体感诱发电位技术在电击伤后神经损伤检测中的运用(英文)

Application of somatosensory evoked potential technique in the examination of electricity-injury nerve

背景:电击伤后,确定神经损伤和移植神经吻合的部位,是神经功能恢复的关键所在。临床上常把在手术显微镜下看到神经正常轴索作为神经正常之起始。但术后效果常表明此方法不可靠。目的:评估体感诱发电位技术在电击伤后神经损伤检测中的运用价值。设计:病例回顾性分析。单位:上海交通大学医学院附属第九人民医院整形外科。对象:选择上海第九人民医院整形外科收治的12例腕部严重电击伤患者。其中男9例,女3例;年龄为6～54岁。方法:对受损神经连续测定体感诱发电位值,并相应作病理切片观察。以体感诱发电位选择平面行神经移植病例的功能恢复情况进行随访、比较。主要观察指标:受损神经体感诱发电位的波幅、潜伏期,相应的病理切片情况以及体感诱发电位选择平面行神经移植病例的功能恢复情况。结果:12例全部进入结果分析。①波幅、潜伏期与神经干质量呈正相关,病理检查支持这一结果。②12例通过体感诱发电位确定神经移植的吻合部位,8例术后得到随访,随访时间17～26个月,平均22.7个月。其中5例术后两点辨别觉达到Ⅱ或Ⅲ级(美国手外科协会标准,二点辨别距<6mm为Ⅰ级,6～10mm为Ⅱ级,11～15mm为Ⅲ级,>15mm为Ⅳ级)。结论:电击伤后神经损伤的病理改变复杂,体感诱发电位技术能有效地评估和选择神经移植的吻合部位。

BACKGROUND： How to determine the proximal section of electricity-injury nerve which is available for nerve grafting, is key point to the functional recovery. The method used before is to observe if there is normal axonal structure under operating microscope. But the clinical result proves unsatisfactory. OBJECTIVE： To evaluate the appliance value of somatosensory evoked potential （SEP） technique in the detection of nerve injury after electrical injury. DESIGN： Retrospective analysis based on the cases. SETTING： Department of Plastic Surgery, Ninth People＇s Hospital Affiliated to Shanghai Jiaotong University. PARTICIPANTS： Totally 12 patients with severe electrical injury who received treatment in the Department of Plastic Surgery, Shanghai Ninth People＇s Hospital were included in this study. Among them, there were 9 male and 3 female, aged from 6 to 54 years. METHODS： SEP of injured nerve was measured progressively and pathological Section observation was given correspondingly. The function recovery of patients receiving nerve transplantation by using SEP was evaluated and compared with that before treatment through a follow-up. MAIN OUTCOME MEASURES： Amplitude, latency and corresponding pathological section of SEP of injured nerve as well as the functional recovery of the SEP plane of the cases with patients receiving nerve transplantation by using SEP to choose transplanted plane. RESULTS： All the 12 cases entered the stage of result analysis. ①Amplitude and latency of .SEP was positively correlative with the quality of nerve, which was supported by pathological observation ②Twelve eases were repaired with SEP technique to select the anastomosis site for nerve transplantation and 8 cases were followed up after operation. The average follow-up time was 22.7 months ranging from 17 to 26 months. And 2- point resolution sense reaches grade Ⅱor Ⅲ in 5 cases.（America hand surgery association criterion： 2-point resolution distance 〈 6 mm was grade Ⅰ ,6-10 mm was grade Ⅱ ,11-15 nun was grade Ⅲ ,〉 15 mm was grade Ⅳ）. CONCLUSION： Electricity-injured nerve owns complicated pathology. SEP technique is a valuable method for function evaluating or selecting of the anastomsis site for nerve grafting in those cases.