正中神经或尺神经损伤后手掌不同部位交感神经皮肤反应研究

Sympathetic skin response in different regions of the palm after median or ulnar nerve injury

目的 研究正中神经和尺神经绝对支配区交感神经皮肤反应（SSR）的特征及其临床意义.方法 以健康志愿者30人（正常组）、正中神经损伤患者10例（正中神经损伤组）、尺神经损伤患者10例（尺神经损伤组）以及正中神经、尺神经均损伤患者3例（正中神经尺神经损伤组）为研究对象,采用神经肌电图电刺激方法引出SSR,分别在掌心、小鱼际、示指和小指指腹记录潜伏期和波幅,并进行统计学分析.结果 正中神经完全损伤后,示指指腹SSR消失,掌心SSR波幅降低,而小指指腹SSR正常;尺神经损伤后,小指指腹SSR消失,小鱼际SSR波幅降低,而示指指腹SSR正常.正中神经和尺神经均损伤后,整个掌面均不能引出SSR.结论 掌心和小鱼际SSR受正中神经和尺神经双重影响;示指指腹和小指指腹SSR分别受正中神经和尺神经单一神经通路上的交感神经调控;示指指腹和小指指腹是检测单神经通路上交感传出功能的理想部位.

Objective To explore sympathetic skin response （SSR） in the region innervated only by the median or ulnar nerve. Methods Thirty healthy volunteers, ten patients with median nerve injury, ten patients with ulnar nerve injury and three patients with both median and ulnar nerve injury were involved in the study. SSR was elicited by electrical stimulation and the latency and amplitude of the SSR were recorded in the center of the palm and on the hypothenar, and the pulps of the index and little fingers. Results After median nerve injury the SSR of the index finger pulp disappeared, the SSR amplitude of the palmar center was reduced, while the SSR amplitude of the little finger pulp was normal. In contrast, after ulnar nerve injury the SSR of the little finger pulp disappeared,the SSR amplitude of the hypothenar was reduced, while the SSR of the index finger pulp was normal. When both nerves were injured, no SSR could be elicited anywhere on the palm. Conclusions The SSR of the palmar center and hypothenar are affected by both the median and ulnar nerves. The index and little finger pulps are sites for recording SSR which represent the SSR of the median and ulnar nerve distribution, respectively. Index and little finger pulps are ideal sites for detec t ing efferent functioning of sympathetic nerves from the median and ulnar nerve paths,respectively.