本文選題：神經(jīng)電生理 + 腕管綜合征�。� 參考：《南華大學(xué)》2014年碩士論文

【摘要】：目的 探討術(shù)中超強(qiáng)電刺激對(duì)成人腕管綜合征的輔助治療作用,并尋求敏感的檢測(cè)指標(biāo)。 方法 選擇20例成人腕管綜合征患者，分別在術(shù)前（麻醉后）、腕管松解后神經(jīng)松解前、神經(jīng)外膜松解后、超強(qiáng)電刺激后、術(shù)后1月予以神經(jīng)電生理檢測(cè)，通過觀察患者正中神經(jīng)拇短展肌復(fù)合動(dòng)作電位（CMAP）的潛伏期（DMN）、波幅（AMP）的動(dòng)態(tài)變化，并詳細(xì)記錄相關(guān)數(shù)據(jù)，再應(yīng)用單因素方差分析法進(jìn)行統(tǒng)計(jì)學(xué)分析，最后得出相應(yīng)有意義的結(jié)果。 結(jié)果 在本次臨床實(shí)驗(yàn)中：1.正中神經(jīng)—拇短展肌CMAP潛伏期:術(shù)前平均為(5.69士1.47)ms，腕管切開后平均為(4.89士1.10)ms，神經(jīng)外膜松解后平均為(4.68士0.99)ms，超強(qiáng)電刺激后平均為(3.93士0.57) ms，術(shù)后1月平均為(3.81士0.53)ms，超強(qiáng)電刺激后潛伏期平均為(3.93士0.57) ms與術(shù)前(5.69士1.47) ms比較平均改善了28.8%，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.正中神經(jīng)—拇短展肌CMAP波幅:術(shù)前平均為(3.719士1.55) mv，，腕管切開后平均為(4.55士1.47) mv，神經(jīng)外膜松解后平均為(4.77士1.41) mv，超強(qiáng)電刺激后平均為(5.70士1.82) mv，術(shù)后1月平均為(5.88士1.88) mv，超強(qiáng)電刺激后波幅平均為(5.70士1.82) mv與術(shù)前(3.71士1.55) mv比較平均改善了56.6%，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.術(shù)后一個(gè)月神經(jīng)電生理檢測(cè)復(fù)查，同時(shí)臨床療效按中華醫(yī)學(xué)會(huì)手外科學(xué)會(huì)上肢部分功能評(píng)定試行標(biāo)準(zhǔn)評(píng)定，結(jié)果顯示本組優(yōu)12例，良5例，可2例，差1例，優(yōu)良率為85.0%。 結(jié)論 在腕管開放性手術(shù)的術(shù)中予以正中神經(jīng)干超強(qiáng)直接電刺激，可引起正中神經(jīng)一拇短展肌復(fù)合動(dòng)作電位（CMAP）的波幅增高、潛伏期值縮短，因此具有較好的輔助治療作用；正中神經(jīng)拇短展肌復(fù)合動(dòng)作電位（CMAP）的波幅比潛伏期更能敏感體現(xiàn)治療效果，是成人腕管綜合征在神經(jīng)電生理檢測(cè)中的主要指標(biāo)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 鹵1.47 Ms, the average after carpal tunnel incision was 4.89 鹵1.10 ms, the average after release of the epineurium was 4.68 鹵0.99 ms, the average after superelectric stimulation was 3.93 鹵0.57) Ms, the average was 3.81 鹵0.53 ms1 month after operation. The average latency after strong electrical stimulation was 3.93 鹵0.57) Ms, compared with 5.69 鹵1.47 Ms. The mean CMAP amplitudes of median nerve and abductor brevis muscle were 3.719 鹵1.55) MV before operation, 4.55 鹵1.47) MV after carpal tunnel incision, 4.77 鹵1.41) MV after release of epineurium, 5.70 鹵1.82) MV after superelectric stimulation, and 5.88 鹵5.88 after 1 month after operation. 1.88) MV, the average amplitude after superintense stimulation was 5.70 鹵1.82) MV, compared with that before operation (3.71 鹵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.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R688

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