磁電刺激於周邊神經檢查之運用

The Utility of Magnetic Stimulation in Peripheral Nerve Study

蘇王麟(Wang-Lin Su) ； 楊百嘉(Baii-Jia Yang)

《中華民國復健醫學會雜誌》 22卷1期 (1994/06) Pp. 1-8

摘要

傳統經皮電刺激神經傳導檢查，在病人有局部皮膚病變而刺激點蓋有紗布時無法順利操作。在此情況下，磁電刺激是否可代替運用，其可行性有待實驗評估。
本研究以13位年青正常人為對象．用磁電刺激器Cadwell MES-10，直徑9公分尖頭線圈．以tangential edge之方位平貼刺激各受測者肘及腕部正中神經。比較磁電刺激在前臂蓋與不蓋紗布及傳統經皮電刺激三種方式下神經傳導各項參數之差異。結果，在NCV及distal latency方面，三種刺激方式間之比較，統計上均無明顯差異。相反地，在CMAP振幅之比較，則三者間皆有異。另外，磁電刺激正中神經而同時電到尺神經之機率，在肘部約27%，在腕部為0%。綜上，我們認為，在病人因燒燙傷，壓碎傷等情形而局部蓋有紗布無法用經皮電刺激測其神經是否損傷時，磁電刺激是一個可考慮的替代方式，其較通用於評估神經是否完全損傷。現階段用來評估不完全神經損傷之程度，其可行性仍極有限。

關鍵字

磁電刺激 ； 周邊神經 ； 肌電圖

並列摘要

Clinically, we were occasionally asked to evaluate peripheral nerve injuries in patients whose local cutaneous conditions, such as burn wound, crushing wound, skin graft, and gauze overlying limb, were not suitable for percutaneous electrical stimulation or needle EMG. Could the magnetic stimulation be used in these conditions? How much potential deviation could be produced with this technique when the limbs were covered by gauze? Its our purpose to solve these questions.
Thirteen young volunteers participated in this tudy. First, we performed the motor and sensory NCV with percutaneous electrical stimulation. Then, the magnetic stimulation was performed with Cadwell MES-10, 9cm pointed coil. We stimulated the median nerve at wrist and elbow region with orientation of tangential edge. Each volunteer received magnetic stimulation with and without gauze overlying forearm respectively. The data of NCV parameters among above three different techniques were analysed. We found there was no significant difference at NCV and distal latency, but was significantly different at CMAP amplitude among three kinds of stimulation tenchniques. The costimulation of ulnar nerve in magnetic stimulation is about 27% in elbow, 0% in wrist region respectively. This study indicates that the peripheral nerves underlying gauze could be studied by magnetic stimulation, which is impossible by percutaneous electrical stimulation. Clinically, a complete peripheral nerve lesion that couldn't be evaluat ed by ES due to local cutaneous conditions such as bum wound, crushing wound, skin graft and gauze overlying limb might be studied by magnetic stimulation. But a reliable conclusion couldn't be drawn for the study of incomplete peripheral lesion by magnetic stimulation at present.

並列關鍵字

Magnetic Stimulation ； Peripheral Nerve ； EMG