TMS-MEP与CSEP诊断脊髓损伤的作用比较

Comparison between TMS MEP and CSEP in diagnosing the spinal cord injury

目的比较脊髓损伤（ＳＣＩ）后经颅磁刺激（ＴＭＳ）运动诱发电位（ＭＥＰ）和皮层体感诱发电位（ＣＳＥＰ）检测的诊断价值。方法１５只家猫脊髓部分切断实验和６９例ＳＣＩ的ＭＥＰ和ＣＳＥＰ检测。结果ＭＥＰ对脊髓前柱损伤、前后柱混合损伤和肌力异常极敏感，对后柱损伤不敏感；而ＣＳＥＰ对脊髓后柱损伤、前后柱混合损伤和关节位置觉异常十分敏感，对前柱伤却相反。在ＳＣＩ病例中，ＭＥＰ和ＣＳＥＰ检测的准确率分别为９２．８％和９１．３％；如将二者合并检测分析，其准确率可提高到９７．１％。结论ＭＥＰ的脊髓传导通路主要是皮质脊髓束的中枢运动神经，而ＣＳＥＰ是中枢感觉传导束。因此，只有ＭＥＰ和ＣＳＥＰ同时检测。

Objective To compare the diagnostic value in spinal cord injury(SCI) between transcranial magnetic stimulation(TMS) of motor evoked potential(MEP) and cortical somatosensory evoked potential(CSEP). Methods The spinal cord in 15 cats was partially cut and tested, and the MEP and CSEP in 69 cases of SCI were measured. Results MEP is extremely sensitive to the injury of the anterior columm, and the complex injury of the anterior and posterior column of spinal cord, and the abnormal ites of muscular strength, but insensitive to the injury of the mere posterior column. While CSEP is very sensitive to the injury of the posterior column, the complex injury of the anterior and posterior column, and the abnormal sensation of the articular position, but insensitive to the injury of the anterior column In all cases of SCI, the accurate rates of MEP and CSEP are respectively 92 8% and 91 3%.The accurate rate may raise to 97 1% if combination of MEP and CSEP is used. Conclusion The conduction path of MEP in the spinal cord is mainly the central motorius of the corticospinal bundle, while that of CSEP is the conduction bundle of the central sensation. Therefore, only meosurement of combination of MEP and CSEP can reflect the function of the spinal cord more entirely and accurately.