目的:比较电针配合穴位注射与单纯穴位注射治疗糖尿病周围神经病的疗效差异。方法:在血糖控制理想情况下将60例糖尿病周围神经病患者随机分为电针加穴注组与穴注组,每组30例。电针加穴注组采用电针加穴位注射弥可保,电针穴取公孙透泉中...目的:比较电针配合穴位注射与单纯穴位注射治疗糖尿病周围神经病的疗效差异。方法:在血糖控制理想情况下将60例糖尿病周围神经病患者随机分为电针加穴注组与穴注组,每组30例。电针加穴注组采用电针加穴位注射弥可保,电针穴取公孙透泉中、涌泉透太冲为主,穴位注射取三阴交;穴注组采用单纯三阴交穴位注射弥可保。治疗2个疗程后,检测患者尺神经、胫神经神经传导速度,记录治疗前后中医症候积分及糖尿病周围神经病变积分,并评定疗效。结果:电针加穴注组与穴注组总有效率分别为90.0%(27/30)和63.3%(19/30),差异有统计学意义(P<0.05);治疗后电针加穴注组尺神经和胫神经运动神经传导速度(MCV)及感觉神经传导速度(SCV)均高于穴注组(P<0.05,P<0.01);治疗后电针加穴注组中医症候积分低于穴注组(14.36±1.88 vs 26.58±3.52,P<0.01),糖尿病周围神经病变积分亦低于穴注组(12.86±4.28 vs 17.89±4.35,P<0.01)。结论:电针加穴位注射弥可保治疗糖尿病周围神经病临床疗效显著,疗效优于单纯穴位注射弥可保,能够有效提高神经传导速度,控制和改善糖尿病周围神经病症状。展开更多
Background Hirayama disease is a rare disease characterized by juvenile-onset of asymmetric amyotrophy, of which etiology has not been clarified. The aim of our study was to investigate the clinical and neurophysiolog...Background Hirayama disease is a rare disease characterized by juvenile-onset of asymmetric amyotrophy, of which etiology has not been clarified. The aim of our study was to investigate the clinical and neurophysiologic characteristics of Hirayama disease. Methods Neurophysiological tests, including nerve conduction studies （NCS）, F-wave and routine electromyography （EMG）, were performed in seventy-three patients with Hirayama disease. EMG was selectively performed on upper and lower extremities, sternocleidomast and thoracic paravertebral muscles according to the clinical features of the patients. Results Abnormal NCS parameters, including decreased compound muscle action potentials or delayed distal motor latency, were found in 34.2% （25/73） and 12.3% （9/73） of the patients, respectively. A total of 24.6% （18/73） of the patients showed decreased F-wave frequency. EMG demonstrated the presence of neurogenic lesions in all patients with spontaneous potentials, prolonged duration or augmentation of amplitude in motor unit potentials （MUPs）, or a single pattern of MUP recruitment. About 17.8% （13/73） of the patients showed neurogenic lesions, mostly in the C7-8 level of the cervical cord, only in the upper extremity of affected side, whereas 35.6% （26/73） of the patients possessed lesions in the upper extremities bilaterally. A total of 46.6% （34/73） of patients exhibited abnormalities in the lower extremities, sterno- cleidomast or thoracic paravertebral muscle. Changes in motor NCS were significantly correlated with muscle strength. Conclusions EMG detects diffused subclinical neurogenic lesion in a high proportion of patients with Hirayama disease. Results of our study challenge the hypothesis that Hirayama disease is a type of cervical myelopathy.展开更多
This study determined the prevalence of diabetic peripheral neuropathy(DPN) and subclinical DPN(s DPN) in patients with type 2 diabetes mellitus(T2DM) using nerve conduction study(NCS) as a diagnostic tool. We also in...This study determined the prevalence of diabetic peripheral neuropathy(DPN) and subclinical DPN(s DPN) in patients with type 2 diabetes mellitus(T2DM) using nerve conduction study(NCS) as a diagnostic tool. We also investigated the factors associated with the development of s DPN and compared factors between the sD PN and confirmed DPN(cDPN). This cross-sectional study involved 240 T2DM patients who were successively admitted to the endocrinology wards of Wuhan Union Hospital over the period of January to December 2014. Data on the medical history, physical and laboratory examinations were collected. DPN was diagnosed using NCS. One-way ANOVA with least significant difference(LSD) analysis or chi-square tests was used to compare parameters among DNP-free, s DPN and c DPN patients. Independent factors associated with s DPN were determined using logistic regression. The results showed that 50.8% of the participants had DPN, and among them, 17.1% had sDPN. sDPN showed significant independent associations with age, height, HbA1c, presence of atherosclerosis and diabetic retinopathy. Patients with DPN differed significantly from those without DPN with respect to age, duration of disease(DOD), HbA1c, presence of atherosclerosis, diabetic retinopathy, nephropathy and hypertension. Patients with cDPN, relative to those with sDPN, had significantly longer DOD and higher prevalence of peripheral artery disease(PAD) and coronary artery disease(CAD). Our study suggests that a significant number of T2DM patients are affected by s DPN, and the development of this condition is associated with advanced age, tall stature, poor glycaemic control, presence of diabetic retinopathy and atherosclerosis. On the other hand, patients with cDPN tend to have a longer DOD and are more likely to suffer from PAD and CAD.展开更多
