16例非外伤性桡神经病损的临床表现及电生理特点分析
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摘要
目的分析非外伤性桡神经病损的临床表现及电生理特点。方法回顾性分析我院肌电图室16例桡神经病损患者的临床资料,非外伤性桡神经病损分析临床表现及电生理特点。结果桡浅神经病损最为常见,临床表现为手背桡侧区麻木,以桡浅神经SNAP诱发的波幅降低为主,传导速度为正常下限。桡神经在桡神经沟处病损临床表现为不同程度手背桡侧麻木、垂腕及垂指,桡神经运动传导在桡神经沟上下存在传导阻滞。1例为后骨间神经病损,临床表现为垂指重于垂腕,无感觉障碍,桡神经运动神经诱发波幅明显减弱。结论桡神经是上肢最大的一条神经,其损害在肌电图室并不少见,非外伤性损害以桡浅神经病损最为多见,其次为桡神经沟处,多由于桡神经长时间受压所致。除了根据临床表现外,神经电生理检查是重要的辅助检查手段,不仅可以确定损害部位,还可以判断损害的严重程度和评估预后。
Objective To investigate the clinical manifestations and electrophysiological characteristics of 16 cases of nontraumatic radial nerve lesions. Methods The clinical data of 16 patients with radial nerve lesions in EMG room of our hospital were retrospectively analyzed. The clinical manifestations and electrophysiological characteristics of non-traumatic radial nerve lesions were analyzed. Results Superficial radial nerve lesions were the most common, the clinical manifestation was numbness in the dorsal radial area of the hand, amplitude decreases induced by SNAP of superficial radial nerve decreased and conduction velocity was the normal lower limit. The clinical manifestations of radial nerve lesions in the radial nerve groove were vary degrees of radial numbness of dorsum of hand, vertical wrist and fingers.Radial nerve motor conduction was blocked in the upper and lower radial nerve groove. One case was a posterior interosseous nerve lesion. The clinical manifestation were that the vertical finger was heavier than the vertical wrist, without sensory disturbance, and the amplitude induced by the motor nerve of radial nerve decreased. Conclusion Radial nerve is the largest nerve in the upper limb, its damage is not uncommon in EMG room. The most common non-traumatic damage is superficial radial nerve, followed by radial nerve groove, which mainly caused by long-term compression of radial nerve. In addition to the clinical manifestations, neuroelectrophysiological examination is an important auxiliary examination means,it can not only determine the damage site, but also judge the severity of the damage and evaluate the prognosis.
Objective To investigate the clinical manifestations and electrophysiological characteristics of 16 cases of nontraumatic radial nerve lesions. Methods The clinical data of 16 patients with radial nerve lesions in EMG room of our hospital were retrospectively analyzed. The clinical manifestations and electrophysiological characteristics of non-traumatic radial nerve lesions were analyzed. Results Superficial radial nerve lesions were the most common, the clinical manifestation was numbness in the dorsal radial area of the hand, amplitude decreases induced by SNAP of superficial radial nerve decreased and conduction velocity was the normal lower limit. The clinical manifestations of radial nerve lesions in the radial nerve groove were vary degrees of radial numbness of dorsum of hand, vertical wrist and fingers.Radial nerve motor conduction was blocked in the upper and lower radial nerve groove. One case was a posterior interosseous nerve lesion. The clinical manifestation were that the vertical finger was heavier than the vertical wrist, without sensory disturbance, and the amplitude induced by the motor nerve of radial nerve decreased. Conclusion Radial nerve is the largest nerve in the upper limb, its damage is not uncommon in EMG room. The most common non-traumatic damage is superficial radial nerve, followed by radial nerve groove, which mainly caused by long-term compression of radial nerve. In addition to the clinical manifestations, neuroelectrophysiological examination is an important auxiliary examination means,it can not only determine the damage site, but also judge the severity of the damage and evaluate the prognosis.
引文
[1]陈香葵,尚媛媛.30例桡神经损伤患者的神经肌电图检测报告[J].癫痫与神经电生理学杂志,2017,26(4):216-218
[2]党静霞.肌电图诊断与临床应用[M].2版.北京:人民卫生出版社,2013:191.
[3]LATEF TJ,BILAL M,VETTER M,et al.Injury of the radial nerve in the arm:a Review[J].Cureus,2018,10(2):e2199.
[4]BUMBASIREVIC M,PALIBRK T,LESIC A,et al.Radial nerve palsy[J].EFORT Open Rev,2016,1(8):286-294.
[5]柳三凤,李炳钻,庄智勇.肌电图在53例桡神经损伤患者中的定位诊断价值[J].现代电生理学杂志,2018,25(1):21-23.
[6]陈志豪,徐华梓,徐刚,等.桡神经浅支及其分支的解剖学研究及临床意义[J].浙江创伤外科,2010,15(4):417-420.
[7]IKIZ ZA,UCERLER H.Anatomic characteristics and clinical importance of the superficial branch of the radial nerve[J].Surg Radiol Ana,2004,26(6):453-458.
[8]余军,周莅源,张承洁.自身压迫致周围神经损伤12例临床分析[J].临床神经病学杂志2011,24(2):143-144.
[9]PRABHU LV,ASIF M,MURLIMANJU BV.Anomalous fascicle of triceps brachii muscle and its clinical importance in relation to radial nerve entrapment[J].Clin Ter,2012,163(2):123-124.
[10]HASAN SA,RAULS RB,CORDELL CL,et al."Zone of vulnerability"for radial nerve injury:anatomic study[J].Journal of Surgical Orthopaedic Advances,2014,23(2):105-110.
[11]DAVIDOVICH ER,NASCIMENTO OJ.Superficial radial nerve-lateral antebrachial cutaneous nerve anatomic variation[J].Brain Behav,2014,4(1):70-74
[2]党静霞.肌电图诊断与临床应用[M].2版.北京:人民卫生出版社,2013:191.
[3]LATEF TJ,BILAL M,VETTER M,et al.Injury of the radial nerve in the arm:a Review[J].Cureus,2018,10(2):e2199.
[4]BUMBASIREVIC M,PALIBRK T,LESIC A,et al.Radial nerve palsy[J].EFORT Open Rev,2016,1(8):286-294.
[5]柳三凤,李炳钻,庄智勇.肌电图在53例桡神经损伤患者中的定位诊断价值[J].现代电生理学杂志,2018,25(1):21-23.
[6]陈志豪,徐华梓,徐刚,等.桡神经浅支及其分支的解剖学研究及临床意义[J].浙江创伤外科,2010,15(4):417-420.
[7]IKIZ ZA,UCERLER H.Anatomic characteristics and clinical importance of the superficial branch of the radial nerve[J].Surg Radiol Ana,2004,26(6):453-458.
[8]余军,周莅源,张承洁.自身压迫致周围神经损伤12例临床分析[J].临床神经病学杂志2011,24(2):143-144.
[9]PRABHU LV,ASIF M,MURLIMANJU BV.Anomalous fascicle of triceps brachii muscle and its clinical importance in relation to radial nerve entrapment[J].Clin Ter,2012,163(2):123-124.
[10]HASAN SA,RAULS RB,CORDELL CL,et al."Zone of vulnerability"for radial nerve injury:anatomic study[J].Journal of Surgical Orthopaedic Advances,2014,23(2):105-110.
[11]DAVIDOVICH ER,NASCIMENTO OJ.Superficial radial nerve-lateral antebrachial cutaneous nerve anatomic variation[J].Brain Behav,2014,4(1):70-74