经颅磁刺激运动诱发电位对脊髓损伤的评价及法医学意义  

The Evaluation of SCI by TMS-MEP and Its Forensic Significance

作　　者：杨蕾 刘兴本[2] 朱镕霆 徐晓明[2] 郑传斐[2] 周禹鑫[3] 

机构地区：[1]新联司法鉴定所,浙江嘉兴314000 [2]中国医科大学法医学院,辽宁沈阳110001 [3]中国医科大学附属盛京医院康复中心,辽宁沈阳110001

出　　处：《法医学杂志》2013年第3期172-175,共4页Journal of Forensic Medicine

摘　　要：目的为脊髓损伤(spinal cord injury,SCI)的法医临床学鉴定寻找客观且准确的检查方法。方法采用经颅磁刺激运动诱发电位(transcranial magnetic stimulation-motor evoked potential,TMS-MEP)测定68例SCI患者(颈段损伤23例,胸腰段损伤45例)拇短展肌和胫前肌的皮层起始潜伏期、N1峰潜伏期、中枢运动传导时间(central motor conduction time,CMCT)和波宽,并以30例正常人作为对照,比较两组差异。结果实验组随拇短展肌、胫前肌肌力下降或消失,皮层起始潜伏期、N1峰潜伏期、CMCT延长,波宽增宽,且实验组中的2、3级肌力者上述指标均高于对照组(P<0.05)。结论 TMS-MEP检测可以直接、客观地反映脊髓锥体束的运动功能状态,为法医学鉴定提供更客观、准确的依据。Objective To find an objective and accurate examination for evaluation of spinal cord injury （SCI） in forensic clinical medicine. Methods The onset latency of cortex, peak latency of N1, central motor conduction time （CMCT） and wave width of the abductor pollicis brevis and the anterior tibialis were calculated by transcranial magnetic stimulation-motor evoked potential （TMS-MEP）. The data of 68 patients suffered from SCI including 23 cervical levels and 45 thoracolumbar levels were collected and compared with that of 30 normal controls. Results In experimental group, when the muscle strength of the abductor pollicis brevis or the anterior tibialis decreased or disappeared, the onset latency of cor- tex, the peak latency of N1, and CMCT prolonged and the wave width broadened. And these indexes of grade 2 and 3 muscle strength in experimental group were higher than that in the control group （P〈0.05）. Conclusion The TMS-MEP can determine directly and objectively the motor functional status of pyramidal tract of spinal cord in order to provide more accurate and objective evidences in forensic medicine.

关 键 词：法医学 脊髓损伤 诱发电位 运动 经颅磁刺激 

分 类 号：DF795.1[医药卫生—法医学]