腕部尺神经损伤后骨间肌同步兴奋的电生理研究

Electrophysiological study of synchronous excitation of interosseous muscle after wrist ulnar nerve injury

目的分析尺神经损伤患者骨间肌同步兴奋的电生理表现。方法选取自2019年5月至2020年8月于我院就诊的腕部尺神经损伤后患者50例,分别检测第一、二、三、四背侧骨间肌及第二掌侧骨间肌复合肌肉动作电位(compound muscle action potential,CMAP),记录潜伏期及波幅,肌电图随机选取10个运动单位电位(motor unit potential,MUP),计算MUP波幅平均值,并观察募集反应,所有数据均与健侧比较,进行统计学分析。结果患侧第二、三四背侧骨间肌分指与第二掌侧骨间肌并指时,MUP波幅与健侧比较差异均有统计学意义(P<0.01);大部分患侧第二、三、四背侧骨间肌与第二掌侧骨间肌分并指时均有募集反应;患侧第一、二、三、四背侧骨间肌与第二掌侧骨间肌刺激CMAP潜伏期与健侧比较差异均有统计学意义(P<0.05),CMAP波幅与健侧比较差异无统计学意义(P>0.05)。结论腕部尺神经损伤后,掌侧骨间肌与背侧骨间肌易产生同步兴奋后遗症,导致分并指障碍,电生理检查可帮助临床诊断。

Objective To analyze the electrophysiological manifestations of synchronous excitation of interosseous muscle in patients with ulnar nerve injury.Methods Fifty patients with wrist ulnar nerve injury treated in our hospital from May 2019 to August 2020 were selected.The compound muscle action potential(CMAP)of the first,second,third and fourth dorsal interosseous muscle and the second volar interosseous muscle were detected respectively,and the latency and amplitude were recorded.10 motor unit potentials(MUP)were randomly selected by electromyography,the average amplitude of MUP was calculated,and the recruitment response was observed.All the data were compared with the healthy side.The statistical analysis was performed.Results The amplitude of MUP of the second,third and fourth dorsal interosseous muscles as the fingers were separated and the second volar interosseous muscle as the fingers were closed together was significantly different from that of the healthy side(P<0.01).Most of the second,third and fourth dorsal interosseous muscle and the second volar interosseous muscle had recruitment reaction when the fingers were separated or closed together.The latency of CMAP stimulated by the first,second,third and fourth dorsal interosseous muscle and the second volar interosseous muscle on the affected side was significantly different from that on the healthy side(P<0.05),and there was no significant difference in CMAP amplitude between the affected side and the healthy side(P>0.05).Conclusion After wrist ulnar nerve injury,volar interosseous muscle and dorsal interosseous muscle are easy to produce synchronous excitation sequelae,resulting in finger separation and convergence disorder.The electrophysiological examination can help clinical diagnosis.