ELECTROPHYSIOLOGICAL TESTING OF SPINAL ACCESSORY NERVE IN SUSPECTED CASES OF NERVE TRANSECTION
ELECTROPHYSIOLOGICAL TESTING OF SPINAL ACCESSORY NERVE IN SUSPECTED CASES OF NERVE TRANSECTION
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DOI：
10.1002/mus.22135
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发表时间：
2011-11-01
期刊：
影响因子：
3.4
通讯作者：
Daube, Jasper R.
中科院分区：
文献类型：
--
作者：
Laughlin, Ruple S.;Spinner, Robert J.;Daube, Jasper R.
简介：在本研究中，我们试图确定脊髓副神经（SAN）的标准电生理测试是否能够准确识别出将从手术修复中受益的患者。方法：对16例单侧SAN损伤的连续患者进行临床和电生理研究。结果如下：所有患者均表现出低振幅SAN复合肌肉动作电位（CMAP），需要更高的刺激强度才能获得它比未受影响的一侧。上斜方肌针肌电图显示16条神经中有16条出现密集的纤颤电位，5条出现自主运动单位电位（MUP）。术中，16条神经中有12条被切断; 16条神经中有4条患有神经瘤，其上没有神经动作电位。患者接受了直接修复（6/16）或间置神经移植（10/16）。术后15例患者中有14例在疼痛、肌肉体积和活动度方面有所改善。结论：在有严重损伤临床体征的患者中，即使电生理测试显示低振幅CMAP和/或残留MUP，也需要对SAN进行手术探查。肌肉神经44：715-719，2011
Introduction: In this study we sought to determine whether standard electrophysiological testing of the spinal accessory nerve (SAN) accurately identifies patients who would benefit from surgical repair. Methods: Sixteen consecutive patients sent for surgical evaluation of unilateral SAN injury were studied clinically and electrophysiologically. Results: All patients demonstrated a low-amplitude SAN compound muscle action potential (CMAP) that required a higher stimulus intensity to obtain it than on the unaffected side. Upper trapezius needle electromyography showed dense fibrillation potentials in 16 of 16 nerves, with voluntary motor unit potentials (MUPs) in 5 of 16. Intraoperatively, 12 of 16 nerves were transected; 4 of 16 had neuromas across which there was no nerve action potential. Patients underwent direct repair (6 of 16) or interpositional nerve grafting (10 of 16). Fourteen of 15 patients seen postoperatively had improvement in pain, muscle bulk, and range of motion. Conclusions: Surgical exploration of the SAN is warranted in patients with clinical signs of severe injury, even when electrophysiological testing shows low-amplitude CMAPs and/or residual MUPs. Muscle Nerve 44: 715-719, 2011