经颅电刺激运动诱发电位对急性坐骨神经损伤兔模型的评估价值  

Evaluation value of transcranial electrical stimulation motor evoked potential in acute sciatic nerve injury model of rabbits

作　　者：周云飞 郝帅 宋启民[3] Zhou Yunfei;Hao Shuai;Song Qimin(Binzhou Medical College,Binzhou 274900,China;Department of Neurosurgery,Juye County People′s Hospital,Juye 274900,China;Department of Neurosurgery,Linyi City People′s Hospital,Linyi 276000,China)

机构地区：[1]滨州医学院,在读研究生256600 [2]巨野县人民医院神经外科,274900 [3]临沂市人民医院神经外科,276000

出　　处：《中华诊断学电子杂志》2019年第1期48-53,共6页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：山东医药卫生科技发展计划面上项目(2015WS0375)

摘　　要：目的探讨经颅电刺激运动诱发电位(Tce MEP)对发现兔急性坐骨神经根损伤的敏感性及Tce MEP早期波形变化对急性坐骨神经根部损伤的评估价值。方法新西兰大白兔12只24条坐骨神经随机区组法分3组,实验组分为1个血管夹组(n=8),2个血管夹组(n=8)和对照组(n=8);实验组分别应用1个或2个血管夹夹压坐骨神经根部建立急性坐骨神经损伤模型,观察并记录2 h坐骨神经根部受夹压损伤急性期Tce MEP的变化特点,并记录Tce MEP波形稳定后的波幅与基线波幅比值和潜伏期;对照组仅手术分离出坐骨神经而不夹压坐骨神经,用于排除麻醉药和手术操作对Tce MEP的影响; 2 d后应用Tarlov评分对各组兔下肢运动功能进行评估。应用配对t检验,单因素方差分析,秩和检验和Speraman相关性进行统计学分析。结果实验组1个血管夹组经过[0. 20(0. 00,0. 431)]min Tce MEP波形开始变化,经过[2. 60(1. 40,3. 35)]min波形平稳; 2个血管夹组经过[0. 35(0. 05,1. 63)]min Tce MEP波形开始变化,经过[4. 45(2. 83,5. 65)]min波形平稳。1个和2个血管夹组手术后Tce MEP波形平稳后波幅与基线波幅百分比[(49. 84±15. 27)%,(15. 47±12. 64)%]均低于手术前[(100. 00±0. 00)%,(100. 00±0. 00)%],均差异有统计学意义(t=9. 293,18. 912;均P <0. 01);对照组和实验各组手术后Tce MEP波形平稳后波幅与基线波幅百分比比较,差异有统计学意义(F=110. 196,P <0. 05)。1个和2个血管夹组手术后Tce MEP波形平稳后潜伏期[(12. 60±0. 61) ms,(14. 29±1. 24) ms]高于手术前Tce MEP潜伏期[(12. 21±0. 59) ms,(12. 31±1. 10) ms],均差异有统计学意义(t=7. 519,5. 721;均P <0. 05);对照组和实验各组手术后Tce MEP波形平稳后潜伏期比较,差异有统计学意义(F=6. 702,P <0. 05)。1个血管夹组和2个血管夹组夹压后2 d下肢运动功能评分[4. 00(3. 00,4. 00),2. 50(2. 00,3. 00)],低于夹压前[5. 00(5. 00,5. 00),5. 00(5. 00,5. 00)],均差异有统计学意义(Z=-2. 598Objective To explore the sensitivity of transcranial electrical stimulation motor evoked potential(TceMEP)after acute sciatic nerve root injury in rabbits and the evaluation value of its early waveform changes after acute sciatic nerve root injury.Methods Twelve New Zealand rabbits with 24 sciatic nerves were divided into 3 groups by random grouping method,one vascular clamping group(n=8),two vascular clamping groups(n=8)and the control group(n=8).The acute sciatic nerve injury model was established by using one or two vascular clamp compression of the sciatic nerve root,the TceMEP was recorded for 2 hours to observe the characteristics of TceMEP in the acute phase of sciatic nerve root compression injury,the percentage of TceMEP amplitude of stabilized waveform after compression injury to baseline amplitude and latency were recorded.The control group was used to exclude the effects of anesthetic and surgical operations on TceMEP.The lower limb motor function was evaluated using the Tarlov score after 2 days of clamping.Statistical analysis was performed using t-test,one-way ANOVA,rank sum test and spearman correlation analysis.Results TceMEP waveform of 1 vascular clamping group was changed at[0.20(0.00,0.43)]min and was stable at[2.60(1.40,3.35)]min;TceMEP waveform of 2 vascular clamping group was changed at[(0.35(0.05,1.63)]min and was stable at[4.45(2.83,5.65)]min.The percentage of postoperative amplitude when the waveform was stable to baseline in 1 and 2 vascular clamping group[(49.84±15.27)%,(15.47±12.64)%]were lower than the percentage of preoperative amplitude[(100.00±0.00)%,(100.00±0.00)%],there were statistically significant differences(t=9.293,18.912,all P<0.01).There was statistically significant difference between the control group and the experimental groups in the percentage of postoperative amplitude when the waveform was stable to baseline(F=110.196,P<0.05).The postoperative latency when the waveform was stable in 1 and 2 vascular clamping groups[(12.60±0.61)ms,(14.29±1.24)ms]were higher t

关 键 词：经颅电刺激运动诱发电位 坐骨神经 神经根损伤 椎弓根螺丝钉 兔 

分 类 号：R687.3[医药卫生—骨科学] R-332[医药卫生—外科学]