摘要目的 探讨平山病患者屈颈位与颈椎中立位F波的差异.方法 本研究于2010年5月至2014年3月施行,共纳入健康志愿者25名及平山病患者22例.平山病患者均为男性,年龄15 ～44岁,身高165 ～183 cm,病程6～240个月.所有研究对象于颈椎中立位及屈曲位(屈曲45 °,维持30 min)时分别行双侧正中神经及尺神经F波检测.组间数据比较采用独立样本t检验,中立位及屈颈位的比较采用配对资料t检验或Fisher确切概率法.结果 对照组屈颈位和中立位F波诸参数差异无统计学意义,且无论屈颈与否都未记录到重复F波.患者组中立位时,症状较重侧尺神经F波的响应频率(=5.209,P=0.000)、最小潜伏期(t=23.843,P=0.006)及平均潜伏期(t=4.731,P =0.022)等参数都较对照组下降或延长,3例患者出现重复F波;正中神经F波的异常则主要为双侧响应频率的明显下降(t=23.696、23.998,均P=0.000),且症状较重侧5例患者存在重复F波.屈颈位时,症状较重侧尺神经F波的平均波幅(t=-3.322,P=0.003)、最大波幅(t=-2.552,P=0.019)、持续时间(t=-3.323,P=0.003)、响应频率(t=-2.604,P=0.017)及重复F波的数目(9/22)(P=0.044)都较颈椎中立位时明显增加,并且10例尺神经F波消失的患者5例再次诱发F波;而症状较重侧正中神经则主要以平均波幅(t=-2.188,P=0.040)、最大波幅(t=-3.847,P=0.001)及响应频率(t=-2.421,P=0.025)的增加为主要表现,并且6例正中神经F波消失的患者1例再次诱发F波.结论 平山病患者屈颈位F波较颈椎中立位时存在明显的规律性改变,尤以F波波幅的异常增大最为明显.

abstractsObjective To identify whether there is significant changes between the cervical neutral F-waves and cervical flexion F-waves in the patients with Hirayama disease.Methods This study was performed on 25 normal subjects and 22 male patients with identified Hirayama disease (age:15 to 44 years; height:165 to 183 cm; duration:6 to 240 months) between May 2010 and March 2014.Both cervical flexion F-wave (cervical flexion 45 °,30 minutes) and conventional F-waves to median nerve stimulation and to ulnar nerve stimulation were performed in all subjects bilaterally.Results were analyzed by t-test or Fisher exact probability.Results In the normal subjects,all measurements of the bilateral F-waves didn't have any difference between the cervical flexion position and the cervical neutral position.On the cervical neutral position,the persistence (t =5.209,P =0.000),average latencies (t =4.731,P =0.022) and minimal latencies (t =23.843,P =0.006) of ulnar F-wave on the symptomatic heavier side from the patients with identified Hirayama disease were significantly lower or longer than those from the normal subjects,and the repeat F-waves were found in 3 patients (13.6％).On the symptomatic lighter side,the ulnar F-waves only had lower persistence (t =22.306,P =0.001) along with 5 repeat F-waves.Only lower persistence were found in the median F-wave on the both side (higher side t =23.696,P =0.000 ; lighter side t =23.998,P =0.000),along with 5 (22.7％) repeat F-waves on the symptomatic heavier side and 6 (27.3％) ones on the symptomatic lighter side.After cervical flexion maintaining 30 minutes,the increased maximal amplitudes (t =-2.552,P =0.019),average amplitudes (t =-3.322,P =0.003),duration (t =-3.323,P =0.00),persistence (t =-2.604,P =0.017) and frequency of repeat F-waves (9/22,41％) (P =0.044) were found on the symptomatic heavier side of ulnar F-wave,and 5 of 10 absent ulnar F-wave on the cervical neutral position were also recover.The median F-wave on the symptomatic heavier side mainly had increased maximal amplitude (t =-3.847,P =0.001),average amplitudes (t =-2.188,P =0.040) and persistence (t =-2.421,P =0.025),and 1 of 6 absent median F-wave on the cervical neutral position were also recover after cervical flexion.Conclusion The cervical flexion F-waves have significant regular changes compared to the cervical neutral F-waves in patients with Hirayama diseases,especially maximal and average amplitudes of F-waves.