经皮电刺激治疗外伤性外周神经损伤40例的效果分析

目的 本文分析使用经皮神经肌肉电刺激治疗外伤性周围神经损伤的临床疗效,探讨经皮电刺激对神经周围微循环的影响.方法 采用丹迪Keypoint型肌电图仪对40例上肢周围神经不全损伤的患者,行经皮神经肌肉电刺激治疗,配合运动疗法.治疗中使用激光多普勒血流仪(LDF)检测电刺激前、后神经周围微循环血流改变情况,并分析电刺激对微循环的影响.同时在治疗前、后行神经电生理检查对比检测,并对不同病程患者治疗后的效果作对比分析.利用以上分析手段观察受损神经功能的恢复情况.结果 40例臂丛神经、正中神经、桡神经、尺神经不全损伤的患者,经2-10个疗程的治疗后,受损神经功能治愈率达63％ (25/40),有效率为90％ (36/40).LDF检测结果显示电刺激后神经周围微循环血流量较刺激前增加23.36％-26.96％,改善受损神经局部微循环,神经肌电检测结果显示较治疗前有明显好转.在不同病程的患者中进行比较,病程越短者,效果越好.结论 经皮神经肌肉电刺激在外伤性周围神经损伤的治疗中,是一种行之有效的方法,可提高受损神经肌肉的兴奋度,促进受损神经局部的血液循环,有利于周围神经的再生.运动疗法的干预,能改善肌萎缩,增强肌协调力,预防关节僵硬,保持关节活动度,最终取得对外伤性周围神经损伤的满意疗效.应用激光多普勒血流成像技术,测得电刺激前、后神经周围微循环出现明显的血流量增加,证实电刺激能改善受损神经局部微循环.     

辅助瘫痪患者上肢活动的电刺激系统

当前,恢复四肢瘫痪病人上肢功能的强有力手段之一,是神经肌肉电刺激。本文从康复工程的角度,简要地介绍上肢功能性神经肌肉电刺激的生理特点;系统地描述植入式仪器的设计以及临床使用的最新成果。     

小儿上肢骨折手术的快通道麻醉

目的:观察喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞的快通道麻醉在小儿上肢骨折术中的应用效果,并与传统的麻醉方法咪唑安定加氯胺酮作比较.方法:选择ASA Ⅰ级小儿上肢骨折手术40例.随机分为2组:试验组(喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞)20例和对照组(咪唑安定+氯胺酮)20例.试验组惠儿静脉注射丙泊酚和雷米芬太尼后置入喉罩,连接麻醉机控制通气,麻醉维持采用丙泊酚和雷米芬太尼持续输注.1%利多卡因8□/□在神经刺激器引导下臂丛阻滞,手术结束停麻醉药.对照组静脉给予咪唑安定和氯胺酮,术中微量泵入咪唑安定加氯胺酮,术中根据需要调整输注速度,手术结束前5min停药.记录两组患儿的镇静镇痛效果、术中SPO2、手术时间、苏醒时间.结果:两组惠儿术中镇静镇痛效果均能满足手术需要,差异无统计学意义;两组患儿术中SPO2差异有统计学意义,试验组对气道的控制优于对照组;两组患儿手术时间差异无统计学意义,苏醒时间差异有统计学意义,对照组显著长于试验组.结论:喉罩下丙泊酚复合雷米芬太尼加神经刺激器引导下臂丛阻滞是小儿上肢骨折手术一种很好的快通道麻醉技术.     

低频神经和肌肉电刺激对产程、分娩方式、母婴结局的影响分析

目的:观察低频神经和肌肉刺激仪用于分娩镇痛对产程、分娩方式、产后出血、会阴完整度、母婴结局的影响.方法:随机选择2019年8月～2020年3月在我院分娩的足月妊娠产妇220名,根据第一产程是否应用低频神经和肌肉刺激仪分为观察组112例及对照组108例,两组均接受常规分娩护理,观察组为自愿接受低频神经和肌肉电刺激镇痛的产...     

