神经肌电图在腰椎间盘突出症诊断中的应用价值分析

Clinical Value of Electroneuromyography in the Diagnosis of Lumbar Disc Herniation

目的探讨神经肌电图检查在腰椎间盘突出症诊断中的应用价值。方法对 40 例腰椎间盘突出症患者进行神经肌电图、腰椎 MRI 检查,并进行腰椎 JOA 评分,分析神经肌电图的临床特点及与腰椎 MRI、JOA 评分的相关性。结果 40 例腰椎间盘突出症患者,神经肌电图异常 37 例,其中L5、S1 神经根较常受累,其次是 L4 神经根受累,多累及 1~2 个神经根节段,与腰椎 MRI 所示的受累神经节段一致。神经肌电图与腰椎 MRI 结果完全符合 34 例( 85%),不符合 6 例( 15%),其中 3 例( 7.5%)神经肌电图正常,但腰椎 MRI 有椎间盘突出表现,另外 3 例( 7.5%)均表现为腰椎 MRI L3 /4、L4 /5 椎间盘突出,但神经肌电图显示 S1 神经根亦受累。神经肌电图评分与腰椎 MRI 分级呈正相关( OR= 0.436,P = 0.005),而与 JOA 评分呈负相关( OR=-0.424,P= 0.006)。结论神经肌电图与腰椎 MRI 反映腰椎间盘突出症受累神经根节段一致性较高,能弥补腰椎 MRI 检查的不足,反映神经根受压的严重程度。

Objective To explore the clinical value of electroneuromyography ( EMG) in the diagnosis of lumbar disc herniation. Methods 40 patients with lumbar disc herniation were examined by EMG and lumbar MRI. The JOA score of lumbar spine was evaluated in all cases. The correlation of EMG and MRI,JOA scores of lumbar spine were analyzed. Results Among the 40 patients with lumbar disc herniation,37 had abnormal EMG,of which L5 and S1 nerve roots were the most often involved,followed by L4 nerve roots,which most in- volved 1 to 2 nerve root segments,and was consistent with the involved ganglion segments reflected by lumbar MRI. The results of EMG and lumbar MRI were completely consistent in 34 cases ( 85%),and not agreement in 6 cases ( 15%),including 3 cases ( 7.5%) had normal EMG,but lumbar MRI appeared disc herniation,and the other 3 cases ( 7.5%) were revealed L3/4 and L4/5 disc herniation by lumbar MRI,but appeared S1 nerve root involvement too by EMG. EMG score was positively correlated with lumbar MRI grading ( OR=0.436,P=0.005),but negatively correlated with JOA score ( OR=-0.424,P= 0.006). Conclusion The consistency of EMG and lumbar MRI is high in reflecting the nerve root segments involved of lumbar intervertebral disc herniation,so EMG can redeem the deficiency of lumbar MRI and confirm the severity of nerve root compression.