正中神经体感诱发电位在脊髓型颈椎病手术预后评估中的作用  

Using median nerve somatosensory evoked potentials for prognosis of cervical spondylotic myelopathy surgery

作　　者：胡勇[1] 丁宇[2] 阮狄克[2] 黄一华[1] 张文智[1] 陆瓞骥[1] 

机构地区：[1]香港大学 矫形及创伤外科学系 [2]海军总医院骨科,北京100037

出　　处：《中国骨与关节外科》2009年第1期4-8,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：目的回顾性分析正中神经体感诱发电位(somatosensory evoked potential,SEP)的检测结果和分型在脊髓型颈椎病(cervical spondylotic myelopathy,CSM)手术预后评估中的作用。方法随访76例接受手术治疗的CSM患者,男49例,女27例;年龄55～74岁,平均62.4岁。将术前检测SEP的波形分为5型:Ⅰ型为正常SEP,Ⅱa型为单独幅值异常,Ⅱb型为单独潜伏期异常,Ⅲ型为幅值和潜伏期同时异常,Ⅳ型为SEP消失。根据术前和术后随访的JOA评分评估临床症状和计算康复率,统计分析SEP与临床数据之间的相关性。结果SEPⅠ型18例,Ⅱa型16例,Ⅱb型17例,Ⅲ型14例,Ⅳ型11例。SEP与术前JOA评分有显著相关性(x^2=53.9,P<0.05)。比较术后2年随访时的康复率发现Ⅰ型和Ⅱa型、Ⅱb型和Ⅲ型之间无显著性差异,而Ⅰ型和Ⅱa型、Ⅱb型和Ⅲ型、Ⅱb型和Ⅳ型之间有显著性差异(独立样本检验,P<0.05)。结论SEP分型为临床提供客观、有价值的信息,有助于准确了解脊髓的受损程度和评估手术预后。Objective To clarify the prognostic value of median nerve somatosensory evoked potential （SEP） for outcomes of cervical spondylotie myelopathy （CSM） with surgical management. The measurement of SEP was classified and correlated with the clinical evaluation after cervical surgery. Methods Totally 76 cases of CSM undergone surgical treatment were selected and retrospective studied. Patients were divided into five groups according to the classification of their preoperative SEP waveforrns. Group Ⅰ patients had normal SEPs, group Ⅱ a had normal latency and abnormal amplitude, group Ⅱb had abnormal latency and normal amplitude, group Ⅲ had abnormal latency and amplitude, and group Ⅳ had immeasurable waveforms. The waves of SEP were classified, the pathological changes of spinal cords were esti-mated, and the clinical improvement rate according to Japanese Orthopaedic Association （JOA） scores was calculated. The clinical evaluation, JOA improvement rate in different groups were compared by the Kruskal-Wallis test. Results Examinations of SEP showed 18 cases of Type Ⅰ, 16 cases of Type Ⅱa, 17 cases of Type Ⅱb, and 14 cases of Type Ⅲ and Ⅱ cases of Type Ⅳ. The analysis between the classifications of SEP and the clinical state in JOA score presented good correlation （ Pearson＇s Chi -square test,X^2= 53.9,P〈0.05）. The recovery ratio was significantly higher in groups Ⅰand Ⅱ a than in all the other groups （ Kruskal-Wallis test, P 〈 0. 05）, and in groups Ⅱ b and Ⅲ than in group Ⅳ （Kruskal-Wallis test, P 〈 0. 05）. Conclusion SEPs technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Median nerve SEP recording is sensitive in detecting spinal cord function, and can be identified as a prognostic factor. Classified SEPs are well correlated with CSM disability, and those with normal latencies seem to forecast a relatively better outcome.

关 键 词：颈椎病 正中神经 诱发电位 躯体感受 

分 类 号：R687.3[医药卫生—骨科学]