美国 Nicolet 肌电图/神经传导/诱发电位/术中监护系统 Nicolet EDX

摘要 · 中文整理：目的：结合喉运动神经传导检查（LMCS）对喉肌电图特征进行定量，以评估喉神经损伤。方法：纳入 809 例单侧声带麻痹患者，对患侧甲杓肌（TA）、环杓后肌（PCA）和环甲肌（CT）的异常自发电活动、运动单位电位（MUP）、募集相及联带运动进行定量测量；计算 LMCS 中记录到复合肌肉动作电位的比例，据此将肌肉分为 LMCS+ 与 LMCS− 组，并在两组之间确定募集相的截断值。结果：喉肌纤颤电位波幅 90–100 μV、时限 2.2–2.4 ms，正锐波波幅 80–90 μV、时限 4.8–5.0 ms；异常 MUP 波幅较正常增高，时限延长至 6.16 ± 1.02 ms、6.57 ± 1.32 ms 和 6.19 ± 1.19 ms（P < 0.01）；异常募集相的波幅和转折数显著小于正常喉肌（P < 0.01），混合相和单纯相的转折数分别为完全干扰相的 30% 和 20–25%；在混合相中 LMCS− 组波幅更小，TA、PCA、CT 的截断值分别为 298.50 μV、355.00 μV 和 379.50 μV。结论：波幅和时限是识别喉肌异常自发电活动和 MUP 的关键参数，其中时限特异性更高；结合 LMCS 得出的波幅截断值，减少的转折数有助于区分募集相类型，从而评估喉神经损伤程度。

原文摘要：OBJECTIVES: To quantify characteristics of laryngeal electromyography with the laryngeal motor conduction study (LMCS) for evaluating laryngeal nerve injury. METHODS: This study included 809 patients with unilateral vocal fold paralysis. Quantitative parameters were measured on abnormal spontaneous activity, motor unit potential (MUP), recruitment patterns, and synkinesis of the affected thyroarytenoid (TA), posterior cricoid (PCA), and cricothyroid (CT) muscles. The proportion of recorded compound muscle action potential in LMCS was calculated to further divide muscles into LMCS+ and LMCS- groups, between which cut-off values for recruitment patterns were determined. RESULTS: In laryngeal muscles, amplitudes of fibrillation potentials were 90-100 μV and durations were 2.2-2.4 milliseconds, which were of 80-90 μV and durations of 4.8-5.0 milliseconds in positive sharp waves. Amplitudes of abnormal MUP showed increased amplitude compared to the normal, with prolonged durations of 6.16 ± 1.02 milliseconds, 6.57 ± 1.32 milliseconds, and 6.19 ± 1.19 milliseconds (P < 0.01). The amplitude and turns of abnormal recruitment were significantly smaller than those of normal laryngeal muscles (P < 0.01), with turns in the mixed and simple pattern being 30% and 20-25% of the full interference pattern, respectively. In mixed patterns, the LMCS- group exhibited smaller amplitudes, with cut-off values at 298.50 μV, 355.00 μV and 379.50 μV for TA, PCA and CT muscles. CONCLUSIONS: Amplitude and duration are critical parameters for identifying abnormal spontaneous activity and MUP in laryngeal muscles, with duration being of higher specificity. Combined with LMCS-derived cut-off values for amplitude, the reduced turns can help distinguish recruitment patterns to assess the degree of laryngeal nerve injury.

关键词：喉肌电图、喉运动神经传导检查、喉神经损伤、定量分析、声带麻痹

研究目标：解决喉肌电图判读缺乏定量标准的问题，建立喉肌异常自发电活动、运动单位电位与募集相的定量参数，并结合喉运动神经传导检查评估喉神经损伤的程度。

主要结论：波幅与时限是识别喉肌异常自发电活动和 MUP 的关键参数且时限特异性更高；结合 LMCS 得出的 TA、PCA、CT 波幅截断值及转折数减少程度，可区分募集相类型并评估喉神经损伤程度。

创新点：基于 809 例大样本首次系统给出喉肌纤颤电位、正锐波、异常 MUP 及各类募集相的定量参考值，并创新性地将喉肌电图定量指标与喉运动神经传导检查结合，提出分肌肉的波幅截断值用于分级喉神经损伤。

