神经电生理检查对腰骶神经根病与腓总神经病的鉴别诊断价值

The Value of Electrophysiological Examination in the Differential Diagnosis of Lumbosacral Radiculopathy and Peroneal Neuropathy

目的探讨神经电生理检查对腰骶神经根病与腓总神经病的鉴别诊断价值。方法对10例以足下垂为主要临床表现的患者进行双侧胫神经F波、双侧腓总神经和胫神经传导、双侧胫前肌、胫后肌、腰椎旁肌肌电图检查。结果 4例以腓骨小头上-下段传导速度减慢>10 m/s或动作电位波幅下降超过50%及胫前肌神经源性损害为主,诊断为腓总神经病;5例以胫神经F波潜伏期延长和胫前肌、胫后肌、腰椎旁肌肌神经源性损害为主,诊断为腰骶神经根病;1例为腓总神经、胫神经动作电位波幅下降,感觉电位未引出,胫前肌、胫后肌神经源性损害,腰椎旁肌肌电图未见异常,诊断为坐骨神经病。10例均行腰骶段脊髓MRI,其中5例所见均与神经电生理检查结果相符。结论神经电生理检查在腰骶神经根病与腓总神经病的鉴别诊断中具有重要提示意义。

Objective To explore the value of electrophysiological examination in the differential diagnosis of lumbosacral radicu- lopathy and peroneal neuropathy. Methods Bilateral tibial nerve F wave, bilateral common peroneal nerve and tibial nerve con- duction, bilateral tibialis anterior, posterior tibial muscle, and lumbar paraspinal EMG examination were performed in 10 patients with foot drop as the main clinical manifestations. Results 4 cases with the main symptoms of conduction velocity of fibular head- under section slower than lOm/s or action potential amplitude decreased more than 50% and the anterior tibial muscle neurogenic damage, were diagnosed as common peroneal neuropathy; 5 cases with the main symptoms of tibial nerve F wave latency and tib- ialis anterior, posterior tibial muscle, lumbar paraspinal muscle neurogenic damage, were diagnosed as lumbosacral radiculopathy; 1 case of common peroneal nerve, tibial nerve action potential amplitude decreased, with no sensory potential, muscle neurogenic tibialis anterior, posterior tibial, lumbar paraspinal muscle EMG abnormalities, was diagnosed as sciatic neuropathy. All 10 cases underwent lumbosacral spinal cord MRI, of whom the results of 5 cases conformed to the electrophysiological examination results. Conclusion Neural electrophysiological examination has important significance in differential diagnosis of lumbosacral radiculopa- thy and peroneal neuropathy.