幅度增加约 10%/cm。与 Izzo 中间技术相比，Daube 腓浅神经技术产生的振幅更高（高 22.46%，p<.001）。振幅侧-侧差异的计算正常上限在腓肠神经约为 50%，但在腓浅神经中超过 70%。
建议对两条神经的 10cm 记录距离为最佳，假阴性率最低，与现有技术相比，诱发出的振幅更高。