肌电生物治疗联合运动康复在桡神经损伤治疗中的临床应用及疗效评价

目的:探究肌肉电刺激生物疗法联合运动疗法对于治疗桡神经损伤患者的临床疗效及运动恢复效果评价。方法:选择2013年5月至2016年5月我院收治的100例桡神经损伤患者。采用随机数字表法随机分为研究组和对照组各50例。对照组采用常规治疗(营养神经药物+针灸)和运动疗法,研究组在此基础上联合肌电生物治疗。治疗时间均为12周。治疗结束后应用统计学方法对两组患者的治疗有效率、腕伸肌和指总伸肌恢复情况、伸腕角度和伸肘角度以及神经传导速度和波幅等方面进行疗效对比。结果:治疗12周后,研究组治疗有效率66.00%高于对照组的50.00%,差异有统计学意义(P0.05)。研究组肌力恢复至4-5级的比例和表面肌电信号(s EMG)增幅均高于对照组,差异均有统计学意义(P0.05)。经治疗后,研究组伸腕角度和伸肘角度的优良率分别为84.00%、80.00%,明显高于对照组的66.00%、68.00%,差异均有统计学意义(P0.05)。两组患者胫神经运动传导速度(MCV)及波幅的均有改善,但研究组的改善效果明显优于对照组,差异有统计学意义(P0.05)。结论:常规治疗联合肌电生物反馈和运动疗法的治疗方案明显能使得患者受益更多,能更好地恢复患者的患肢运动功能,值得临床推广。     

肌电生物反馈对急性期脑卒中偏瘫患者上肢功能的影响

目的:评价肌电生物反馈联合常规康复训练对急性期脑卒中偏瘫患者上肢功能的影响,为脑卒中后急性期上肢运动功能障碍的康复治疗探寻更有效的方法.方法:将35例生命体征平稳、无意识障碍的急性期脑卒中偏瘫患者分为观察组18例和对照组17例.两组患者均给予神经内科药物治疗和常规康复训练,观察组患者偏瘫侧上肢加以肌电生物反馈治疗.两组均于治疗前和治疗2个月后对偏瘫侧上肢进行Bmnnstrom运动功能分级、简式Fugl-Meyer(FMA)上肢运动功能评定和腕背伸时肌肉最大收缩时肌电(EMG)幅值的测定.结果:经2个月治疗后,两组患者偏瘫侧上肢的Bnnnstrom分级、FMA及EMG幅值较治疗前均有提高(P＜0.05),且观察组各项评分均优于对照组(P＜0.05).结论:本文中观察组和对照组的患者经康复治疗后,偏瘫侧上肢的运动功能均较治疗前提高.但在脑卒中患者的急性期应用肌电生物反馈治疗联合常规康复训练,较单独使用常规运动疗法和作业疗法治疗,能更好地改善急性期脑卒中偏瘫患者上肢的功能,更显著地促进偏瘫上肢的运动功能恢复及分离运动的产生,同时对促进腕关节背伸肌力的恢复方面提供了电生理学依据.总之,在常规康复训练的基础上加用肌电生物反馈治疗,可更显著地促进急性期脑卒中偏瘫患者的上肢功能,为脑卒中急性期肢体运动障碍的康复治疗提供了更有效的方法.     

功能性电刺激联合循环运动系统对老年脑卒中后肌肉衰减综合征患者肢体功能、平衡能力以及认知功能的影响

摘要 目的：研究功能性电刺激联合循环运动系统对老年脑卒中后肌肉衰减综合征患者肢体功能、平衡能力以及认知功能的影响。方法：选择2020年6月到2021年6月在我院进行康复治疗的老年脑卒中后肌肉衰减综合征患者64例,据其治疗方式的不同分为对照组和研究组,两组患者均给予常规康复治疗,对照组患者在常规治疗的基础上加用功能性电刺激治疗,而研究组在对照组基础上加用脑循环系统治疗仪进行治疗,比较两组患者临床治疗疗效。使用运动功能评分法（FMA）和上肢功能评定（STEF）评价肢体患者功能,使用平衡量表（BBS）和Fuglg-Meyer平衡量表（FM-B）评价患者平衡能力,使用自拟认知量表评价患者认知功能。结果：（1）研究组患者临床治疗总有效率较对照组高（93.75 % vs 75.00 %,P<0.05）;（2）两组患者治疗后FMA和STEF评分均显著增高（P<0.05）,并且研究组患者治疗后BBS和FM-B评分显著高于对照组患者（P<0.05）;（3）两组患者治疗后BBS和FM-B评分均显著增高,并且研究组患者治疗后BBS和FM-B评分显著高于对照组患者（P<0.05）;（4）两组患者治疗后认知功能评分均升高,并且研究组患者较对照组患者高（P<0.05）。结论：功能性电刺激联合循环运动系统对老年脑卒中后肌肉衰减综合征患者具有显著的临床治疗效果,可显著改善患者肢体功能、平衡能力和认知功能。     