Background Involvement of peripheral nerves in dermatomyositis （DM） and polymyositis （PM） is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospi...Background Involvement of peripheral nerves in dermatomyositis （DM） and polymyositis （PM） is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy. Methods The data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients （118 patients with DM and 68 with PM） were retrospectively analyzed. Nerve conduction studies （NCSs） of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously. Results There were 71 （38.2%） patients with abnormal NCS findings, 37 （19.9%） with pure motor involvement （decreased compound muscle action potential, CMAP）, and 34 （18.3%） with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 （7.5%） had polyneuropathy, 1 （0.5%） had multiple mononeuropathy, 16 （8.6%） had carpal tunnel syndrome （CTS）, 1 （0.5%） had trigeminal sensory neuropathy, 1 （0.5%） had ulnar sensory neuropathy, and 1 （0.5%） had brachial plexus involvement. The prevalence of malignant disease （3/34, 8.8%）, other connective tissue diseases （CTDs） （7/34, 20.6%） and diabetes （6/34, 17.6%） was significantly greater in DM/PM patients with peripheral neuropathy （X2=15.855, P=0.000） compared with DM/PM patients without involvement of peripheral nerves （5/115, 4.3% and 7/115, 6.1%, respectively）. Conclusions Peripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders.展开更多
<span style="font-family:Verdana;">The clinician-administered Kamath and Stothard’s questionnaire is a recommended tool for assessing Carpal Tunnel Syndrome (CTS). The</span><span style="...<span style="font-family:Verdana;">The clinician-administered Kamath and Stothard’s questionnaire is a recommended tool for assessing Carpal Tunnel Syndrome (CTS). The</span><span style="font-family:Verdana;"> authors investigated whether the self-administered Kamath and Stothard’s questionnaire (KSQ) can categorize the severity of CTS according to the Nerve Conduction Study (NCS) and predict the outcome of Carpal Tunnel Release (CTR). One hundred and forty-two consecutive patients were enrolled in this prospective study, who completed the KSQ and were referred for NCS. Symptom relief after CTR was considered as the reference standard. KSQ’s scores were compared with the severity of CTS confirmed by NCS and the effectiveness of the surgery, Sensitivity and Positive Predictive Value (PPV) of the KSQ was calculated. The sensitivity of KSQ in each NCS severity category (mild</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">moderate</span><span style="font-family:Verdana;">, and </span><span style="font-family:Verdana;">severe CTS) was low (11.9% - 50.0%), however, the sensitivity and PPV of KSQ in the moderate + severe CTS category was 88.9% and 95.5%. The KSQ score of 5 or greater was found to be correlated with a successful CTR (sensitivity 92.8%, PPV of 90.2%). The study revealed that the KSQ with a score of 5 or greater is able to distinguish the mild conditions from moderate and severe ones. The KSQ’s score </span><span style="font-family:Verdana;">of </span><span style="font-family:Verdana;">5 or greater also can predict the successful outcome of CTR. The authors believe that in addition to reducing the duration and cost of diagnostics, the KSQ can also reduce patient appointments and clinic time. Application of the KSQ may be of paramount importance in the current Covid pandemic era.</span>展开更多
AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the...AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients(41 hands) by computer generated(Block of four randomization) into COR and HTFPF group. Nerve conduction study(NCS) included distal sensory latency(DSL), distal motor latency(DML), sensory amplitude (S-amp), motor amplitude(M-amp) and sensory nerve conduction velocity(SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale(VAS)], 2-point discrimination(2-PD), Semmes-Weinstein monofilament test(SWM), Phalen test and Tinel's sign were evaluated in order to compare treatment outcomes.RESULTS The COR group, 19 patients(20 hands) mean age 50.4 years. The HTFPF group, 20 patients(21 hands) mean age 53.3 years. Finally 33 patients(36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk(P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups(P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain(VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel's sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSION There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.展开更多
