碰撞技術應用於馬丁古柏連合之一病例

Collision Study in a Patient with Martin - Gruber Anastomosis – A Case Report

張佐文(Tso-Wen Chang)

《慈濟醫學雜誌》 4卷1期 (1992/03) Pp. 46-50

https://doi.org/10.6440/TZUCMJ.199203.0046

摘要

馬丁古柏連合係指正中神經有分枝通往尺神經，此為一種重要之周圍神經現象，經常造成電氣生理診斷上之困擾。本病例為一名59歲男性，診斷為雙側腕道症候群及左側遲緩性尺神經麻痺。刺激肘部正中神經時可於小指外展肌記錄得複合運動電位，表示有馬丁古柏連合。應用碰撞技術，同時刺激肘部正中神經及腕部尺神經，當腕部刺激強度逐漸增加後，可使得肘部正中神經引起之運動電位因碰撞而消失。以後逐漸延後肘部之刺激，則可見該運動電位又漸出現。碰撞技術簡易、可重視、又不具侵害性，於證實神經連合甚有幫助。

關鍵字

馬丁古柏連合 ； 正中神經尺神經連合 ； 碰撞技術

並列摘要

A 59-year-old male with bilateral carpal tunnel syndrome and left tardy ulnar palsy was found to have Martin-Gruber anastomosis on the left side, manifest with an compound muscle action potential (CMAP) in the left abductor digiti minimi muscle on median nerve stimulation at the elbow. Collision technique was applied to the patient with the ulnar nerve stimulation at the wrist (S1) and median nerve stimulation at the elbow (S2). The CMAP was recorded on the abductor digiti minimi muscle. S1 alone elicited a CMAP, abbreviated to CMAP(U), of 5 mV in amplitude, whereas S2 evoked a small CMAP, abbreviated to CMAP(M), of only 1 mV high. When S1 and S2 were given simultaneously by gradually increasing the S1 intensity, CMAP(M) disappeared as the antidromic impulse from S1 became large enough to eradicated the proximal impulse from S2. However, the CMAP(M) would recover upon progressively delaying the S2 shock.
The simple, reproductive and noninvasive method of collision is very helpful in confirming the presence of anomalous communications.

並列關鍵字

Martin-Gruber anastomosis ； median-Ulnar anastomosis ； collision study