背景:肌萎缩型颈椎病治疗方法仍有争议。对于肌萎缩型颈椎病患者,保守治疗一般可以稳定或者改善症状,但无法治愈。进展性或严重的神经功能恶化的肌萎缩型颈椎病推荐手术治疗,但多数临床医师根据自己的临床经验选择手术方式,尚未达成统...背景:肌萎缩型颈椎病治疗方法仍有争议。对于肌萎缩型颈椎病患者,保守治疗一般可以稳定或者改善症状,但无法治愈。进展性或严重的神经功能恶化的肌萎缩型颈椎病推荐手术治疗,但多数临床医师根据自己的临床经验选择手术方式,尚未达成统一的标准或行业共识。不同分型的肌萎缩型颈椎病预后显著不同,可能影响手术方案选的选择。目的:通过对肌萎缩型颈椎病相关研究进行综述,总结并分析疾病发病机制、临床表现、分型、诊断、治疗和预后情况,以期为此病的临床治疗和手术方案选择提供参考。方法:通过计算机检索1952-2020年发表在PubMed、EMbase、Web of Science、中国知网和万方数据库的肌萎缩型颈椎病相关研究文章,选择符合纳入标准的44篇文献进行综述。结果与结论:(1)肌萎缩型颈椎病的临床表现以上肢运动无力伴有明显的肌肉萎缩,而下肢没有明显的感觉障碍或痉挛性麻痹为特征,具有不对称性、节段性等特点;(2)临床多采用依据肌肉萎缩位置的不同进行分型,分为近端型、远端型和混合型,该疾病需与运动神经元病、肌肉营养不良疾病相鉴别,避免误诊和误治;(3)目前关于肌萎缩型颈椎病的发病机制尚不清楚,有腹侧神经根和脊髓前角细胞损伤两种观点,后者得到大部分学者认可;(4)肌萎缩型颈椎病的诊断主要依据临床症状、影像学检查及神经电生理检查,鉴别诊断上主要需排除运动神经元病等;(5)肌萎缩型颈椎病的治疗以手术为主,颈椎前路前路手术是治疗首选,而对于多节段颈椎后纵韧带骨化、前路不可能减压或者减压风险太大的患者需选择后路手术;(6)不同类型肌萎缩型颈椎病患者术后取得的预后效果有一定差异,其中近端型较远端型预后效果更佳,混合型预后最差,颈椎前路较后路手术效果佳。展开更多
Background： Dysfunctional spinal circuit may play a role in the pathophysiology ofarnyotrophic lateral sclerosis （ALS）. The purpose of this study was to use F waves for assessment of segmental motoneuronal excitabi...Background： Dysfunctional spinal circuit may play a role in the pathophysiology ofarnyotrophic lateral sclerosis （ALS）. The purpose of this study was to use F waves for assessment of segmental motoneuronal excitability following upper motor neuron （UMN） dysfunctions in ALS. Meihods： We studied the F waves of 152 ulnar nerves recorded fi＇om abductor digiti minimi in 82 patients with ALS. Two groups of hands were defined based on the presence or absence of pyramidal signs in the same upper limb. The group with pyramidal signs in tile upper limbs was designated as the P group, and the group without pyramidal signs in the upper limbs was designated as the NP group. Results： The mean （P 〈 0.001）, median （P 〈 0.001） and maximum （P = 0.035） F wave amplitudes, mean （P 〈 0.001 ）, median （P 〈 0.001） and maximum （P - 0.003） F/M amplitude ratio, index repeating neuron （P 〈 0.001 ） and index repeater F waves （P 〈 0.001 ） of the P group were significantly increased compared with the NP group. No significant differences were identified for F wave chronodispersion （P= 0.628）, mean F wave latency （P 0.151 ）, minimum F wave latency （P = 0.211 ）, maximum F wave latency （13 = 0. 199）. F wave persistence （P = 0.738）. F wave duration （P = 0. 152）, F wave conduction velocity （P = 0.813） and number of giant F waves （P = 0.072） between the two groups. Conclusions＂ In this study, increased F wave amplitude, F/M amplitude ratio and number of repeater F waves reflected enhanced segmental lnotoneuronal excitability following UMN dysfunctions in ALS.展开更多
Background：In amyotrophic lateral sclerosis （ALS）,repeater F waves are increased.Accurate assessment of repeater F waves requires an adequate sample size.Methods：We studied the F waves of left ulnar nerves in ALS ...Background：In amyotrophic lateral sclerosis （ALS）,repeater F waves are increased.Accurate assessment of repeater F waves requires an adequate sample size.Methods：We studied the F waves of left ulnar nerves in ALS patients.Based on the presence or absence of pyramidal signs in the left upper limb,the ALS patients were divided into two groups：One group with pyramidal signs designated as P group and the other without pyramidal signs designated as NP group.The Index repeating neurons （RN） and Index repeater F waves （Freps） were compared among the P,NP and control groups following 20 and 100 stimuli respectively.For each group,the Index RN and Index Freps obtained from 20 and 100 stimuli were compared.Results：In the P group,the Index RN （P =0.004） and Index Freps （P =0.001） obtained from 100 stimuli were significantly higher than from 20 stimuli.For F waves obtained from 20 stimuli,no significant differences were identified between the P and NP groups for Index RN （P =0.052） and Index Freps （P =0.079）; The Index RN （P ＜ 0.001） and Index Freps （P ＜ 0.001） of the P group were significantly higher than the control group; The Index RN （P =0.002） of the NP group was significantly higher than the control group.For F waves obtained from 100 stimuli,the Index RN （P ＜ 0.001） and Index Freps （P ＜ 0.001） of the P group were significantly higher than the NP group; The Index RN （P ＜ 0.001） and Index Freps （P ＜ 0.001） of the P and NP groups were significantly higher than the control group.Conclusions：Increased repeater F waves reflect increased excitability of motor neuron pool and indicate upper motor neuron dysfunction in ALS.For an accurate evaluation of repeater F waves in ALS patients especially those with moderate to severe muscle atrophy,100 stimuli would be required.展开更多
