Selective stimulation of human intrinsic laryngeal muscles: Analysis in a mathematical three-dimensional space.

人类固有喉肌的选择性刺激: 数学三维空间中的分析。

  • 影响因子：0
  • DOI：10.1002/lary.28184
  • 作者列表："Broniatowski M","Grundfest-Broniatowski S","Schiefer M","Ludlow DH","Broniatowski DA","Tucker HM
  • 发表时间：2020-04-01

OBJECTIVES/HYPOTHESIS:Standard stimulating methods using square waves do not appropriately restore physiological control of individual intrinsic laryngeal muscles (ILMs). To further explore our earlier study of evoked orderly recruitment by quasitrapezoidal (QT) currents, we integrated the contribution of the cricothyroideus (CT) with attention to mutual activation in an additional patient, based on recent studies of appropriate responses via strict recurrent laryngeal nerve (RLN) stimulation. STUDY DESIGN:Basic science study. METHODS:The patient received functional electrical stimulation (FES) with QT pulses at 5 Hz, 60 to 2,000 μAmp, 100 to 500 μs pulse width, 0 to 500 μs decay. Ipsilateral electromyography (EMG) responses were calculated using the average maximum amplitude, area under the curve, and the root mean square of the rectified amplitude waveforms. The thyroarytenoideus (TA), posterior cricoarytenoideus (PCA), lateral cricothyroideus (LCA), and the CT were each interrogated via two monopolar electrodes, values were recorded in MATLAB, exported to Excel, and analyzed. Individual and mutual recruitment configurations and activation delays with stimulation were explored using multiple regression and exploration factor analyses. RESULTS:A total of 868 EMG data points based on 18 trials and up to 11 subtrials were captured from each of the four ILMs. Various combinations of pulse amplitude, pulse width, and exponential decay were found to produce significant (P ≤ .001) individual ILM responses. CT mirrored the LCA, whereas the TA and PCA exhibited separate interactions along shared trajectories in a three-dimensional space. CONCLUSIONS:FES calibrated to individual and coupled ILMs offers promise for restoring normal and pathological contraction patterns via strict RLN stimulation. LEVEL OF EVIDENCE:5 Laryngoscope, 130:967-973, 2020.


目的/假设: 使用方波的标准刺激方法不能适当地恢复个体固有喉肌 (ilm) 的生理控制。为了进一步探索我们早期通过QT电流诱发有序募集的研究，我们基于最近通过严格喉返神经 (RLN) 刺激的适当反应研究，将环甲肌 (CT) 的贡献与对额外患者相互激活的关注结合起来。 研究设计: 基础科学研究。 方法: 患者接受功能性电刺激 (FES)，QT脉冲为5Hz，60至2,000 μ amp，100至500 μ s脉冲宽度，0至500 μ s衰减。使用平均最大振幅、曲线下面积和整流振幅波形的均方根计算同侧肌电图 (EMG) 反应。通过两个单极电极分别检查甲状腺腱鞘 (TA) 、后环腱鞘 (PCA) 、外侧环腱鞘 (LCA) 和CT，在MATLAB中记录值，输出到Excel中，并进行分析。使用多元回归和探索因子分析探索了刺激的个体和相互招募配置和激活延迟。 结果: 基于18项试验和多达11项子试验，从4项ilm的每一项中总共捕获了868个EMG数据点。发现脉冲幅度、脉冲宽度和指数衰减的各种组合产生显著 (P ≤.001) 的个体ILM反应。CT反映了LCA，而TA和PCA在三维空间中沿共享轨迹表现出单独的相互作用。 结论: 针对个体和耦合ILMs校准的FES提供了通过严格RLN刺激恢复正常和病理性收缩模式的前景。 证据级别: 5喉镜，130:967-973，2020。

关键词： 三维喉操作


来源期刊：European radiology


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