强度-时间曲线与腰椎间盘突出症的诊断及预后评估

Intensity-time curve for diagnosis and prognostic evaluation of lumbar disc herniation

背景:强度-时间曲线检查是应用一定参数的电流刺激神经、肌肉,测定神经、肌肉兴奋性并进行定性或定量分析,用于神经、肌肉疾病诊断和判定预后的方法,也是电诊断中比较精确、常用的监测技术,对腰椎间盘突出症的诊断具有一定的意义,但目前对腰椎间盘突出症疗效的评定研究较少。目的:观察分析强度-时间曲线测定对腰椎间盘突出症的诊断及预后评估效果,以便于更好地指导治疗。方法:采用日本欧技技研公司制造的CX-3型电诊断仪对113例腰椎间盘突出症患者进行强度-时间曲线测定,并与自身健侧进行对比。以及进行物理治疗后分析。患者分别检测股二头肌107条、腓肠肌101条、胫前肌45条,共253条曲线。患者在通过强度-时间曲线诊断后,均选用牵引、中频、超短波、电针并红外线照射治疗,1次/d,10次为1个疗程,3个疗程后休息10d,治疗3个疗程后复查强度-时间曲线,并根据临床症状、体征恢复情况进行疗效评估。结果与结论:首次测定强度-时间曲线正常神经支配占36.36%,部分失神经支配为62.85%,完全失神经支配为0.79%,总异常神经支配达63.64%。经物理治疗后,正常神经支配者痊愈显效率为92.86%,异常神经支配者痊愈显效率58.82%。结果提示,强度-时间曲线测定对腰椎间盘突出症的诊断、判断神经损伤的程度和评估预后具有实用价值。正常神经支配者治疗效果好,异常神经支配者治疗效果较差。

BACKGROUND：Intensity-time（I/T） curve examination is a monitoring technology used for diagnosis of nerve damage,muscle disease and prognostic evaluation using current stimulation and qualitative or quantitative analysis.It also has significance to the diagnosis of lumbar disc herniation（LDH）.Whether it can be used in LDH prognostic evaluation is poorly understood.OBJECTIVE：To explore the effectiveness of I/T curve in diagnosis and prognostic evaluation of LDH.METHODS：I/T curves of 113 LDH patients were measured by CX-3 electrodiagnostic equipment,and the results were compared with their unaffected sides and analyzed after physiotherapy.A total of 253 curves were measured,including 107 biceps femoris,101 gastrocnemius and 45 tibialis anterior muscle curves.All patients were sequential treated by traction,medium frequency,ultrashort wave,electric acupuncture as well as infrared radiation following I/T diagnosis,once a day,10 days for a course,with 10 days interval in 3 courses.I/T curves were performed after 3 courses.The therapeutic effect was evaluated by using I/T results combined with clinical symptom and physical signs.RESULTS AND CONCLUSION：The first estimated percentage by I/T curved line were 36.36%（controlled by normal nerve）,62.85%（controlled by part of the denervated）,0.79%（controlled by the completely denervated） and 63.64%（controlled by total abnormal nerve）.After the physiotherapy,the effectiveness of the complete recovery was 92.86% by the normal nerve as well as 58.82% by the abnormal nerve.Above all,the practical value could be concluded from the diagnosis,evaluation and effectiveness of LDH used by I/T curve line.The therapeutic effectiveness controlled by the normal nerve is much better than that controlled by the abnormal.