盆底电刺激对大鼠盆底肌肌肉、神经发育的形态学影响研究

目的:探讨与研究盆底电刺激对大鼠盆底肌肌肉、神经发育的形态学影响.方法:36只Wistar产后健康雌性大鼠分为对照组、模型组与刺激组,每组12只.模型组与刺激组都建立了压力性尿失禁模型,对照组不给予任何处理.建模后刺激组给予盆底电刺激,每3 d一次,持续治疗12d;模型组在建模后不给予任何治疗处理.结果:模型组与刺激组...     

丘脑底核脑深部电刺激治疗帕金森病的临床分析

目的:通过丘脑底核脑深部电刺激术治疗帕金森病,观察其肌肉僵直、静止性震颤、运动迟缓等症状的改善情况。方法:选取以丘脑底核为刺激靶点收治的帕金森病患者8例,对比手术前后患者肌强直、静止性震颤、运动迟缓等症状的改善情况,并进行UPDRS评分。结果:接受丘脑底核脑深部电刺激术治疗帕金森病6个月后,患者肌肉僵直、静止性震颤、运动迟缓等临床主症的改善上效果良好;与手术前相比,患者术后UPDRS评分均有所降低,差异具有统计学意义(P0.05);患者术后美多巴服用量显著减少,差异具有统计学意义(P0.05);患者术后没有产生永久性的并发症以及较明显的临床症状;但对大量油脂性渗出及典型面具性面容的治疗上未见明显疗效。结论:丘脑底核脑深部电刺激术治疗帕金森氏病,可以使帕金森病主要临床症状肌肉僵直、静止震颤及运动迟缓得到明显改善,显著减少美多巴服药量,具有安全可靠的疗效,对临床具有指导意义,值得临床推广应用。     

CPM结合早期康复训练在儿童肘部骨折术后肘关节功能障碍的康复疗效

目的:探讨CPM结合早期康复训练对儿童肘部骨折术后肘关节功能恢复临床疗效。方法:选取我院2015年12月~2017年2月期间骨科收治的儿童肘部骨折患者122例为研究对象,根据患者术后康复模式的不同将其分成了研究组(给予CPM结合早期康复训练)和对照组(给予早期康复训练),每组各61例。对两组患儿治疗前后的肘关节功能评分结果和综合疗效进行观察和比较。结果:(1)治疗后,研究组患儿的各项肘关节功能评分均明显优于对照组,且差异具有统计学意义;(2)治疗后优良率组间比较,研究组高于对照组,且差异具有统计学意义。结论:CPM结合早期康复训练能够有效的促进儿童肘部骨折术后肘关节功能恢复,是临床实际中的理想选择之一。     

Somatosensory evoked potentials (SEPs) elicited by magnetic nerve stimulation

Magnetic stimulation of peripheral nerves at distal and proximal sites of the upper and lower extremities and at the midlumbar level were used to elicit cortical somatosensory evoked potentials. Evidence is provided that peripheral nerve trunks, rather than distal receptor afferents, are the anatomical structures stimulated by the electromagnetic fields. Magnetic stimulation of peripheral nerves is considered to be useful for an evaluation of the integrity of proximal nerves, nerve roots and central conduction along sensory pathways. In contrast to electrical nerve stimulation, magnetic stimulation is painless and can be applied to proximal nerves and plexus. By means of proximal nerve stimulation central sensory conduction can be tested even in patients with peripheral nerve lesions or polyneuropathy.     

