术前神经肌电图在评估腰椎椎管狭窄症患者疼痛程度及预后的价值  

The value of preoperative neuromyography in evaluating pain degree and prognosis of patients with lumbar spinal stenosis

作　　者：叶君 陈哲 白鲁佳 YE Jun;CHEN Zhe;BAI Lu-jia(Electromyography Room,2Spinal Center,the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou,Zhejiang 310005,China)

机构地区：[1]浙江中医药大学附属第二医院肌电图室,浙江杭州310005 [2]浙江中医药大学附属第二医院脊柱中心,浙江杭州310005

出　　处：《临床骨科杂志》2025年第2期178-182,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨术前神经肌电图(EMG)在评估腰椎椎管狭窄症患者疼痛程度及预后的价值。方法选取经后路椎体间融合术治疗的85例腰椎椎管狭窄症患者为观察组、同期80例健康志愿者为对照组,EMG检测两组运动及感觉神经的动作电位波幅、潜伏期及传导速度,分析观察组EMG相关参数与疼痛VAS评分及预后的关系。结果相较于对照组,观察组EMG的运动神经的潜伏期增长,波幅降低,运动传导速度减慢;感觉神经的波幅降低,感觉传导速度减慢(P<0.05)。观察组术前疼痛VAS评分与运动神经传导速度、感觉神经传导速度、波幅、胫后神经F波出现率呈负相关(P<0.05),与潜伏期、胫神经H反射指标(H潜伏期、H-M潜伏期、H/M波幅比)、F波潜伏期、F波离散度呈正相关(P<0.05)。观察组中,相较于预后良好的患者,预后不良的患者胫神经、腓总神经及股神经的潜伏期增长,波幅降低,运动传导速度减慢;腓浅神经、腓肠神经的波幅降低,感觉传导速度减慢;胫后神经F波出现率减少,F波潜伏期延长,离散度增加,胫神经H潜伏期延长,H-M潜伏期延长,H/M波幅比增大。结论术前EMG相关指标可作为评估腰椎管狭窄症患者术前疼痛程度的潜在指标及预测术后不良发生的评估指标。Objective To investigate the value of preoperative neuromyography in evaluating pain degree and prognosis of patients with lumbar spinal stenosis.Methods The 85 patients with lumbar spinal stenosis treated by posterior lumbar interbody fusion were selected as the observation group,and 80 healthy volunteers were selected as the control group.EMG was used to detect the action potential amplitude,latency and conduction velocity of motor and sensory nerves in twog groups.In the observation group,the relationship between EMG parameters and pain VAS,prognosis was analyzed.Results Compared with the control group,the motor latency of EMG in observation group were increased,the amplitude was decreased,and the motor conduction velocity slowed down,the amplitude of sensory nerve was decreased and the sensory conduction speed slowed down(P<0.05).In the observation group,the preoperative pain VAS was negatively correlated with motor nerve conduction velocity,sensory nerve conduction velocity,amplitude and F-wave occurrence rate of posterior tibial nerve(P<0.05),and positively correlated with latency,tibial nerve H reflexion indexes(H latency,H-M latency,H/M amplitude ratio),F-wave latency and F-wave dispersion(P<0.05).In the observation group,compared with the patients with good prognosis,the latency of tibial nerve,common peroneal nerve and femoral nerve were increased,the amplitude decreased,and the motor conduction speed slowed down in the patients with poor prognosis.The amplitude of superficial peroneal nerve and sural nerve were decreased,and the speed of sensory conduction slowed down.F-wave occurrence rate of posterior tibial nerve was decreased,F-wave latency prolonged,dispersion increased,tibial nerve H latency prolonged,H-M latency prolonged,H/M amplitude ratio was increased.Conclusions Preoperative EMG can be used as a potential indicator to evaluate the pain degree of patients with lumbar spinal stenosis,and can be used as an indicator to predict the occurrence of postoperative poor prognosis.

关 键 词：腰椎椎管狭窄症 神经肌电图 疼痛程度 预后 

分 类 号：R681.57[医药卫生—骨科学] R444[医药卫生—外科学]