皮肤电流感觉阈值测定法对多节段腰椎退行性病变责任节段定位的诊断价值

Diagnostic value of skin current perception threshold method in locating the responsible segments of multi-segmental lumbar degenerative diseases

目的评估皮肤电流感觉阈值(current perception threshold,CPT)测定法对多节段腰椎退行性病变责任节段定位的诊断价值。方法选取2016年10月至2019年2月首都医科大学附属北京同仁医院收治的多节段腰椎退行性变患者84例,男32例,女52例;平均年龄65.3岁,其中腰椎管狭窄症41例,腰椎管狭窄症合并腰椎间盘突出26例,腰椎管狭窄症合并腰椎滑脱症17例。术前对所有患者行双下肢皮肤CPT定量检测,测试点CPT等级评分大于0为异常,提示对应神经根病变可能,以此确认责任节段,均行减压手术。术前、术后采用视觉模拟评分法(visual analogue score,VAS)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分进行疗效评估。结果皮肤CPT测定法明确单节段责任间隙84例。术前、术后及最后随访时JOA评分分别为(5.7±1.8)分、(11.9±2.1)分、(11.7±1.6)分,VAS分别为(6.8±2.1)分、(2.6±1.5)分、(2.1±1.7)分。术后及最后随访时JOA、VAS与术前比较差异有统计学意义(P<0.05)。结论CPT测定法在多节段腰椎退行性变的定位诊断方面,是明确责任节段准确而有效的无创方法,诊断价值较大,有助于减小手术范围。

Objective To evaluate the diagnostic value of skin current perception threshold(CPT)measurement in the localization of the responsible segments of multi-segmental lumbar degenerative diseases.Methods From October 2016 to February 2019,84 patients(32 males and 52 females)with multi-segmental lumbar degeneration were admitted in the study.The average age was 65.3 years.There were 41 cases of lumbar spinal stenosis,26 cases of lumbar spinal stenosis combined with lumbar disc herniation,and 17 cases of lumbar spinal stenosis combined with lumbar spondylolisthesis.Preoperative quantitative detection of sensory nerve conduction threshold in skin of both lower extremities was performed on all patients.If the CPT grade score of the test site was greater than 0,it was abnormal,indicating that the corresponding nerve root may be damaged.The clinical outcomes were evaluated by Japanese Orthopedie Association(JOA)score and visual analogue score(VAS).Results The responsible segment was identified single level in 84 cases by skin CPT measurement.JOA scores were(5.7±1.8),(11.9±2.1)and(11.7±1.6),VAS were(6.8±2.1),(2.6±1.5)and(2.1±1.7)in pre-operation,post-operation and final follow-up,respectively.There were significant differences of JOA and VAS between pre-operation and post-operation(P<0.05).Conclusions Skin CPT measurement is an effective and accurate method to identify the responsible segment in the treatment of multilevel degenerative lumbar diseases.It is a noninvasive method that helps reduce the scope of surgery.