脑卒中后反射性交感神经营养不良的针极肌电研究

Mechanism of post-stroke reflex sympathetic dystrophy:study with needle electromyography

目的探讨脑卒中后反射性交感神经营养不良发生机制及其临床意义。方法采用临床对照研究,观察脑卒中后反射性交感神经营养不良患者针极肌电图的表现。选取50例脑卒中患者行双侧正中神经传导速度测定及双侧拇短展肌、小指展肌肌电图检查,其中30例为临床确诊脑卒中后反射性交感神经营养不良患者,另外20例非反射性交感神经营养不良脑卒中患者作为对照组。对各波波幅、潜伏期及自发肌电活动评分进行统计学分析。结果与非反射性交感神经营养不良组比较,反射性交感神经营养不良组患侧上肢运动神经复合动作电位波幅明显降低(非 RSD 组为13.2mV±4.6 mV;RSD 组8.6 mV±2.9 mV);患侧拇短展肌、小指展肌自发电位发生率(RSD 组为100%;非 RSD 组为65%)及自发电位数量明显增高,两组间差异均有统计学意义(P<0.05)。而患侧上肢运动传导速度及感觉神经电生理检查无明显异常。结论脑卒中后反射性交感神经营养不良患者患侧上肢远端运动神经纤维存在部分轴突变性,原因可能与中枢损伤后继发的周围神经损伤有关。

Objective To explore the mechanism of post-stroke reflex sympathetic dystrophy （RSD） patients electromyographic abnormity and confirm its clinical value. Methods Fifty patients with first-onset stroke, aged 33-78, including 30 with RSD and 20 without RSD, underwent needle electromyography （EMG） to test the nerve conduction velocity （NCV） and sensory nerve conduction velocity （SCV） of bilateral median nerves, and the number and position of spontaneous EMG activity of bilateral short abductor muscles of thumb and abductor muscles little finger. Results The median nerve obmpound muscle action potential （CMAP） amplitude of the affected upper extremities of the RSD group was 8.6 mV ± 2.9 mV, significantly lower than that of the non-RSD group （ 13. 2 mV ± 4. 6 mV, P 〈 0.01 ）. The incidence of spontaneous electrical potential of the RSD group was 100% ; significantly higher than hat of the non - RSD group （ 65% , P 〈 0. 001 ）. The quantity of spontaneous EMG activity on the short abductor muscles of thumb and abductor muscles little finger was increased in the RSD group（ P 〈0.01 ）. The motor nerve conduction velocity and electrophysiological presentation of sensory nerve of these 2 groups were all normal and without significant differences between them. Conclusion Partial axonal degeneration occurs on the distal motor never fibers of the affected upper extremity of the RSD patients, which may be related to subsequent peripheral nerve injury after central nerve system impairment.