發(fā)布時(shí)間：2018-10-24 17:24

【摘要】：目的通過(guò)對(duì)2014年10月至2015年10月來(lái)我院進(jìn)行治療的面肌痙攣患者進(jìn)行回顧性分析,探究肌電圖在面肌痙攣病因診斷中的臨床應(yīng)用價(jià)值。方法選取2014年10月至2015年10月來(lái)我院接受治療的43例面肌痙攣患者作為研究對(duì)象,臨床診斷標(biāo)準(zhǔn)參考面肌痙攣的診斷標(biāo)準(zhǔn)。依據(jù)標(biāo)準(zhǔn)選擇病例,最后納入30例患者。應(yīng)用肌電圖技術(shù)檢測(cè)面肌痙攣患者的面神經(jīng)傳導(dǎo)潛伏期、波幅、瞬目反射及面神經(jīng)支配肌肉電活動(dòng),并與顱腦MR顱神經(jīng)掃描3D-TOF成像對(duì)比,觀察面神經(jīng)與血管的毗鄰關(guān)系以及敏感性及特異性。EMG檢查分為神經(jīng)傳導(dǎo)檢查和面肌肌電圖檢測(cè)兩部分。前者(電極置于耳前方)指對(duì)面神經(jīng)電刺激,從而記錄神經(jīng)或肌肉電活動(dòng)。后者指將針極置于肌肉中或表面電極貼于面部肌肉皮膚上(口輪匝肌上唇處、額肌、眼輪匝肌)記錄其電活動(dòng)。結(jié)果1、30例患者中瞬目反射的早反應(yīng)(R1)和晚反應(yīng)(R2、R2’)的潛伏期和波幅與健側(cè)相比無(wú)明顯差異,患者患側(cè)晚反應(yīng)波幅明顯高于健側(cè),但僅僅是刺激同側(cè)的晚反應(yīng)差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2、30例面肌痙攣患者在放松狀態(tài)下,眼輪匝肌健側(cè)和患側(cè)的MF值分別為(71.2±20.3)Hz和(69.4±17.7)Hz,二者相比,基本一致(P0.05);健側(cè)和患側(cè)的MPF值分別為(97.6±21.4)Hz和(93.5±17.2)Hz,二者相比,基本一致(P0.05);健側(cè)和患側(cè)的EMG值分別為(5.1±3.1)m V和(6.8±4.3)m V,二者相比,患側(cè)明顯高于健側(cè),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、30例面肌痙攣患者在收縮狀態(tài)下,眼輪匝肌健側(cè)和患側(cè)的MF值分別為(103.2±16.4)Hz和(94.2±15.3)Hz,二者相比,健側(cè)明顯高于患側(cè),差異有統(tǒng)計(jì)學(xué)意義(P0.05);健側(cè)和患側(cè)的MPF值分別為(124.3±16.3)Hz和(112.4±14.6)Hz,健側(cè)明顯高于患側(cè),差異有統(tǒng)計(jì)學(xué)意義(P0.05);健側(cè)和患側(cè)的EMG值分別為(47.2±41.2)m V和(36.3±26.4)m V,二者相比,健側(cè)明顯高于患側(cè),差異有統(tǒng)計(jì)學(xué)意義(P0.05)4、通過(guò)對(duì)30例面肌痙攣患者行顱腦MR顱神經(jīng)掃描3D-TOF成像,檢查血管與神經(jīng)的毗鄰關(guān)系,發(fā)現(xiàn)患側(cè)有6例為可疑接觸,15例為明確接觸或壓迫,陽(yáng)性率為70.0%(21/30),健側(cè)有3例為可疑接觸,3例為明確接觸或壓迫,陽(yáng)性率為20.0%(6/30),二者相比,患側(cè)陽(yáng)性率明顯高于健側(cè),差異有統(tǒng)計(jì)學(xué)意義(P0.01)。5、通過(guò)對(duì)30例面肌痙攣患者同時(shí)行顱腦MR檢查和肌電圖檢查發(fā)現(xiàn),30例患者中,肌電圖異常者23例,陽(yáng)性率為76.7%(23/30),顱腦MR異常者21例,陽(yáng)性率為70.0%(21/30),兩者同時(shí)異常者15例,陽(yáng)性率為50.0%(15/30)。結(jié)論肌電圖在血管壓迫性面肌痙攣的病因診斷中有著重要的應(yīng)用價(jià)值,能夠?yàn)榕R床治療提供可靠的參考依據(jù),可以在臨床醫(yī)學(xué)中得以廣泛地推廣應(yīng)用。
[Abstract]:Objective to explore the clinical value of electromyography (EMG) in the etiological diagnosis of hemifacial spasm by retrospective analysis of hemifacial spasm patients who were treated in our hospital from October 2014 to October 2015. Methods from October 2014 to October 2015, 43 patients with hemifacial spasm received treatment in our hospital were selected as the study object. The clinical diagnostic criteria for hemifacial spasm were referred to the diagnostic criteria of hemifacial spasm. Cases were selected according to the criteria, and 30 patients were included. The latent period of facial nerve conduction, amplitude of wave, blink reflex and innervation of facial nerve were measured by electromyography in patients with hemifacial spasm, and compared with cranial nerve scanning 3D-TOF imaging of craniocerebral MR. The relationship between facial nerve and blood vessel and its sensitivity and specificity were observed. EMG was divided into two parts: nerve conduction test and facial electromyography. The former (electrode placed in front of the ear) refers to the electrical stimulation of the facial nerve, thereby recording the electrical activity of the nerve or muscle. The latter refers to placing the needle pole in the muscle or the surface electrode attached to the