脑卒中后肩-手综合征急性期正中神经传导的变化

Changes of Median Nerve Conduction in Acute Stage of Should- Hand Syndrome after Stroke

目的观察脑卒中后肩-手综合征(SHS)急性期正中神经传导的变化。方法 50例脑卒中并发SHS急性期患者(SHS组)、50例脑卒中无SHS患者(N-SHS组)和50例无脑卒中无SHS者(N-S组)均行双侧正中神经传导检测(包括感觉、运动神经传导及F波)。结果 SHS组患侧正中神经感觉动作电位波幅(SNAP)、复合肌肉动作电位波幅(CMAP)与自身健侧比较均降低(P<0.05);患侧感觉传导速度(SCV)、末端运动潜伏期(DML)、F波潜伏期(FL)与健侧比较无显著性差异(P>0.05);与N-SHS组、N-S组比较,SHS组患侧正中神经SCV减慢、SNAP及CMAP减低(P<0.05);DML、FL无显著性差异(P>0.05)。结论脑卒中后SHS急性期患侧正中神经受损,以轴索为主,其损伤部位主要在远端,提示正中神经远端的轴索损伤是SHS的一项指标。

Objective To analyze the changes of nerve conduction of median nerves in acute stage of shoulder-hand syndrome （SHS） af- ter stroke. Methods 50 stroke patients with SHS in the acute stage were selected as SHS group, 50 stroke patients without SHS was selected as N-SHS group, and 50 non-stroke and without SHS patients were selected as N-S group. The detection of bilateral nerve conduction of me- dian nerve included sensory and motor nerve conduction, and F wave. Results In SHS group, the sensory nerve action potential amplitude （SNAP） and compound muscle action potential amplitude （CMAP） of median nerve of the affected hand were lower than that of the unaf- fected hand （P〈0.05）. There was no significant difference in sensory conduction velocity （SCV）, distal motor latency （DML） and F wave la- tency of the median nerve between the affected and the unaffected hand in SHS group （P〉0.05）. The SCV of median nerve was slower, the SNAP and CMAP were lower in SHS group than in N-SHS group and N-S group （P〈0.05）. There was no significant difference in DML and F wave latency among 3 groups （P〉0.05）. Conclusion The median nerve on the affected hand is impaired in acute stage of SHS after stroke. The lesion is mostly located in the distal end of median nerve, and is mainly the dystrophy of axonal neuropathy, which indicates that the le- sion in the distal segment of median nerve is an essential expression of SHS after stroke.