慢性脊髓压迫患者神经电生理分析

A clinical study on the chronic compression of spinal cord with cortical somatosensory evoked potential

目的研究慢性脊髓压迫患者脊髓神经电生理变化及对预后康复的评价作用。方法采用Dantec公司Keypoint型肌电图诱发电位仪对54例脊髓型颈椎病(CSM)患者和21例胸椎黄韧带骨化症(OLF)患者行正中神经及胫后神经的CSEP检查,记录N1、P1潜伏期,P1-N1峰间波幅值,根据日本骨科学会评分系统将CSM患者分为轻重A、B两组;根据MR I表现将OLF患者分为E、F两组,分析两组CSEP值的变化;其中28例CSM患者根据手术前后CSEP是否改善分为C、D两组,在术前、术后1周和6月分别行JOA评分评价临床症状恢复,分析判定CSEP变化与神经功能恢复之间的关系。结果 75例患者中62例(83%)术前CSEP异常;A、B组及E、F组病人在潜伏期和波幅上无显著性差异;C、D两组病人在术后1周的JOA评分有显著性差异,但在6月时已无明显差异。结论慢性脊髓压迫患者的CSEP大多数出现异常,但不能仅根据CSEP值来判断脊髓功能受损的严重程度。术后CSEP波形出现改善者,预示近期临床症状恢复快,但对长期预后不能较好的衡量。

Objective： To study the characteristics and prognostic value of the cortical somatosensory evoked potential（CSEP） for cervical spondylitic myelopathy（CSM） and ossification of the ligamentun flavum in the thoracic spine（OLF）.Methods：54 cases of CSM received CSEP examination performed with a Keypoint Electromyograph preoperatively.Two distinct groups（A,B group） of patients were identified from analyzing JOA scores.Two distinct groups（C,D group）of 28 cases were identified from analyzing the CSEP preoperatively and postoperatively.The relationship between the changes of CSEP and JOA score was studied.21 cases of OLF received CSEP examination pre-and post-operatively and were divided into two groups（E,F group） according to MRI appearence.The variance of the latency（P1） and amplitude（P1-N1） of CSEP recorded was analyzed.Twenty matched healthy volunteers were examined as control group.Results：62 patients had abnormal CSEP.The amplitude and latency had no statistically significant difference between A and B group.Seventeen patients in C group showed improvements in their CSEP had a more rapid clinical improvement.Long-term reassessment did not show any difference between C and D groups.Eighteen patients of ossification of the ligamentum flavum abnormal CSEP and manifested by elongation of latency and decreased amplitude or disappeared CSEP.After operation the latency and amplitude were improved to different degrees.But there was no difference between E and F groups.Conclusion：Most patients with CSM and OLF have abnormal CSEP,but the recordings of CSEP can not reflect the neurological function in CSM and OLF.Patients with improvements in CSEP have more clinical improvement than patients with stable recording in CSM.But CSEP can not be used to determine ultimate prognosis.