CAJ | 학술논문

目的探讨应用电生理检测肌皮神经肱肌肌支在神经根的定位,为肱肌肌支移位术的临床应用寻求理论依据.方法选择30例臂丛神经损伤行健侧C7移位的患者,年龄16～50岁,平均[(28.9±7.7)岁,-x±s,下同],术中暴露健侧正常的臂丛神经,运用意大利ESAOTE的Reposer四道程肌电诱发电位仪,分别刺激C5～T1神经根,在肱肌记录诱发电位的潜伏期及波幅.结果 30例健侧C7移位者术中电生理检测,刺激臂丛神经根时,其中C529例、C630例、C728例记录到肱肌运动电位,而刺激C8、T1仅有6例记录到较小的肱肌运动电位.C5、6、7运动电位的潜伏期和波幅分别为(6.32±1.50)ms、(6.51±1.36)ms、(6.99±1.33)ms和(4.87±4.43)mV、(5.65±4.76)mV、(0.90±2.29)mV,其中以C6的波幅最大,C5次之,C7波幅较小,提示C5、6支配肱肌的神经纤维数可能最多.结论肱肌主要接受来自C5、6神经纤维的支配,该肌支移位至正中神经(骨间前神经)是可行及有效的,同时该方法为今后临床研究周围神经的定位提供了检测手段.
목적 탐토응용전생리검측기피신경굉기기지재신경근적정위,위굉기기지이위술적림상응용심구이론의거.방법 선택30례비총신경손상행건측C7이위적환자,년령16～50세,평균[(28.9±7.7)세,-x±s,하동],술중폭로건측정상적비총신경,운용의대리ESAOTE적Reposer사도정기전유발전위의,분별자격C5～T1신경근,재굉기기록유발전위적잠복기급파폭.결과 30례건측C7이위자술중전생리검측,자격비총신경근시,기중C529례、C630례、C728례기록도굉기운동전위,이자격C8、T1부유6례기록도교소적굉기운동전위.C5、6、7운동전위적잠복기화파폭분별위(6.32±1.50)ms、(6.51±1.36)ms、(6.99±1.33)ms화(4.87±4.43)mV、(5.65±4.76)mV、(0.90±2.29)mV,기중이C6적파폭최대,C5차지,C7파폭교소,제시C5、6지배굉기적신경섬유수가능최다.결론 굉기주요접수래자C5、6신경섬유적지배,해기지이위지정중신경(골간전신경)시가행급유효적,동시해방법위금후림상연구주위신경적정위제공료검측수단.
Objective To identify the origin of brachialis branch of musculocutaneous nerve (BBMCN)at root level using intraoperative electrophysiologic testing and provide theoretical basis for BBMCN transfer. Methods Thirty patients of brachial plexus injury who underwent eontralateral C7 transfer were involved in the study.Patients'age ranged from 16 to 50 years with an average of(28.9±7.7)years.After exposure of the heMthy side brachial plexus,C5 to T1 nerve roots were stimulated respectively to record compound muscle action potential (CMAP) in the brachialis muscle using Esaote 4 channel eleetrophysiologieal devise.Onset latency and amplitude of CMAPs were measured. Results Ample CMAP was recorded in the braehialis muscle in 29 cases upon C5 stimulation,in 30 cases upon C6 stimulation and in 28 cases upon C7 stimulation.Only subtle CMAP was recorded in the brachialis muscle of 6 cases while C8 and T1 were stimulated.The amplitude and latency of CAMAP were(4.87±4.43)mV and(6.32±1.50)ms for C5,(5.65±4.76)mV and(6.51±1.36)ms for C6,and(0.90±2.29)mV and(6.99 ±1.33)ms for C7.CMAP amplitude from C5 and C6 was significantly higher than that from C7,while there was no significant difference between C5 and C6 nerve root. Conclusion Analysis of CMAP suggested that BBMCN is mainly comprised of fibers from C5 and C6 nerve roots.Transfer of this muscle branch to the median nenre (anterior interosseous nerve)is a feasible and effeetive procedure.The technique proposed here was a more direct and functional method to trace the origin of a specific nerve or of the nerve fibers innervating a given muscle.