中華民國復健醫學會雜誌
臺灣復健醫學會,刊名變更
選擇卷期
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Retrospective review of electromyographic (EMG) reports on 98 patients with clinical diagnosis of lumbar radiculopathy was performed to assess the correlation between the mean motor unit recruitment (MUR) of L5 and/or S1 innervated muscles and amplitude of compound muscle action potential (A-CMAP) in motor nerve conduction study (MNCS) of peroneal or tibial nerves. MUR was measured as the ratio of motor units to the number of firing motor units in 4 scales (from 0 to 3: 0= no motor unit potential recorded; 1= a ratio greater than 15; 2 = a ratio between 5 and 15; and 3 = a ratio less than 5). A-CMAP was measured from the baseline to the peak of the evoked muscle action potentials recorded from extensor digitorum brevis and abductor hallucis muscles for peroneal and tibial nerve respectively. It was found that the mean MUR of muscles innervated by L5+S1 roots was significantly lower (p＜0.05) in patients with EMG evidence of L5, S1, or L5+S1 radiculopathy compared to that with normal EMG findings. Mean A-CMAP of tibial nerve (but not of peroneal nerve) was significantly lower (p＜0.05) in patients with EMG evidence of L5, Sl, or L5+S1 radiculopathy compared to that with normal EMG findings. However, based on analysis of linear regression, the correlation between mean MUR and A-CMAP was very low (r＜ 0.5). This correlation was also weak (r ＜ 0.7) even when the patients with normal MURS were excluded. There was a tendency that correlation coefficients for comparison between mean MUR and A-CMAP of tibial nerve were higher than that of peroneal nerve. It is suggested that there is a poor correlation between mean MUR in EMG test and A-CMAP in MNCS in patients with lumbar radiculopathy, although both measurements are useful in the assessment of motor units loss. In patients with lumbar radiculopathy, measuring A-CMAP of tibial nerve may estimate axon loss better than that of peroneal nerve.
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腦中風病患在發病後無論於生理上、心理上均有巨大之影響，能否重回工作崗位不論對其個人之自信心、社會、人格家庭負擔及經濟上均有莫大之關係。本研究即對病患中風後能否恢復工作之相關因子做一探討。 本研究對象以民國74年8月至83年2月間曾住入基隆長庚醫院及有規律門診追蹤之腦中風病患，並符合65歲以下，中風前有固定工作或家管、中風六個月以上等條件做為調查之對象，研究方法以問卷為主配合門診檢查及電話訪問，共收集105位病患並分為兩組，其中有工作者33位（31%），無工作者72位（69%），比較兩組之年齡、性別、工作性質、經濟狀況、教育程度、腦中風之部位、肢體障礙肢程度、大小便失禁、過去病史等相關因子，全部資料以T-tes、Chisquare test及Logistic regression analysis加以統計分析。 研究結果顯示中風發生時之年齡、工作性質、中風初期是否有小便失禁及肢體障礙之程度均為統計上有意義之因子。
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phrenic nerve paralysis. For analysis influence of different level of C-SCI on phrenic nerve conduction study, we collected 51 cases including 35 cervical spinal cord injury (C-SCI) patients and 16 normal controls in this study. The patients were divided into the group A with C-SCI level above or at C4 (N=18), group B with C-SCI level below or at C5 (N=17)and group C with normal control subjects (N=16). The phrenic nerve was stimulated at the supramaximal level and the onset latency, amplitude and duration of compound muscle action potential (CMAP) were analyzed. The results are as followed : (1) The CMAP amplitude of group A is significantly less than group B and group C (P＜0.05,respectively). (2) The mean maximal CMAP amplitude is on the 7th intercostal space/anterior axillary line (ICS/AXL) of all the three groups except left side of group B. (3) When comparing the subgroup divided according to the severity of injury, we find that CMAP amplitude is lower on the more severe injury subgroup. (4)There are no difference of CMAP latency and duration in all three groups. The conclusions are as follow: (1) The CMAP amplitude of group A (high C- SCI combined with phrenic nerve injury) is significantly less than the other groups. (2) The best recording position is on the 7th intercostal space.
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「腕隧道症候群」為臨床上相當常見的神經壓迫症候群，傳統治療方法中，除手術療法外，還有保守療法，如口服消炎鎮痛藥物，維生素B的補充，局部類固醇注射或腕部護木固定等，但療效並不十分理想，近年來低能量雷治療已被醫界應用於疼痛之治療，因而嚐試以低能量雷射來治療腕隧道症候群的患者。 本研究為民國82年1月至12月間，對以臨床症狀、理學檢查，並經電學檢查證實為腕隧道症候群之患者共32名，施以低能量雷射治療12週（共36次）後，觀其療效。 結果顯示於主觀症狀中，麻木感由原先之30名（94%）降低至16名（50%），疼痛感由原先之7名（22%）降低至2名（7%），夜間不適由原先之12名（40%）降低至5名（15%），理學檢查中之Tinel's sign由16名（50%）降至5名（15%）。Phalen's test 陽性者由10名（31%）降至9名（28%）；除Phalen's test外，均達統計學上的意義，而於電學檢查之各參數，包括遠端運動傳導潛期，遠端感覺神經潛期，複合肌肉電位波振幅，感覺神經電位波振幅，遠端感覺神經傳導速度，近端運動神經傳導速度均呈現好轉的傾向，但未達統計學上的意義。所有病患於治療期間及治療後3個月之追蹤並未發現明顯之副作用。
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為明瞭復健治療患者之疾病分類狀況，本研究以八家不同醫療分級之公私立醫院進行為期一年的病例登錄，共收集14916位個案。結果發現在醫學中心，準醫學中心及區域醫院接受復健治療之病患皆以骨骼肌肉及結締組織系統為最常見之疾病，佔全部復健治療病患之51%，也是門診最常見的疾病；腦部疾患則佔15.6%次之，其中腦梗塞，腦出血為住院最常見疾病。頭部損傷、脊髓損傷等為住院常見疾病，心臟病及慢性阻塞性肺病則為照會常見疾病，而癌症僅佔所有疾病的1%。進一步探討不同年齡層之疾病分佈狀況，45歲以上之中老年人佔復健治療人口之51.9%，其中又以頸椎關節炎、腰椎關節炎、膝骨性關節炎、脊椎壓迫性骨折及股骨頸骨折等與老化有關的疾病佔了不少比例。15歲以下幼兒復健則佔10.4%，以語言障礙及腦性麻痺最為常見，其中65%集中於醫學中心接受治療。