肌电图在腰骶神经根压迫性损伤定位诊断中的价值  

The value of electromyography in localizing lumbosacral radiculopathy

作　　者：冯淑艳[1] 李六一[1] 朱愈[2] 宋新光[1] 

机构地区：[1]河南省人民医院神经电生理室,郑州450003 [2]美国纽约州立大学上州医学院康复医学科

出　　处：《中华物理医学与康复杂志》2014年第8期614-616,共3页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的探讨针肌电图（EMG）在腰骶神经根压迫性损伤定位诊断中的应用价值，明确其定位诊断的准确性。方法选取腰椎间盘突出症合并神经根压迫的患者198例，所有患者于术前行针EMG检测，并定位存在压迫性损伤的神经根，将所得结果与术中探查所见进行对比。采用神经传导检测（NCS）检查胫神经及腓总神经的运动传导、腓肠及腓浅神经的感觉传导和H反射。结果EMG对病程在3周以上患者的阳性检测率（90．0％）高于病程在3周以内患者的阳性检测率（21．1％）（P〈0．05）。在EMG异常患者中，定位诊断的准确率为92．1％。NCS检查中，46例患者胫神经、52例患者腓总神经的复合肌肉动作电位（CMAP）波幅降低，异常率为49．4％。所有患者胫神经、腓总神经的运动传导速度正常，腓浅神经和腓肠神经的感觉传导正常，其中45例患者H反射消失，33例患者H反射潜伏期较健侧延长1．5ms以上（P〈0．05）。结论EMG对病程3周以上的腰骶神经根压迫性损伤患者的阳性诊断率高，联合NCS检测对神经根损害有较高的诊断价值，值得临床应用、推广。Objective To evaluate the accuracy of electromyography （EMG） in localizing the compressed nerve root in lumbar intervertebral disc protrusion （LIDP） pre-operatively. Methods Data were collected on 198 cases of LIDP. Of those, 152 cases had positive EMG findings and were treated surgically to relieve compression of the nerve roots caused by LIDP. The intra-operative findings were compared with the pre-operative EMG findings. Results The sensitivity of EMG in detecting radiculopathy was 76.8% （ 152/198）. Among those 152 EMG positive cases, 140 were confirmed in the subsequent operation （92.1%） , 24 clinically suspected cases of single L5 or S1 compression had indicated of both L5 and S1 damage by EMG and subsequently confirmed on surgical exploration. Conclusions Almost all preoperative EMG findings were confirmed in the subsequent operations （92.1%）. Moreover, the indication of combined double nerve root damage by EMG was valuable for guiding the surgical procedure.

关 键 词：腰椎间盘突出症 神经根受压 肌电图诊断 

分 类 号：R681.5[医药卫生—骨科学]