CAJ | 학술논문

目的分析臂丛颈5～7神经根性撕脱伤后相应皮区感觉神经动作电位(sensory nerve action potential,SNAP)、体感诱发电位(somatosensory evoked potential,SEP)的神经电生理表现及其临床意义.方法随机选择20例经手术探查证实为臂丛颈5～7神经根撕脱的患者,回顾性统计分析术前神经电生理检测所得颈5(三角肌皮区)、颈6(拇指及前臂背外侧、桡骨上至虎口区)、颈7(示指)皮区SNAP和SEP的指标.结果 20例臂丛颈5皮区SNAP均未引出.臂丛颈5.6皮区SNAP、SEP检测结果显示:SNAP、SEP均未引出各3例;臂丛颈6皮区SNAP、SEP均可引出10例,其SEP潜伏期较健侧延长14.3%,波幅较健侧降低54.4%.臂丛颈7皮区SNAP、SEP均可引出8例,其SEP潜伏期较健侧延长13.1%,波幅较健侧降低51.8%;臂丛颈6皮区SNAP可引出,SEP未引出7例.臂丛颈7皮区9例.结论三角肌皮区的SNAP未引出可定性为臂丛颈5神经根性完全损伤,需综合其他神经根性损伤证据共同判别颈5神经根性撕脱与否.SNAP、SEP均未引出提示神经损伤均较为严重,可伴有神经节的损毁或臂丛神经多平面损伤.臂丛颈6、7皮区SNAP、SEP均可引出的患者中,SEP潜伏期较对侧延长大于15%或波幅下降大于55%可作为判别神经根节前损伤的佐证.只有不到50%的患者出现SNAP可引出、SEP未引出的典型电生理表现.对臂丛颈6神经根,拇指或前臂背外侧、桡骨上至虎口区中任有一项表现为SNAP可引出、SEP未引出,即有判断神经撕脱的指征.
목적 분석비총경5～7신경근성시탈상후상응피구감각신경동작전위(sensory nerve action potential,SNAP)、체감유발전위(somatosensory evoked potential,SEP)적신경전생리표현급기림상의의.방법 수궤선택20례경수술탐사증실위비총경5～7신경근시탈적환자,회고성통계분석술전신경전생리검측소득경5(삼각기피구)、경6(무지급전비배외측、뇨골상지호구구)、경7(시지)피구SNAP화SEP적지표.결과 20례비총경5피구SNAP균미인출.비총경5.6피구SNAP、SEP검측결과 현시:SNAP、SEP균미인출각3례;비총경6피구SNAP、SEP균가인출10례,기SEP잠복기교건측연장14.3%,파폭교건측강저54.4%.비총경7피구SNAP、SEP균가인출8례,기SEP잠복기교건측연장13.1%,파폭교건측강저51.8%;비총경6피구SNAP가인출,SEP미인출7례.비총경7피구9례.결론 삼각기피구적SNAP미인출가정성위비총경5신경근성완전손상,수종합기타신경근성손상증거공동판별경5신경근성시탈여부.SNAP、SEP균미인출제시신경손상균교위엄중,가반유신경절적손훼혹비총신경다평면손상.비총경6、7피구SNAP、SEP균가인출적환자중,SEP잠복기교대측연장대우15%혹파폭하강대우55%가작위판별신경근절전손상적좌증.지유불도50%적환자출현SNAP가인출、SEP미인출적전형전생리표현.대비총경6신경근,무지혹전비배외측、뇨골상지호구구중임유일항표현위SNAP가인출、SEP미인출,즉유판단신경시탈적지정.
Objective To analyze the dectrophysiological features and clinical value of SNAP(sensory nerve action potential)and SSEP(somatosensory evoked potential)in C5,C6 and C7 dermatomes after brachial plexus C5-7 avulsion.Methods Twenty randomly selected,surgically confirmed cases of C5-7 root avulsions were reviewed retrospectivdy for pre-operative SNAP and SSEP values of C5(deltoid region),C6(thumb,dorsolateral forearm,first web space and C7(index finger)dermatomes. Results In C5 dermatomic area,no SNAP could be detected in all 20 cases.In C5 and C6 dermatomic areas neither SNAP nor SSEP could be detected in 3 cases.In C6 dermatomic area,both SNAP and SSEP could be detected in 10 cases.Comparing to the uninjured side,SSEP latency prolonged 14.3%and SSEP amplitude decreased 54.4%.In C7 dermatomic area,both SNAP and SSEP could be detected in 8 cases.SSEP latency prolonged 13.1%and SSEP amplitude decreased 51.8%.There were 7 cases in which SNAP was detectable and SSEP was not detectable in C6 dermatome,and 9 cases in which SNAP was detectable and SSEP was not detectable in C7 dermatome.Conclusion No detection of SNAP in the deltoid dermatomic area indicates complete C5 root injury.Determination of C5 root avulsion needs other evidences.No detection of SNAP and SSEP indicates severe nerve root injury,which is accompanied by ganglion daimage or multiplanar brachial plexus injury.If both SNAP and SSEP can be detected in C6,C7 dermatomes,a 15% or over prolongation of SSEP latency or a 55%or more reduction of SSEP amplitude can be useful evidences to diagnosis of preganglionic injury.Less than half of the cases had typical electrophysidogical features of detectable SNAP and undetectable SSEP.C6 nerve root avulsion can be determined if SNAP is detectable while SSEP is undetectable in any of the following areas,thumb,dorsolateral forearm,or fast web space.