文摘目的:比较电针配合穴位注射与单纯穴位注射治疗糖尿病周围神经病的疗效差异。方法:在血糖控制理想情况下将60例糖尿病周围神经病患者随机分为电针加穴注组与穴注组,每组30例。电针加穴注组采用电针加穴位注射弥可保,电针穴取公孙透泉中、涌泉透太冲为主,穴位注射取三阴交;穴注组采用单纯三阴交穴位注射弥可保。治疗2个疗程后,检测患者尺神经、胫神经神经传导速度,记录治疗前后中医症候积分及糖尿病周围神经病变积分,并评定疗效。结果:电针加穴注组与穴注组总有效率分别为90.0%(27/30)和63.3%(19/30),差异有统计学意义(P<0.05);治疗后电针加穴注组尺神经和胫神经运动神经传导速度(MCV)及感觉神经传导速度(SCV)均高于穴注组(P<0.05,P<0.01);治疗后电针加穴注组中医症候积分低于穴注组(14.36±1.88 vs 26.58±3.52,P<0.01),糖尿病周围神经病变积分亦低于穴注组(12.86±4.28 vs 17.89±4.35,P<0.01)。结论:电针加穴位注射弥可保治疗糖尿病周围神经病临床疗效显著,疗效优于单纯穴位注射弥可保,能够有效提高神经传导速度,控制和改善糖尿病周围神经病症状。
文摘Background Hirayama disease is a rare disease characterized by juvenile-onset of asymmetric amyotrophy, of which etiology has not been clarified. The aim of our study was to investigate the clinical and neurophysiologic characteristics of Hirayama disease. Methods Neurophysiological tests, including nerve conduction studies （NCS）, F-wave and routine electromyography （EMG）, were performed in seventy-three patients with Hirayama disease. EMG was selectively performed on upper and lower extremities, sternocleidomast and thoracic paravertebral muscles according to the clinical features of the patients. Results Abnormal NCS parameters, including decreased compound muscle action potentials or delayed distal motor latency, were found in 34.2% （25/73） and 12.3% （9/73） of the patients, respectively. A total of 24.6% （18/73） of the patients showed decreased F-wave frequency. EMG demonstrated the presence of neurogenic lesions in all patients with spontaneous potentials, prolonged duration or augmentation of amplitude in motor unit potentials （MUPs）, or a single pattern of MUP recruitment. About 17.8% （13/73） of the patients showed neurogenic lesions, mostly in the C7-8 level of the cervical cord, only in the upper extremity of affected side, whereas 35.6% （26/73） of the patients possessed lesions in the upper extremities bilaterally. A total of 46.6% （34/73） of patients exhibited abnormalities in the lower extremities, sterno- cleidomast or thoracic paravertebral muscle. Changes in motor NCS were significantly correlated with muscle strength. Conclusions EMG detects diffused subclinical neurogenic lesion in a high proportion of patients with Hirayama disease. Results of our study challenge the hypothesis that Hirayama disease is a type of cervical myelopathy.
基金supported by the Scientific Research Grants from the Ministry of Education of China[No.005-383(6-144)]
文摘This study determined the prevalence of diabetic peripheral neuropathy(DPN) and subclinical DPN(s DPN) in patients with type 2 diabetes mellitus(T2DM) using nerve conduction study(NCS) as a diagnostic tool. We also investigated the factors associated with the development of s DPN and compared factors between the sD PN and confirmed DPN(cDPN). This cross-sectional study involved 240 T2DM patients who were successively admitted to the endocrinology wards of Wuhan Union Hospital over the period of January to December 2014. Data on the medical history, physical and laboratory examinations were collected. DPN was diagnosed using NCS. One-way ANOVA with least significant difference(LSD) analysis or chi-square tests was used to compare parameters among DNP-free, s DPN and c DPN patients. Independent factors associated with s DPN were determined using logistic regression. The results showed that 50.8% of the participants had DPN, and among them, 17.1% had sDPN. sDPN showed significant independent associations with age, height, HbA1c, presence of atherosclerosis and diabetic retinopathy. Patients with DPN differed significantly from those without DPN with respect to age, duration of disease(DOD), HbA1c, presence of atherosclerosis, diabetic retinopathy, nephropathy and hypertension. Patients with cDPN, relative to those with sDPN, had significantly longer DOD and higher prevalence of peripheral artery disease(PAD) and coronary artery disease(CAD). Our study suggests that a significant number of T2DM patients are affected by s DPN, and the development of this condition is associated with advanced age, tall stature, poor glycaemic control, presence of diabetic retinopathy and atherosclerosis. On the other hand, patients with cDPN tend to have a longer DOD and are more likely to suffer from PAD and CAD.
