评估兔坐骨神经急性挤压伤扩散张量成像与肌电图对比研究  

Evaluation of Acute Crush Injury of The Sciatic Nerve in Rabbits: A Comparative Study of Diffusion Tensor Imaging and Electromyography

作　　者：万齐[1] 余煜栋 李新春[1] 许启锋[2] 雷强[1] 包盈莹 王鹏[1] 彭玉 WAN Qi;YU Yudong;LI Xinchun(Department of Radiology,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong Province 510120,P.R.China)

机构地区：[1]广州医科大学附属第一医院放射科,510120 [2]广州医科大学附属第一医院肌电图室,510120 [3]惠州市中心人民医院放射科,516008

出　　处：《临床放射学杂志》2020年第6期1220-1224,共5页Journal of Clinical Radiology

基　　金：国家自然基金项目(编号:81171800);广东省科技计划项目(编号:2016A020215168)

摘　　要：目的对比扩散张量成像(DTI)与复合肌肉动作电位(CMAP)评估兔周围神经挤压伤的准确性。方法选用健康新西兰大白兔27只,选取右后肢作为损伤侧,建立坐骨神经损伤与修复模型,左侧为假手术侧。于术前、术后1天、3天、1周、2周、4周、6周及8周各时间点行肌电图检查,后行MRI扫描观察损伤段神经及周围肌肉的信号改变。随机于各时间点各取2只兔的损伤段坐骨神经进行病理检查。MRI及肌电图数据分析采用在各时间点均有完整数据的11只兔进行分析。结果损伤段神经第1天各向异性分数(FA)值明显下降至最低点;3天~8周FA值逐步上升,各时间点的FA值的差异均有统计学差异(P均<0.001)。损伤后第1天表观扩散系数(ADC)值明显升高,此后ADC逐渐降低,3天~6周各时间点两侧ADC值差异均无统计学意义,两侧ADC值仅在第8周差异有统计学意义(P=0.038)。损伤后各时间点双侧腓肠肌CMAP波幅差异均有统计学意义(P均<0.001)。结论肌电图与DTI均为评估周围神经急性挤压伤的敏感手段,但对于周围神经再生的改变,DTI可能较CMAP更为敏感。Objective To compare the accuracy of diffusion tensor imaging(DTI)and compound muscle action potential(CMAP)in the evaluation of sciatic nerve crush injury in rabbits.Methods A total of 27 healthy New Zealand white rabbits were selected and the right hind limb was selected as the injured side to establish a sciatic nerve injury and repair model.The left side was the sham surgical side.Parallel electromyography and MRI scanning were performed to observe the changes of signals of the injured nerves and surrounding muscles at the time points of preoperative,1 day,3 days,1 week,2 weeks,4 weeks,6 weeks and 8 weeks,respectively.At each time point,2 rabbits were randomly selected from the injured sciatic nerves for pathological examination.MRI data analysis was performed on 11 rabbits with complete data at each time point.Results FA decreased to the lowest level at 1 day,then gradually increased from 3 days to 8 weeks.FA values of the two groups were statistically different at each time point(all P<0.001).The ADC significantly increased at 1 day,then gradually decreased.There was no significant difference in the ADC values on both sides at each time point,except for 8 weeks(P=0.038).The CMAP of bilateral gastrocnemius at each time point was statistically significant(all P<0.001).Conclusion Electromyography and DTI are sensitive methods to evaluate the acute crush injury of peripheral nerves,however,DTI may be more sensitive to the changes of peripheral nerve regeneration than CMAP.

关 键 词：周围神经损伤 扩散张量成像 磁共振成像 肌电图 复合肌肉动作电位 

分 类 号：R651.3[医药卫生—外科学] R-332[医药卫生—临床医学]