外固定器牵拉腰椎对马尾诱发电位及功能的影响  

The SEP and Functional Changes of Cauda Equina Effected by External Fixator Traction in Lumbar Area

作　　者：贺西京[1] 陈君长[1] 李辉[1] 赵龙柱[1] 常浩胜 李国庆 李浩鹏[1] 史明启 杨哲[1] 

机构地区：[1]西安医科大学第二附属医院,710004

出　　处：《中国骨伤》1998年第1期12-15,共4页China Journal of Orthopaedics and Traumatology

摘　　要：为研究马尾神经对牵拉损伤的耐受极限及其在不同强度损伤下的变化过程，作者设计了动物马尾神经牵拉损伤的模型。手术将家犬Ｌ_（３、４）椎骨间连接的韧带及椎间盘彻底松解，并在Ｌ_２、Ｌ_３、Ｌ_４及Ｌ_５椎体中各穿针一枚，连接外固定器。用外固定器撑大Ｌ_（３、４），椎骨间隙，于不同的牵拉强度和时间，检测动物马尾诱发电位、下肢疼痛反射和肌力。实验发现，急性２ｃｍ牵拉损伤可引起马尾诱发电位波形降低和畸变；立即去除牵拉损伤力，马尾诱发电位波形迅速恢复正常，次日动物肌力和疼痛反射恢复正常。但持久的２ｃｍ牵拉损伤，则造成持续的马尾诱发电位降低、畸变和运动、痛觉障碍。将牵拉损伤长度增加到３ｃｍ、４ｃｍ，则见到马尾诱发电位波形进一步降低、畸变，最后消失。由此可见椎骨间分离移位，可造成椎管内神经根牵拉损伤，使马尾诱发电位波幅降低或消失，并产生运动、痛觉障碍。轻度牵拉损伤引起的神经功能障碍是可以恢复的。但严重的牵拉损伤则引起不可逆转的神经功能障碍或丧失。In order to study the endurance and the changing process of cauda equina under tractive trauma, the animal model of tractive trauma was designed. The ligament and disc between the 3rd and 4th lumbar vertebra were loosened or incised. At same time, the nails 4mm in diameter were drilled into L_2, L_3, L_4, L_5 vertebral body respectively and the other ends of nails were fixed with the external fixator. The gap between L_3 and L_4 was enlarged by external fixator traction. In different length and duration of traction, the CESEP and the pain reflex and muscular power of the posterior limbs were examined. The experimental results were shown as follows: (1) Acute traction 2cm in length can lower the amplitude of CESEP; as the traction was removed immediately, the lowered amplitude of CESEP was recovered very quickly, and on the next day, the pain reflex and muscular power were recovered ; (2) The 2cm continuous traction resulted in permanent low of CESEP and disability of movement and pain; (3) As the length of traction was increased to 3cm and 4cm, the amplitude and,form of CESEP became more abnormal, and at last it vanished. The results showed that separated displacement of the lumbar vertebras can result in the tractive trauma of cauda equina and thus the amplitude of CESEP is lowered or vanished and the pain reflex and muscular power is abnormal. As the tractive trauma is light, the nerve function can be recovered after removing tracting force ; as the tractive trauma is serious, the disability of nerve function will be irreversible.

关 键 词：马尾诱发电位 外固定器 腰椎 

分 类 号：R687.3[医药卫生—骨科学]