文摘Background Involvement of peripheral nerves in dermatomyositis （DM） and polymyositis （PM） is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy. Methods The data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients （118 patients with DM and 68 with PM） were retrospectively analyzed. Nerve conduction studies （NCSs） of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously. Results There were 71 （38.2%） patients with abnormal NCS findings, 37 （19.9%） with pure motor involvement （decreased compound muscle action potential, CMAP）, and 34 （18.3%） with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 （7.5%） had polyneuropathy, 1 （0.5%） had multiple mononeuropathy, 16 （8.6%） had carpal tunnel syndrome （CTS）, 1 （0.5%） had trigeminal sensory neuropathy, 1 （0.5%） had ulnar sensory neuropathy, and 1 （0.5%） had brachial plexus involvement. The prevalence of malignant disease （3/34, 8.8%）, other connective tissue diseases （CTDs） （7/34, 20.6%） and diabetes （6/34, 17.6%） was significantly greater in DM/PM patients with peripheral neuropathy （X2=15.855, P=0.000） compared with DM/PM patients without involvement of peripheral nerves （5/115, 4.3% and 7/115, 6.1%, respectively）. Conclusions Peripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders.
文摘<span style="font-family:Verdana;">The clinician-administered Kamath and Stothard’s questionnaire is a recommended tool for assessing Carpal Tunnel Syndrome (CTS). The</span><span style="font-family:Verdana;"> authors investigated whether the self-administered Kamath and Stothard’s questionnaire (KSQ) can categorize the severity of CTS according to the Nerve Conduction Study (NCS) and predict the outcome of Carpal Tunnel Release (CTR). One hundred and forty-two consecutive patients were enrolled in this prospective study, who completed the KSQ and were referred for NCS. Symptom relief after CTR was considered as the reference standard. KSQ’s scores were compared with the severity of CTS confirmed by NCS and the effectiveness of the surgery, Sensitivity and Positive Predictive Value (PPV) of the KSQ was calculated. The sensitivity of KSQ in each NCS severity category (mild</span><span style="font-family:Verdana;">, </span><span style="font-family:Verdana;">moderate</span><span style="font-family:Verdana;">, and </span><span style="font-family:Verdana;">severe CTS) was low (11.9% - 50.0%), however, the sensitivity and PPV of KSQ in the moderate + severe CTS category was 88.9% and 95.5%. The KSQ score of 5 or greater was found to be correlated with a successful CTR (sensitivity 92.8%, PPV of 90.2%). The study revealed that the KSQ with a score of 5 or greater is able to distinguish the mild conditions from moderate and severe ones. The KSQ’s score </span><span style="font-family:Verdana;">of </span><span style="font-family:Verdana;">5 or greater also can predict the successful outcome of CTR. The authors believe that in addition to reducing the duration and cost of diagnostics, the KSQ can also reduce patient appointments and clinic time. Application of the KSQ may be of paramount importance in the current Covid pandemic era.</span>
文摘AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients(41 hands) by computer generated(Block of four randomization) into COR and HTFPF group. Nerve conduction study(NCS) included distal sensory latency(DSL), distal motor latency(DML), sensory amplitude (S-amp), motor amplitude(M-amp) and sensory nerve conduction velocity(SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale(VAS)], 2-point discrimination(2-PD), Semmes-Weinstein monofilament test(SWM), Phalen test and Tinel's sign were evaluated in order to compare treatment outcomes.RESULTS The COR group, 19 patients(20 hands) mean age 50.4 years. The HTFPF group, 20 patients(21 hands) mean age 53.3 years. Finally 33 patients(36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk(P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups(P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain(VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel's sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSION There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.
