CAJ | 학술논문

目的探讨平山病、肌萎缩性侧索硬化及远侧型肌萎缩型颈椎病的上肢神经电生理特点.方法回顾性分析87例平山病患者、83例肌萎缩性侧索硬化患者和28例远侧型肌萎缩型颈椎病患者的上肢神经电生理检测资料.其中87例平山病患者中,72例单侧上肢、15例双侧上肢出现肌肉萎缩；83例肌萎缩性侧索硬化患者中,30例单侧上肢、53例双侧上肢出现肌肉萎缩；28例远侧型肌萎缩型颈椎病患者中,20例单侧上肢、8例双侧上肢出现肌肉萎缩.结果平山病患者患肢尺神经刺激的复合肌肉动作电位(compound muscle action potential,CMAP)波幅明显低于正中神经刺激的CMAP波幅,肌萎缩性侧索硬化患者患肢正中神经CMAP波幅明显低于尺神经CMAP波幅,远侧型肌萎缩型颈椎病患者正中神经和尺神经CMAP波幅降低程度相同.平山病患者的平均尺神经/正中神经(U/M)CMAP比为0.58±0.40,肌萎缩性侧索硬化为2.28±1.25,远侧型肌萎缩型颈椎病为1.31 ±0.63,三者比较差异有统计学意义.在U/M CMAP比值＜0.6的患肢中,平山病有62例,肌萎缩性侧索硬化和远侧型肌萎缩型颈椎病分别只有3例和1例；在U/M CMAP比值＞1.7的患肢中,肌萎缩性侧索硬化有57例,平山病有12例,远侧型肌萎缩型颈椎病有4例.所有患者双侧的运动神经和感觉神经传导速度、感觉神经动作电位波幅均正常,健肢的CMAP波幅均正常.结论平山病患者小鱼际肌肉萎缩程度重于大鱼际肌,肌萎缩性侧索硬化患者与之相反,而远侧型肌萎缩型颈椎病患者大、小鱼际肌肉萎缩程度相似.
목적 탐토평산병、기위축성측색경화급원측형기위축형경추병적상지신경전생리특점.방법 회고성분석87례평산병환자、83례기위축성측색경화환자화28례원측형기위축형경추병환자적상지신경전생리검측자료.기중87례평산병환자중,72례단측상지、15례쌍측상지출현기육위축；83례기위축성측색경화환자중,30례단측상지、53례쌍측상지출현기육위축；28례원측형기위축형경추병환자중,20례단측상지、8례쌍측상지출현기육위축.결과 평산병환자환지척신경자격적복합기육동작전위(compound muscle action potential,CMAP)파폭명현저우정중신경자격적CMAP파폭,기위축성측색경화환자환지정중신경CMAP파폭명현저우척신경CMAP파폭,원측형기위축형경추병환자정중신경화척신경CMAP파폭강저정도상동.평산병환자적평균척신경/정중신경(U/M)CMAP비위0.58±0.40,기위축성측색경화위2.28±1.25,원측형기위축형경추병위1.31 ±0.63,삼자비교차이유통계학의의.재U/M CMAP비치＜0.6적환지중,평산병유62례,기위축성측색경화화원측형기위축형경추병분별지유3례화1례；재U/M CMAP비치＞1.7적환지중,기위축성측색경화유57례,평산병유12례,원측형기위축형경추병유4례.소유환자쌍측적운동신경화감각신경전도속도、감각신경동작전위파폭균정상,건지적CMAP파폭균정상.결론 평산병환자소어제기육위축정도중우대어제기,기위축성측색경화환자여지상반,이원측형기위축형경추병환자대、소어제기육위축정도상사.
Objective To explore the electrophysiological charaterstics of upper extremities nerves on the patients with Hirayama disease (HD),amyotrophic lateral sclerosis (ALS),and distal cervical spondylotic amyotrophy (DCSA).Methods The data of electrophysiological examination of the upper limbs of 87 patients with HD,83 with ALS and 28 with DCSA were reviewed retrospectively.Seventy-two patients with HD among 87 had unilateral upper limb's amyotrophy and the other 15 ones had bilateral amyotrophy.There were 30 patients had unilater upper limb's amyotrophy and 53 ones had bilateral amyotrophy from the group of patients with ALS; 20 patients with DSCA were affected unilaterally and 8 ones were bilaterally affected.Results Compound muscle action potential (CMAP) evoked by ulnar stimulation had a lower ampititude compared with that evoked by median stimulation in HD patients.In ALS cases that was just the opposite.However,the CMAPs were similar in DCSA cases.The mean ratio of CMAP amplitude by ulnar stimulation to by median stimulation was 0.58±0.40 in HD group; 2.28±1.25 in ALS and 1.31±0.63 in DCSA.The differences in the three groups were statistical significance.The U/M CMAP ratio was less than 0.6in 62 patients with HD,3 with ALS and 1 with DCSA,and more than 1.7 in 73 cases (57 ALS,12 HD and 4 DCSA).Conduction velocities (CV) of the sensory and motor nerves,the amplitude of the sensory nerve action potential in bilateral limbs,and the CMAP amplitude of the unaffected limb were normal in all cases.Conclusion This study could concluded that the severity of amyotropy in hypothenar mucles were higher than that in thenal muscles in patients with HD; there was just opposite in ALS cases and similar in DSCA.