The harvest and clinical application of the superficial peroneal sensory nerve for grafting motor and sensory nerve defects.

Potential donor nerves for autografting are finite and usually limited to cutaneous nerves of the extremities. The superficial peroneal nerve is the major lateral branch of the common peroneal nerve that innervates the peroneus longus and brevis muscles and provides sensation to the lateral aspect of the lower leg and the dorsal foot. It has generally been overlooked as a potential donor of nerve autografts. Cadaver dissections were performed on 10 fresh lower extremity specimens to investigate the anatomic characteristics of the superficial peroneal nerve and to refine a harvesting technique for the nerve. Thirty-one patients underwent nerve grafting of 39 upper and lower extremity nerves using the superficial peroneal donor. There were nine median nerves, four ulnar nerves, two radial nerves, two brachial plexus lesions, 16 digital nerves, and six lower extremity nerves grafted. The superficial peroneal nerve provided a consistently long donor, comparable in length to the sural nerve. The anatomic pattern is consistent, the patient positioning is simple, the surgical harvesting technique is straightforward, and the donor defect is acceptable. The superficial peroneal nerve provides a safe and valuable donor nerve, particularly in cases where multiple or very long nerve grafts are required.     

超声与周围神经刺激器引导技术用于上肢手术锁骨上阻滞效果研究

摘要 目的：探讨超声与周围神经刺激器引导技术用于上肢手术锁骨上阻滞的效果。方法：招募2019年5月~2021年4月在我院收治并接受上肢手术的100例患者为研究对象。所有患者均接受上臂丛神经阻滞。根据研究方案将患者随机均分为对照组和引导组。对照组采用神经刺激器辅助定位锁骨上臂丛神经阻滞,引导组采用超声与周围神经刺激器引导技术对上臂丛神经阻滞,统计分析临床麻醉完成时间等相关指标。结果：两组患者一般资料比较无差异（P>0.05）。引导组麻醉完成时间和神经阻滞起效时间较对照组缩短（P<0.05）,引导组神经阻滞持续时间较对照组延长（P<0.05）。引导组麻醉效果优良率较对照组升高（P<0.05）,引导组麻醉效果中差率较对照组低（P<0.05）。引导组总体并发症较对照组低（P<0.05）。引导组感觉评分、运动评分、应对评分和总评分较对照组升高（P<0.05）。引导组非常满意率和总满意率较对照组升高（P<0.05）,引导组不满意率较对照组降低（P<0.05）。结论：与单独使用神经刺激器相比,超声引导辅助定位锁骨上臂丛神经阻滞具有起效快、阻滞完全、持续时间长等优点,超声与周围神经刺激器引导技术可提高麻醉的有效性、准确性和安全性,值得临床推广。     

Validity of median nerve somatosensory evoked potentials in the diagnosis of supraclavicular brachial plexus lesions

Experience with median nerve SEPs in the diagnosis of brachial plexus lesions is analysed in 49 patients selected from a total material of 264 cases with brachial plexus problems tested by SEP techniques. Median nerve SEPs were always compared with the results of SEPs after stimulation of at least one other nerve relevant to the site of the lesion as suspected clinically and electromyographically. All patients presented with unilateral brachial plexus problems and all root lesions were verified by clinical presentation, EMG studies, myelogram or surgery. There were 19 brachial plexus injuries, 13 cases with cervical spondylopathic rediculopaties without myelopathy and 7 patients presented brachial plexopathy with systemic cancer. It was found that median nerve SEPs were always normal in injuries of upper trunk and root avulsions confined to one or two root levels. Median nerve SEPs were abnormal in multiple trunk lesions and multiple root avulsions. In patients with spondylopathic radiculopathies median nerve SEPs were normal apart from one case where involvement of multiple roots was present. Median nerve SEPs were useful in assessing patients presenting brachial plexus problems in the presence of systematic cancer apart from cases where lower trunk involvement was present.In general, median nerve SEPs are useful if they are combined with SEP testing of other nerves anatomically more closely related to the problem as outlined clinically and electromyographically.     

