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臂丛神经损伤的肌电图与临床随访研究(作者译)

[Electromyographical and clinical follow up study of brachial plexus lesions (author's transl)].

作者信息

Straschill M, Krapp L

出版信息

EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb. 1977 Mar;8(1):47-50.

PMID:405201
Abstract

21 cases of brachial plexus lesions were reexamined clinically and electromyographically after a posttraumatic interval of 3 to 11 years. In accordance with Brooks (1) recovery--as judged by muscle strength, sensation and amount of EMG activity during volontary action--was relatively good in upper plexus lesions, fair in middle plexus lesions and very poor in lower plexus lesions (Fig. 1 A, B). Even in cases of incomplete lower plexus lesions with small residual innervation initially, recovery was only moderate (Fig. 1 C). The tendency for reinnervation decreased with increasing distance of target muscles from the lesion site in the plexus (Fig. 2). Motor and sensory deficits in corresponding dermaresp. myotomes were either congruent or more frequently incongruent with prevalence of motor deficits (Fig. 3). Earliest electromyographical signs of reinnervation were observed after 4 to 9 months (upper and middle plexus lesion). Reinnervation of proximal muscles was completed after 11 months to 2 years (Fig. 4). Posttraumatically regenerated nerve fibers had often decreased conduction velocities (some values as low as 7 m/sec) and showed sometimes abnormal target muscles leading to paradoxical innervation and synkinesias between antagonistic muscles.

摘要

对21例臂丛神经损伤患者在创伤后3至11年进行了临床和肌电图复查。根据布鲁克斯(1)的标准,以上肢力量、感觉以及随意运动时肌电图活动量来判断恢复情况,上干型损伤恢复相对较好,中干型损伤恢复一般,下干型损伤恢复很差(图1A、B)。即使是最初残留神经支配较少的不完全下干型损伤病例,恢复也只是中等程度(图1C)。神经再支配的趋势随着靶肌肉与丛内损伤部位距离的增加而降低(图2)。相应皮节和肌节的运动和感觉障碍要么一致,要么更常见的是不一致,运动障碍更为普遍(图3)。最早在4至9个月后观察到神经再支配的肌电图迹象(上干和中干损伤)。近端肌肉的神经再支配在11个月至2年后完成(图4)。创伤后再生的神经纤维传导速度常常降低(有些值低至7米/秒),有时还会出现靶肌肉异常,导致拮抗肌之间出现反常神经支配和联带运动。

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