超强电刺激在成人腕管综合征术中的应用研究

发布时间：2018-05-06 22:07

本文选题：神经电生理 + 腕管综合征　；参考：《南华大学》2014年硕士论文

【摘要】：目的探讨术中超强电刺激对成人腕管综合征的辅助治疗作用,并寻求敏感的检测指标。方法选择20例成人腕管综合征患者，分别在术前（麻醉后）、腕管松解后神经松解前、神经外膜松解后、超强电刺激后、术后1月予以神经电生理检测，通过观察患者正中神经拇短展肌复合动作电位（CMAP）的潜伏期（DMN）、波幅（AMP）的动态变化，并详细记录相关数据，再应用单因素方差分析法进行统计学分析，最后得出相应有意义的结果。结果在本次临床实验中：1.正中神经—拇短展肌CMAP潜伏期:术前平均为(5.69士1.47)ms，腕管切开后平均为(4.89士1.10)ms，神经外膜松解后平均为(4.68士0.99)ms，超强电刺激后平均为(3.93士0.57) ms，术后1月平均为(3.81士0.53)ms，超强电刺激后潜伏期平均为(3.93士0.57) ms与术前(5.69士1.47) ms比较平均改善了28.8%，差异有统计学意义(P0.05)。2.正中神经—拇短展肌CMAP波幅:术前平均为(3.719士1.55) mv，，腕管切开后平均为(4.55士1.47) mv，神经外膜松解后平均为(4.77士1.41) mv，超强电刺激后平均为(5.70士1.82) mv，术后1月平均为(5.88士1.88) mv，超强电刺激后波幅平均为(5.70士1.82) mv与术前(3.71士1.55) mv比较平均改善了56.6%，差异有统计学意义(P0.05)。3.术后一个月神经电生理检测复查，同时临床疗效按中华医学会手外科学会上肢部分功能评定试行标准评定，结果显示本组优12例，良5例，可2例，差1例，优良率为85.0%。结论在腕管开放性手术的术中予以正中神经干超强直接电刺激，可引起正中神经一拇短展肌复合动作电位（CMAP）的波幅增高、潜伏期值缩短，因此具有较好的辅助治疗作用；正中神经拇短展肌复合动作电位（CMAP）的波幅比潜伏期更能敏感体现治疗效果，是成人腕管综合征在神经电生理检测中的主要指标之一。
[Abstract]:Purpose To explore the adjuvant therapeutic effect of intraoperative superintense electrical stimulation on adult carpal tunnel syndrome and to seek sensitive indicators. Method Twenty adult patients with carpal tunnel syndrome were treated with electrophysiologic examination before operation (after anaesthesia, after decompression of the carpal canal, after release of the epineurium, and after superintense electrical stimulation). By observing the dynamic changes of the latency and amplitude of the median abductor pollicis brevis complex action potential (CMAP), and recording the relevant data in detail, the statistical analysis was carried out by single factor variance analysis, and the corresponding significant results were obtained. Result In this clinical trial, 1: 1. Median nerve-abductor pollicis brevis CMAP latency: the average preoperatively was 5.69 卤1.47 Ms, the average after carpal tunnel incision was 4.89 卤1.10 ms, the average after release of the epineurium was 4.68 卤0.99 ms, the average after superelectric stimulation was 3.93 卤0.57) Ms, the average was 3.81 卤0.53 ms1 month after operation. The average latency after strong electrical stimulation was 3.93 卤0.57) Ms, compared with 5.69 卤1.47 Ms. The mean CMAP amplitudes of median nerve and abductor brevis muscle were 3.719 卤1.55) MV before operation, 4.55 卤1.47) MV after carpal tunnel incision, 4.77 卤1.41) MV after release of epineurium, 5.70 卤1.82) MV after superelectric stimulation, and 5.88 卤5.88 after 1 month after operation. 1.88) MV, the average amplitude after superintense stimulation was 5.70 卤1.82) MV, compared with that before operation (3.71 卤1.55) MV, the average improvement was 56.6%. The difference was statistically significant (P0.05U. 3). One month after operation, nerve electrophysiological examination was performed and the clinical efficacy was evaluated according to the experimental criteria of upper limb function evaluation of the Chinese Medical Association. The results showed that 12 cases were excellent, 5 good, 2 fair, 1 poor, and the excellent and good rate was 85.0%. Conclusion During the open operation of carpal tunnel, the superstrong direct electric stimulation of the median nerve trunk could increase the amplitude of CMAPs and shorten the latent period of CMAPs of median nerve and abductor pollicis brevis muscle, so it had better adjuvant therapeutic effect. The amplitude of the median abductor pollicis brevis complex action potential (CMAP) is more sensitive than the latent period to reflect the therapeutic effect. It is one of the main indicators of adult carpal tunnel syndrome in neuroelectrophysiological detection.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R688

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