肌电图对硬膜外注射治疗腰椎间盘突出症临床疗效的预测作用

The Predictive Effect of Electromyography of the Outcome Following Epidural Injections for Lumbar Disc Herniation

目的：探讨肌电图（Electromyography,EMG）诊断对硬膜外注射治疗腰椎间盘突出症临床疗效的预测作用,进一步明确硬膜外注射的适应证。方法：回顾性分析51例经硬膜外注射治疗的腰椎间盘突出症患者,按照治疗前EMG检查结果分成EMG阳性组（n=30）和阴性组（n=21）,在治疗前和终末随访时,应用Oswestry Disa-bility Index（ODI）评价其功能结果,采用Verbal Rating Scale（VRS）评价疼痛的严重程度。比较治疗前后VAS和ODI改善程度的差异,相关数据进行两独立样本的t检验。结果：51例患者平均随访10.4个月（6~13个月）。EMG阳性组和阴性组治疗前后VAS评分分别为8.4±1.12和8.1±1.20（P〉0.05）以及2.5±2.17和4.3±2.06（P〉0.05）,两组VAS缓解程度的差异有统计学意义,分别为5.9±2.36和3.8±1.69（P〈0.05）。治疗前ODI评分两组无明显差异,EMG阳性组为68.13±12.32,EMG阴性组为72.7±10.11（P〉0.05）,治疗后两组均明显改善,分别为51.46±14.99和63.60±12.18（P〈0.05）,两组ODI降低值分别为16.67±10.31和9.1±5.09（P〈0.05）。结论：对腰椎间盘突出症患者进行肌电图检查具有重要的诊断价值,可以作为硬膜外注射治疗结果的一个预测指标。

Objective ：To determine if electromyographic （EMG）diagnostic evaluation can predict clinical outcome in patients undergoing lumbar spine epidural injections. Methods：51 patients with lumbar disc herniation undergoing epidural injections were analyzed retrospectively. All the patients tested with EMG before injection,30 patients were positive for radiculopathy and 19 had a negative examination. Clinical results by Oswestry Disability Index（ODI）and visual analogue scale（VAS） for functional status and pain severity were evaluated before and after undergoing lumbar epidural injections. Statistical analysis was conducted for functional and pain improvement by SPSS 13. 0 for Student＇s t test. Results：Mean fol- low-up period was 10. 4 months. Pretreatment VAS scores were not significantly different between groups showing positive （8. 4±1.12） and negative （8. 1 ± 1.20, P 〉 0. 05） EMG findings. There was significantly greater improvement of VAS for EMG positive radiculopathy （5. 9 ± 2. 36 ） compared with negative EMG （ 3. 8 ± 1.69, P 〈 0. 05 ）. Before lumbar epidural injections ,ODI scores were not significantly different between groups showing positive（68. 13 ± 12. 32） and negative（72. 7 ± 10. 11 ,P 〉0. 05）,too. ODI scores mean improvement was significantly different in the positive EMG group（ 16. 67 ± 10. 31 ）compared with a negative EMG（9. 1 ± 5.09, P 〈 0. 05）. Conclusion：This study suggests the importance and diagnostic value of ordering electromyography inspections for lumbar disc herniation evaluation, which may lead to prediction of outcome with lumbar epidural injections.