Restoration of elbow flexion after brachial plexus injury: the role of nerve and muscle transfers

Brachial plexus trauma results in a variable loss of upper extremity function. The restoration of this function requires elbow flexion of adequate strength and range of motion. A proper evaluation of brachial plexus lesions is a prerequisite to any reconstructive procedure, and appropriate guidelines are presented. One option for restoring elbow flexion is a nerve transfer. The best results with this procedure are obtained in young patients treated within 6 months of injury. Another option is a free or pedicled muscle transfer, which should be considered in older patients or patients treated more than 6 months after an injury. Muscle transfers may also be used to augment the results of nerve transfer procedures. Choices and clinical results of donor nerves and muscle for transfer are discussed, and an algorithm for treatment is presented.     

Brachial plexus injury.

A 28-year-old man shot himself in the left posterior triangle of the neck with a shotgun. At the initial operation secondary repair of the resultant brachial plexus injury was decided upon in view of the difficulty in assessing lesions in continuity at this point after injury. The patient had total brachial plexus palsy. Nine weeks after the injury sensory and motor function were returning and the only element of the brachial plexus not showing evidence of nerve fibre continuity was the musculocutaneous nerve. Sural nerve autografts were sutured between the trimmed proximal and distal stumps of this nerve. By 4 months after the injury there was further improvement in both sensory and motor function, and by 18 months there was sensation in the autonomous zones of both median and ulnar nerves and good return of muscle power.     

Development of the innervation pattern in the upper limb of staged human embryos

The upper limb nerves of 8 human embryos (Carnegie stages 13-21) were studied by reconstruction. In stage 13, upper limb nerves (C5-T1) extended from the spinal cord. In stage 14, these nerves united to form the nascent brachial plexus. In stages 16 and 17, the median nerve, the radial nerve and the ulnar nerve entered into the hand plate. In stages 20 and 21, the upper limb nerves were observed in an orientation and arrangement similar to those in the adult.     

Long head of the triceps branch transfer to axillary nerve in C5, C6 brachial plexus injuries: anterior approach

Shoulder abduction is a very complex movement and quite important for upper limb function, as more distal functions depend on a stable shoulder, especially in C5, C6 brachial plexus injuries. Various studies in the literature have emphasized the importance of improved functional outcome and shoulder reanimation with concomitant neurotization of suprascapular nerve and axillary nerve in C5, C6 brachial plexus injuries. A number of approaches to axillary nerve transfer in brachial plexus injuries have been reported. The author describes an innovative anterior deltopectoral approach for axillary nerve transfers in five patients with C5, C6 brachial plexus injuries. The spinal accessory nerve was neurotized with the suprascapular nerve through a transverse supraclavicular incision. The axillary nerve and the long head of the triceps branch were identified through the anterior deltopectoral approach and neurotized at the posterior cord level. This approach gives easy access to other donors such as the medial pectoral, thoracodorsal, and median and ulnar nerves. Oberlin's transfer was also performed for elbow flexion by extending the deltopectoral incision. The regained shoulder active abduction (M5) averaged 120 degrees and active external rotation averaged 65 degrees at the final follow-up of 26 months (average). This anterior deltopectoral approach is an excellent alternative for axillary nerve transfer in brachial plexus injuries and produces results comparable with those of other approaches. All brachial plexus surgeons must understand the anatomy and the relationship of the axillary nerve to the surrounding structures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.     

Brachial muscles of dystrophic chick embryos atypically sustain interaction with thoracic nerves

Previous analyses of experimental chick embryos of normal lineage demonstrate the inability of brachial muscles to sustain a successful union with foreign nerves derived from a thoracic neural tube segment transplanted to the brachial region at day 2 in ovo (day 2E). The present experiments were performed to determine if mutant chick embryos afflicted with hereditary muscular dystrophy would respond similarly to this experimental manipulation. Using the same criteria applied to our analysis of experimental normal embryos, our results demonstrated that dystrophic brachial muscles were capable of maintaining a compatible union with foreign thoracic nerves throughout the experimental period analysed. Significant muscle growth occurred, intramuscular nerve branches were maintained, motor endplates formed and wing motility was equivalent to that of unoperated dystrophic embryos. Thus, foreign nerves rejected by normal brachial muscles were accepted by brachial muscles of the mutant dystrophic embryo.