肌电图对多节段腰椎退行性疾病责任节段定位的诊断价值

发布时间：2018-02-05 21:42

本文关键词： 多节段腰椎退行性疾病责任节段肌电图　出处：《中国脊柱脊髓杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的 :评估肌电图(electromyography,EMG)对多节段腰椎退行性疾病责任节段定位的诊断价值。方法:2007年1月~2015年1月收治多节段腰椎退行性疾病手术患者342例,男174例,女168例;平均年龄69.2岁,其中腰椎管狭窄症180例,腰椎管狭窄症合并腰椎间盘突出症95例,腰椎管狭窄症合并腰椎滑脱症55例,腰椎管狭窄症合并腰椎退行性侧凸12例。根据症状、体征和影像学检查确定责任节段224例,行神经根阻滞术确定责任节段118例。行单节段减压手术95例,双节段减压手术212例,3节段减压手术35例。术前对患者下肢运动神经和感觉神经进行神经传导检测,对下肢肌肉和腰骶部椎旁肌进行针电极EMG检测,对比目鱼肌进行H反射检测。所检测肌肉的针电极EMG出现失神经电位即纤颤电位、正锐波及复合重复放电(complex repetitive discharge,CRD)时,提示有神经损害;神经传导检测中运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经传导速度(sensory nerve conduction velocity,SCV)的异常标准:MCV40m/s,SCV39m/s;患侧H反射消失或双侧潜伏期差值1.5ms,提示存在S1神经根病变损害可能。EMG检测的灵敏度=EMG检测结果阳性与手术减压吻合的节段数/EMG检测所有节段中手术减压的节段总数,特异性=EMG检测结果阴性与未手术减压吻合的节段数/EMG检测所有节段中未手术减压的节段总数。结果 :针电极EMG部分,正锐波和纤颤电位判定责任节段的灵敏度为72.5%,特异性为87.2%;CRD判定责任节段的灵敏度为8.7%,特异性为100%;宽大和多相的运动单位电位(motor unit potential,MUP)判定责任节段的灵敏度为92.2%,特异性为18.2%。神经传导检测部分,342例患者中,89例患者胫神经、101例患者腓总神经的肌肉复合动作电位(compound muscle action potential,CMAP)幅值降低,其中45例患者(病程3年)在趾短伸肌记录不到CMAP,但在胫前肌可记录到低幅值、速度正常的CMAP;所有患者胫神经、腓总神经运动传导速度正常,腓浅神经和腓肠神经的感觉传导正常。217例患者H反射消失,54例患者H反射潜伏期较健侧延长1.5ms。结论:CRD、正锐波和纤颤电位对诊断多节段腰椎退行性疾病责任节段的灵敏度和特异性较高,而MUP对责任节段的诊断价值较小。
[Abstract]:Objective: to evaluate electromyography (EMG). Methods: from January 2007 to January 2015, 342 patients with multilevel lumbar degenerative disease were treated. 174 males and 168 females; The average age was 69.2 years, including 180 cases of lumbar spinal stenosis, 95 cases of lumbar spinal stenosis with lumbar disc herniation and 55 cases of lumbar spondylolisthesis. There were 12 cases of lumbar spinal stenosis complicated with lumbar degenerative scoliosis. 224 cases were determined according to symptoms, signs and imaging examination. 118 cases were identified by nerve root block, 95 cases by single segment decompression and 212 cases by double segment decompression. Nerve conduction of motor nerve and sensory nerve of lower extremity and needle electrode EMG of lower extremity muscle and lumbosacral paravertebral muscle were detected by 3 segment decompression operation in 35 cases. The H reflex of soleus muscle was detected. The denervated nerve potential or fibrillation potential was found in the needle electrode EMG of the detected muscle. It was suggested that there was nerve damage in complex repetitive discharges (CRDs) with positive and complex repeated discharges. Motor nerve conduction velocities (MCV). The abnormal standard for sensory nerve conduction SCVs is: MCV 40 m / s. SCV 39m / s; The H-reflex of the affected side disappeared or the difference of bilateral latency was 1.5 Ms. The sensitivity of EMG was positive to the number of segments that were consistent with operative decompression and the total number of segments detected by EMG in all segments. The specific EMG results were negative to the number of segments that were consistent with the unoperated decompression. EMG was used to detect the total number of unoperated decompression segments in all segments. Results: the needle electrode EMG part. The sensitivity of positive sharp wave and fibrillation potential in determining the responsible segment was 72.5 and the specificity was 87.2; The sensitivity of CRD was 8.7 and the specificity was 100. The sensitivity of the broad and multiphase motor unit potentialMUPU to determine the responsible segment was 92.2%. The specificity was 18.20.The nerve conduction test was performed in 342 patients, 89 of them had tibial nerve. The compound muscle action potential CMAPs of the common peroneal nerve were decreased in 101 patients. CMAPs were not recorded in extensor digitorum brevis in 45 patients (course of disease 3 years), but CMAPs with normal velocity and low amplitude were recorded in the anterior tibial muscles. The motor conduction velocity of tibial nerve, common peroneal nerve and sensory conduction of superficial peroneal nerve and sural nerve were normal in all patients. The latency of H reflex in 54 patients was longer than that in normal side by 1.5 ms.Conclusion the sensitivity and specificity of head CRD, positive sharp wave and fibrillation potential in the diagnosis of multilevel lumbar degenerative disease are higher than those of normal side. The diagnostic value of MUP to the responsible segment was small.
【作者单位】：复旦大学附属华山医院骨科;
【分类号】：R681.5

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