神经肌电图在腰椎间盘突出症定位诊断中的临床价值  

Clinical value of nerve electromyography in the localization diagnosis of lumbar disc herniation

作　　者：张蕾 黎鸣[1] 林敏婷[1] 杨轩[1] ZHANG Lei;LI Ming;LIN Minting;YANG Xuan(Electromyography Department,Foshan Hospital of Traditional Chinese Medicine,Guangdong,Foshan 528000,China)

机构地区：[1]佛山市中医院肌电图室,广东佛山528000

出　　处：《中国医药科学》2021年第19期180-184,共5页China Medicine And Pharmacy

摘　　要：目的评估神经肌电图(EMG)检查在腰椎间盘突出症定位诊断中的临床价值。方法选取2018年1月至2020年1月佛山市中医院骨科420例腰椎间盘突出症的住院患者进行MRI、EMG等检查,同时进行神经肌电图评分、腰椎MRI分级,比较EMG与MRI对受累神经节段定位情况,并与术中探查所见进行对比。分析EMG评分与MRI分级关系。结果420例腰椎间盘突出症患者,神经传导异常189例,其中146例胫神经、腓总神经的复合肌肉动作电位(CMAP)波幅下降(34.76%),113例患侧腓浅神经感觉动作电位(SNAP)波幅较健侧下降(26.90%),所有患者胫神经、腓总神经运动传导速度正常。168例胫神经F波潜伏期延长(40.00%),87例胫神经F波出现率下降(20.71%)。EMG在病程大于2周以上患者的阳性率(98.31%)明显高于病程在2周以内的患者阳性率(1.69%)(χ^(2)=774.945,P=0.000)。EMG异常患者中,手术定位诊断的准确率为97.73%。神经肌电图与MRI定位完全符合的410例(97.62%),L5、S1神经根最常受累,其次是L4神经根,多累及1~2个神经根节段,与腰椎MRI所示的神经节段相一致。神经肌电图评分与腰椎MRI分级情况呈正相关(OR=0.417)。结论神经肌电图能较准确的反映腰椎间盘突出症病变神经根节段,同时能反映神经根受压的程度。EMG对病程2周以上的神经根损害患者阳性诊断率高。Objective To assess the clinical value of nerve electromyography(EMG)examination in the localization diagnosis of lumbar disc herniation.Methods A total of 420 inpatients with lumbar disc herniation in the Department of Orthopedics of Foshan Hospital of Traditional Chinese Medicine from January 2018 to January 2020 were selected for MRI and EMG examination,as well as nerve EMG scoring and lumbar MRI grading.EMG and MRI were compared for localization of the involved nerve segments to compare with the intraoperative findings.The relationship between EMG scoring and MRI grading was analyzed.Results In 420 patients with lumbar disc herniation,there were 189 cases of nerve conduction abnormalities,including 146 patients with decreased complex muscle action potential(CMAP)wave amplitude in the tibial and common peroneal nerves(34.76%).There were 113 patients with decreased sensory action potential(SNAP)wave amplitude in the superficial peroneal nerve on the affected side compared to the healthy side(26.90%),and all patients had normal motor conduction velocity in the tibial and common peroneal nerves.The tibial nerve F-wave latency prolonged in 168 cases(40.00%)and the tibial nerve F-wave presence decreased in 87 cases(20.71%).The positive rate of EMG in pat ients with disease duration more than 2 weeks(98.31%)was significantly higher than that in patients with disease duration less than 2 weeks(1.69%)(χ^(2)=774.945,P=0.000).The accuracy of surgical localization diagnosis was 97.73%in patients with abnormal EMG.In 410 cases(97.62%)in which the nerve EMG and MRI localization were fully matched,the L5 and S1 nerve roots were most frequently involved,followed by the L4 nerve root,and mostly 1 to 2 nerve root segments were involved,which were consistent with the nerve segments shown by MRI of the lumbar spine.The nerve EMG score was positively correlated with the lumbar spine MRI grading status(OR=0.417).Conclusion Nerve EMG can accurately reflect the lesioned nerve root segments of lumbar disc herniation and the degree o

关 键 词：腰椎间盘突出症 神经肌电图 腰椎MRI 定位诊断 

分 类 号：R681.5[医药卫生—骨科学] R741.044[医药卫生—外科学]