文摘背景:肌萎缩型颈椎病治疗方法仍有争议。对于肌萎缩型颈椎病患者,保守治疗一般可以稳定或者改善症状,但无法治愈。进展性或严重的神经功能恶化的肌萎缩型颈椎病推荐手术治疗,但多数临床医师根据自己的临床经验选择手术方式,尚未达成统一的标准或行业共识。不同分型的肌萎缩型颈椎病预后显著不同,可能影响手术方案选的选择。目的:通过对肌萎缩型颈椎病相关研究进行综述,总结并分析疾病发病机制、临床表现、分型、诊断、治疗和预后情况,以期为此病的临床治疗和手术方案选择提供参考。方法:通过计算机检索1952-2020年发表在PubMed、EMbase、Web of Science、中国知网和万方数据库的肌萎缩型颈椎病相关研究文章,选择符合纳入标准的44篇文献进行综述。结果与结论:(1)肌萎缩型颈椎病的临床表现以上肢运动无力伴有明显的肌肉萎缩,而下肢没有明显的感觉障碍或痉挛性麻痹为特征,具有不对称性、节段性等特点;(2)临床多采用依据肌肉萎缩位置的不同进行分型,分为近端型、远端型和混合型,该疾病需与运动神经元病、肌肉营养不良疾病相鉴别,避免误诊和误治;(3)目前关于肌萎缩型颈椎病的发病机制尚不清楚,有腹侧神经根和脊髓前角细胞损伤两种观点,后者得到大部分学者认可;(4)肌萎缩型颈椎病的诊断主要依据临床症状、影像学检查及神经电生理检查,鉴别诊断上主要需排除运动神经元病等;(5)肌萎缩型颈椎病的治疗以手术为主,颈椎前路前路手术是治疗首选,而对于多节段颈椎后纵韧带骨化、前路不可能减压或者减压风险太大的患者需选择后路手术;(6)不同类型肌萎缩型颈椎病患者术后取得的预后效果有一定差异,其中近端型较远端型预后效果更佳,混合型预后最差,颈椎前路较后路手术效果佳。
文摘Background： Dysfunctional spinal circuit may play a role in the pathophysiology ofarnyotrophic lateral sclerosis （ALS）. The purpose of this study was to use F waves for assessment of segmental motoneuronal excitability following upper motor neuron （UMN） dysfunctions in ALS. Meihods： We studied the F waves of 152 ulnar nerves recorded fi＇om abductor digiti minimi in 82 patients with ALS. Two groups of hands were defined based on the presence or absence of pyramidal signs in the same upper limb. The group with pyramidal signs in tile upper limbs was designated as the P group, and the group without pyramidal signs in the upper limbs was designated as the NP group. Results： The mean （P 〈 0.001）, median （P 〈 0.001） and maximum （P = 0.035） F wave amplitudes, mean （P 〈 0.001 ）, median （P 〈 0.001） and maximum （P - 0.003） F/M amplitude ratio, index repeating neuron （P 〈 0.001 ） and index repeater F waves （P 〈 0.001 ） of the P group were significantly increased compared with the NP group. No significant differences were identified for F wave chronodispersion （P= 0.628）, mean F wave latency （P 0.151 ）, minimum F wave latency （P = 0.211 ）, maximum F wave latency （13 = 0. 199）. F wave persistence （P = 0.738）. F wave duration （P = 0. 152）, F wave conduction velocity （P = 0.813） and number of giant F waves （P = 0.072） between the two groups. Conclusions＂ In this study, increased F wave amplitude, F/M amplitude ratio and number of repeater F waves reflected enhanced segmental lnotoneuronal excitability following UMN dysfunctions in ALS.
文摘Background：In amyotrophic lateral sclerosis （ALS）,repeater F waves are increased.Accurate assessment of repeater F waves requires an adequate sample size.Methods：We studied the F waves of left ulnar nerves in ALS patients.Based on the presence or absence of pyramidal signs in the left upper limb,the ALS patients were divided into two groups：One group with pyramidal signs designated as P group and the other without pyramidal signs designated as NP group.The Index repeating neurons （RN） and Index repeater F waves （Freps） were compared among the P,NP and control groups following 20 and 100 stimuli respectively.For each group,the Index RN and Index Freps obtained from 20 and 100 stimuli were compared.Results：In the P group,the Index RN （P =0.004） and Index Freps （P =0.001） obtained from 100 stimuli were significantly higher than from 20 stimuli.For F waves obtained from 20 stimuli,no significant differences were identified between the P and NP groups for Index RN （P =0.052） and Index Freps （P =0.079）; The Index RN （P ＜ 0.001） and Index Freps （P ＜ 0.001） of the P group were significantly higher than the control group; The Index RN （P =0.002） of the NP group was significantly higher than the control group.For F waves obtained from 100 stimuli,the Index RN （P ＜ 0.001） and Index Freps （P ＜ 0.001） of the P group were significantly higher than the NP group; The Index RN （P ＜ 0.001） and Index Freps （P ＜ 0.001） of the P and NP groups were significantly higher than the control group.Conclusions：Increased repeater F waves reflect increased excitability of motor neuron pool and indicate upper motor neuron dysfunction in ALS.For an accurate evaluation of repeater F waves in ALS patients especially those with moderate to severe muscle atrophy,100 stimuli would be required.
