首頁 > 期刊首頁 > 中國臨床康復 > 2004年25期 > 小兒坐骨神經注射性麻痹的肌電圖觀察
小兒坐骨神經注射性麻痹的肌電圖觀察
Electromyography observation of sciatic nerve paralysis caused by injection in children
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- 摘要：
- 背景:肌電圖檢測是確診注射性坐骨神經損傷重要方法之一,但其早期異常表現,異常程度與病程的相關性及各項指標的差異比較尚缺乏深入研究.目的:探討注射性坐骨神經損傷的電生理特點.設計:以診斷為依據臨床觀察分析.地點和對象:104例南京醫科大學附屬腦科醫院門診確診患兒,年齡4個月～14歲,病前均有明確臀部肌肉注射史,既往無其他神經肌肉疾病.干預:應用丹迪Neuromatic 2000 M型肌電儀檢測患兒的患肢肌電圖.主要觀察指標:檢測患兒的患肢腓總神經和脛神經/脛后神經的感覺傳導速度(sensory conduction velocity,SCV)、運動傳導速度(motor conduction velocity,MCV)、末端運動潛伏期(distal motor latency,dML)和末端復合肌肉動作電位波幅(distal compound muscle action potential amplitude,dCMAPA)、感覺神經動作電位波幅(sensory nerve action potential ampli-tude,SNAPA);同時檢測坐骨神經支配肌的針極肌電圖.結果:肌注后2～7 d已可檢出多項電生理異常.腓總神經支的神經傳導速度(nerve conduction velocity,NCV)異常率(68.0%)明顯高于脛神經支(43.5%)(x2=12.199,P＜0.005).腓總神經SCV,SNAPA和dML,dCMAPA異常程度與病程正相關(r=0.306 8,P＜0.005;r=0.296 3,P＜0.005;r=0.337 6,P＜0.001;r=0.215 7,P＜0.05).8個月以上病程患兒的SCV, SNAPA和dML異常程度明顯增加(F=3.105,P＜0.05;F=4.095,P＜0.01;F=5.904,P＜0.01),較8個月內有顯著差異.腓總神經NCV各項配對t檢驗發現運動纖維dML和dCMAPA異常程度重于感覺纖維SCV和SNAPA(t=2.070,P＜0.05;t=3.520,P＜0.001).結論:化學藥物對神經髓鞘傳導功能有直接損傷.坐骨神經運動纖維的電生理異常早于且重于感覺纖維.腓總神經運動傳導功能檢測是本病早期診斷的重要依據.8個月以上病程的損傷神經恢復難度增加.
- Abstract：
- BACKGROUND: Electromyography(EMG)is one of the important methods in the diagnosis of sciatic nerve injury caused by injection. However, there is still lacking of deep researches in its early abnormal representation, the correlation between abnormity, the course of the disease, and the comparisons of the differences among each index.OBJECTIVE: To discuss the electrophysiological characters of sciatic nerve injury caused by injection.DESIGN: A clinical observatory analysis based on diagnosis.SETTINGS and PARTICIPANTS: A total of 104 children patients aged from 4 months to 14 years old with a confirmed gluteal muscle injection history but without other neuromuscular disease histories before their admissions into outpatient department of Affiliated Brain Hospital of Nanjing Medical University were selected in our study.INTERVENTION: EMG of the injured limb of the patients was recorded by Neuromatic 2000M instrument.MAIN OUTCOME MEASURES: The sensory conduction velocity (SCV),motor conduction velocity(MCV), distal motor latency (dML), distal compound muscle action potential amplitude (dCMAPA)and sensory nerve action potential amplitude(SNAPA) of common peroneal nerve and tibial nerve/posterior tibial nerve in the injured limb of the patients were observed, and the EMG of sciatic nerve dominating muscles was observed simultaneously.RESULTS: Many electrophysiological abnormities could be detected at 2 to 7 days after muscle injection. The abnormal rate of nerve conduction velocity (NCV)of common peroneal nerve branches was 68.0%, which was significantly higher than that 43.5% of tihial nerve branches (x2 = 12. 199, P ＜ 0. 005) .The abnormal degrees of SCV, SNAPA and dML, dCMAPA of common peroneal nerve positively correlated with the stage of the disease( r = 0. 306 8,P ＜0.005;r=0.2963, P ＜0.005;r=0.3376, P ＜0.001;r=0.2157,P ＜ 0. 05). The abnormal degrees of SCV, SNAPA and dML in patients with a course of disease more than 8 months were significantly increased compared with that of within 8 months( F = 3. 105, P ＜0.05; F=4.095, P ＜0.01;F=5. 904, P ＜0. 01) . The paired t test of each NCV of common peroneal nerve found that the abnormal degrees of dML and dCMAPA were severer than SCV and SNAPA( t = 2. 070, P ＜ 0. 05; t = 3. 520, P ＜ 0. 001).CONCLUSION: Chemical medicine direct injures the conduction function of neural myelin. The electrophysiological abuormity in motor fiber of sciatic nerve is earlier and more severe than sensory fiber. The detection of motor conduction of common peroneal nerve is an important gist in the early diagnosis of this disease. The difficulties in neural rehabilitation increase in the patients with more than 8-month of the eourses of disease.
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