facial muscle skin (upper lip, frontal muscle, orbicularis oculi) to record its electrical activity. Results 1There was no significant difference in latency and amplitude of early response (R1) and late response (R2nR2') between 30 patients with blink reflex and healthy side. The amplitude of late response in affected side was significantly higher than that in healthy side. However, the difference of late response was statistically significant only for ipsilateral stimulation (P0.05). The MF values of the healthy and affected sides of orbicularis oculi muscle were (71.2 鹵20.3) Hz and (69.4 鹵17.7) Hz, respectively, in 230 patients with hemifacial spasm in relaxed state, and the MF values of normal side and affected side of orbicularis oculi muscle were (71.2 鹵20.3) Hz and (69.4 鹵17.7) Hz, respectively. The MPF values of the healthy side and the affected side were (97.6 鹵21.4) Hz and (93.5 鹵17.2) Hz, respectively (P0.05), the EMG values of the healthy side and the affected side were (5.1 鹵3.1) m V and (6.8 鹵4.3) m V, respectively. The difference was statistically significant (P0.05). The MF values of the healthy side and the affected side of orbicularis oculi muscle were (103.2 鹵16.4) Hz and (94.2 鹵15.3) Hz, respectively, in 30 patients with hemifacial spasm in the contractile state, and the healthy side was significantly higher than the affected side. The MPF values of the healthy side and the affected side were (124.3 鹵16.3) Hz and (112.4 鹵14.60) Hz, respectively, which were significantly higher than those of the affected side (P0.05), the EMG values of the healthy side and the affected side were (47.2 鹵41.2) m V) and (36.3 鹵26.4) m V,), respectively, and the healthy side was significantly higher than the affected side. The difference was statistically significant (P0.05) 4. The cranial nerve of 30 patients with hemifacial spasm was examined by MR cranial nerve scanning 3D-TOF imaging. It was found that 6 cases had suspicious contact, 15 cases had definite contact or compression, and 6 cases had suspicious contact, 15 cases had definite contact or compression, 6 cases had suspicious contact, 15 cases had definite contact or compression. The positive rate was 70.0% (21 / 30). The positive rate was 20.0% (6 / 30) in the healthy side, 3 cases in the healthy side and 3 cases in the definite contact or compression. The positive rate of the affected side was significantly higher than that of the healthy side. 5The difference was statistically significant (P0.01). 30 cases of hemifacial spasm were examined by craniocerebral MR and electromyography. Among the 30 cases, 23 cases were abnormal in electromyography, the positive rate was 76.7% (23 / 30), and 21 cases were abnormal in craniocerebral MR. The positive rate was 70.0% (21 / 30), 15 cases were abnormal at the same time, the positive rate was 50.0% (15 / 30). Conclusion EMG has important application value in the etiological diagnosis of vascular compression hemifacial spasm, which can provide reliable reference for clinical treatment and can be widely used in clinical medicine.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R745.12

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