法医学杂志

法医学杂志 ›› 2023, Vol. 39 ›› Issue (2): 137-143.DOI: 10.12116/j.issn.1004-5619.2022.221104

• 论著 • 上一篇    下一篇

肌皮神经损伤后屈肘肌力与针极肌电图指标的相关性

高东1(), 卓佩佩2(), 田东3, 冉聃1, 夏晴1, 夏文涛1()   

  1. 1.司法鉴定科学研究院 上海市法医学重点实验室 司法部司法鉴定重点实验室 上海市司法鉴定专业技术服务平台，上海 200063
    2.复旦大学基础医学院法医学系 复旦大学上海医学院司法鉴定中心，上海 200032
    3.复旦大学附属华山医院手外科，上海 200040
  • 收稿日期:2022-11-16 发布日期:2023-06-06 出版日期:2023-04-25
  • 通讯作者: 夏文涛
  • 作者简介:夏文涛，男，研究员，主任法医师，硕士研究生导师，主要从事法医临床学科学研究和司法鉴定；E-mail：xiawt@ssfjd.cn
    高东（1981—），男，博士，副主任法医师，主要从事法医临床学科学研究和司法鉴定；E-mail：gaod@ssfjd.cn
    卓佩佩（1994—），女，硕士，主要从事法医临床学科学研究和司法鉴定；E-mail：peipeirixi@163.com第一联系人：高东和卓佩佩为共同第一作者
  • 基金资助:
    上海市自然科学基金“科技创新行动计划”面上资助项目(22ZR1462500);中央级科研院所科研专项(GY2022G-8);司法部司法鉴定重点实验室资助项目;上海市法医学重点实验室资助项目(21DZ2270800);上海市司法鉴定专业技术服务平台资助项目

Correlation between Elbow Flexor Muscle Strength and Needle Electromyography Parameters after Musculocutaneous Nerve Injury

Dong GAO1(), Pei-pei ZHUO2(), Dong TIAN3, Dan RAN1, Qing XIA1, Wen-tao XIA1()   

  1. 1.Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
    2.Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Center for Forensic Science of Shanghai Medical College, Fudan University, Shanghai 200032, China
    3.Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2022-11-16 Online:2023-06-06 Published:2023-04-25
  • Contact: Wen-tao XIA

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摘要：

目的 研究肌皮神经损伤者的屈肘肌力变化及其与针极肌电图指标的相关性。 方法 收集单侧臂丛神经损伤（累及肌皮神经）致屈肘肌力降低案例30例，根据Lovett肌力分级标准进行徒手肌力评定，并将30例受试者分为A组（伤侧徒手肌力1级和2级，16例）和B组（伤侧徒手肌力3级和4级，14例）。对所有受试者的伤侧和健侧肱二头肌行针极肌电图检测。记录肱二头肌复合肌肉动作电位（compound muscle action potential，CMAP）的潜伏期和波幅。受试者进行最大随意收缩时，记录募集反应类型以及募集电位的平均转折数和平均波幅，并采用microFET 2便携式肌力测试仪检测屈肘定量肌力。计算残存屈肘肌力百分比（伤侧与健侧定量肌力的比值）。比较各针极肌电图指标、定量肌力、残存屈肘肌力百分比在两组之间和组内伤侧与健侧之间的差异。分别分析屈肘徒手肌力分级、定量肌力与针极肌电图指标的相关性。 结果 肌皮神经损伤后B组的伤侧残存屈肘肌力百分比为23.43%，A组的伤侧残存屈肘肌力百分比为4.13%。伤侧徒手肌力分级与募集反应类型相关，相关系数为0.886（P<0.05）。伤侧定量肌力与CMAP潜伏期、波幅以及募集电位的平均转折数和平均波幅均相关，相关系数分别为-0.528、0.588、0.465、0.426（P<0.05）。 结论 残存屈肘肌力百分比可作为肌力分级的依据，针极肌电图指标的综合分析可用于推断屈肘定量肌力。

关键词: 法医学, 肌力, 针极肌电图, 最大随意收缩, 募集电位, 复合肌肉动作电位, 肌皮神经损伤, 肱二头肌

Abstract:

Objective To explore the changes of elbow flexor muscle strength after musculocutaneous nerve injury and its correlation with needle electromyography （nEMG） parameters. Methods Thirty cases of elbow flexor weakness caused by unilateral brachial plexus injury （involving musculocutaneous nerve） were collected. The elbow flexor muscle strength was evaluated by manual muscle test （MMT） based on Lovett Scale. All subjects were divided into Group A （grade 1 and grade 2, 16 cases） and Group B （grade 3 and grade 4, 14 cases） according to their elbow flexor muscle strength of injured side. The biceps brachii of the injured side and the healthy side were examined by nEMG. The latency and amplitude of the compound muscle action potential （CMAP） were recorded. The type of recruitment response, the mean number of turns and the mean amplitude of recruitment potential were recorded when the subjects performed maximal voluntary contraction. The quantitative elbow flexor muscle strength was measured by portable microFET 2 Manual Muscle Tester. The percentage of residual elbow flexor muscle strength （the ratio of quantitative muscle strength of the injured side to the healthy side） was calculated. The differences of nEMG parameters, quantitative muscle strength and residual elbow flexor muscle strength between the two groups and between the injured side and the healthy side were compared. The correlation between elbow flexor manual muscle strength classification, quantitative muscle strength and nEMG parameters was analyzed. Results After musculocutaneous nerve injury, the percentage of residual elbow flexor muscle strength in Group B was 23.43% and that in Group A was 4.13%. Elbow flexor manual muscle strength classification was significantly correlated with the type of recruitment response, and the correlation coefficient was 0.886 （P<0.05）. The quantitative elbow flexor muscle strength was correlated with the latency and amplitude of CMAP, the mean number of turns and the mean amplitude of recruitment potential, and the correlation coefficients were -0.528, 0.588, 0.465 and 0.426 （P<0.05）, respectively. Conclusion The percentage of residual elbow flexor muscle strength can be used as the basis of muscle strength classification, and the comprehensive application of nEMG parameters can be used to infer quantitative elbow flexor muscle strength.

Key words: forensic medicine, muscle strength, needle electromyography, maximal voluntary contraction, recruitment potential, compound muscle action potential, musculocutaneous nerve injury, biceps brachii

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