后续建议：纳入健康对照与不同病程分层，建立年龄与性别校正的正常参考区间；开展前瞻性随访，验证定量指标对声带功能恢复的预测价值；引入自动化或人工智能算法实现自发电活动与募集相的自动定量；在多中心、不同型号肌电图仪上验证截断值的可重复性

APA 引文：Lin, Y., Cheng, L., Li, X., Hu, R., & Xu, W. (2026). Quantification of laryngeal electromyography combined with laryngeal motor conduction study for evaluating laryngeal nerve injury. Journal of Voice. Advance online publication. https://doi.org/10.1016/j.jvoice.2025.12.005

仪器引用：An electromyography instrument (Nicolet Viking Quest, US) was used for the examination. The concentric needle electrode was inserted transcutaneously into the intrinsic laryngeal muscles, including the thyroarytenoid muscle (TA), posterior cricoarytenoid muscle (PCA), and cricothyroid muscle (CT).

摘要 · 中文整理：单侧声带麻痹（UVFP）源于喉肌功能障碍并损害嗓音空气动力学。本研究对134例不累及环甲肌的UVFP患者进行定量喉肌电图（LEMG）与空气动力学分析，探讨喉肌功能障碍如何影响嗓音空气动力学。结果显示甲杓肌-环杓侧肌（TA-LCA）复合体的turn ratio是气流和功率下降、效率提高的稳健因素，环甲肌对称性改善了空气动力学阻力。保留的TA-LCA功能减少发声时的漏气，而对称的环甲肌激活增强喉阻力。TA-LCA复合体的残余功能有助于减少漏气、减轻发声努力度并提升空气动力学效率。

原文摘要：Unilateral vocal fold paralysis (UVFP) results from dysfunction of the laryngeal muscles and impairs voice aerodynamics. This study examined how laryngeal muscle dysfunction affects voice aerodynamics using quantitative laryngeal electromyography (LEMG) and aerodynamic analysis in 134 UVFP patients without cricothyroid involvement. The turn ratio of TA-LCA muscles was a robust factor in the decrease in airflow and power while increasing efficiency, and cricothyroid muscle symmetry improved aerodynamic resistance. Preserved thyroarytenoid-lateral cricoarytenoid (TA-LCA) function reduces air leakage during phonation, whereas symmetric cricothyroid activation enhances laryngeal resistance. The residual function of the TA-LCA muscle complexes facilitates less air leakage and alleviates voice effort, enhancing aerodynamic efficiency.

关键词：单侧声带麻痹、喉肌电图、空气动力学

研究目标：阐明单侧声带麻痹患者喉肌（TA-LCA 复合体与环甲肌）残余神经肌肉功能与发声空气动力学参数之间的关系，解释喉神经肌肉控制如何影响声门功能。

主要结论：患侧 TA-LCA 与 CT 峰值转折频率均低于健侧；TA-LCA 残余功能减少漏气与功率耗散、提高气动效率，而 CT 肌对称性代偿提高气动阻力；TA-LCA 去神经可引起 CT 不对称代偿从而恶化空气动力学。

创新点：首次以大样本（134 例）定量喉肌电图转折频率指标联合空气动力学测量，揭示无环甲肌受累的 UVFP 患者仍存在患侧环甲肌抑制，并通过逐步回归量化两组喉肌对不同空气动力学参数的独立贡献。

后续建议：纳入环甲肌受累患者进行分层比较，验证结论的普适性；增加术后或注射喉成形术前后的纵向随访，评估肌电指标对疗效的预测价值；联合嗓音声学与主观嗓音评估建立多模态预测模型；采用自动化转折分析算法减少人工分段带来的主观差异

APA 引文：Chung, W.-L., Liu, K.-C., Chuang, H.-F., Lu, Y.-A., Li, H.-Y., Wong, A. M. K., Pei, Y.-C., & Fang, T.-J. (2022). Aerodynamic performance and neuromuscular control in patients with unilateral vocal fold paralysis. Diagnostics, 12(12), 3124. https://doi.org/10.3390/diagnostics12123124

仪器引用：The LEMG activity of bilateral TA-LCA muscle complexes and cricothyroid muscles was recorded through the concentric needle electrode using the Nicolet Viking Select system (Cardinal Health, Dublin, OH, USA) with a ground-surface electrode adhered to the forehead.