神经肌电图在腰椎间盘突出症患者中的应用价值

Application value of neuroelectromyography in patients with lumbar disc herniation

目的:探讨神经肌电图在腰椎间盘突出症(LDH)患者中的应用价值。方法:选取2020年10月至2021年10月于山东中医药大学附属医院骨科收治住院的92例经影像学(腰椎CT或MRI)诊断为LDH的患者作为研究对象,其中女49例,男43例,年龄28~75岁,病程2 d至20年。所有患者进行神经肌电图检查,观察所测神经传导及针极肌电图异常率,并与术中神经根受累探查所见进行对比,观察其符合率。结果:在92例LDH患者中,共检测运动神经368根,感觉神经184根,运动神经传导异常率28.8%(106/368根),主要表现为运动传导波幅降低,患侧腓总神经波幅较健侧降低(P<0.01)。感觉神经传导异常率17.9%(33/184根),主要表现为感觉传导波幅下降及传导速度的轻度减慢。腓总神经F波检测184根,异常率35.9%(66/184根),主要表现为出现率降低,患侧腓总神经F波出现率较健侧降低(P<0.01)。92例患者中,针极肌电图异常患者81例,异常率88.0%,L_(5)神经根损害50例(54.3%,50/92例),S_(1)神经根损害16例(17.4%,16/92例),L_(5)、S_(1)神经根均损害15例(16.3%,15/92例)。术中所观察到神经根受累与神经肌电图结果一致者75例,定位符合率为81.5%(75/92例)。结论:神经肌电图不仅可以了解腰椎间盘突出症患者的神经功能状态,还能够确定神经根病变的部位和范围,对腰椎间盘突出症的诊断及手术定位具有重要的临床应用价值。

Objective:To explore the clinical application value of neuroelectromyography in patients with lumbar disc herniation(LDH).Methods:A total of 92 patients diagnosed with LDH by imaging(CT or MRI)in Department of Orthopedics of Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2020 to October 2021 were selected as the research objects,including 49 females and 43 males,aged 28-75 years,with disease duration of 2 days to 20 years.All patients underwent neuroelectromyography to observe the abnormal rate of nerve conduction and needle electrode EMG,and compared with the intraoperative nerve root involvement exploration to observe the coincidence rate.Results:In 92 patients with LDH,a total of 368 motor nerves and 184 sensory nerves were detected.The abnormal rate of motor nerve conduction was 28.8%(106/368 nerves),mainly manifested as the decrease of motor conduction amplitude.The amplitude of common peroneal nerve in the affected side was lower than that in the healthy side(P<0.01).The abnormal rate of sensory nerve conduction was 17.9%(33/184 nerves),mainly manifested as the decrease of sensory conduction amplitude and the slight slowing of conduction velocity.F waves of 184 common peroneal nerve was detected,and the abnormal rate was 35.9%(66/184 nerves),which was mainly manifested as the reduced occurrence rate.The occurrence rate of F wave in the common peroneal nerve of the affected side was lower than that of the healthy side(P<0.01).Among the 92 patients,81 patients(88.0%)had abnormal EMG,50 patients(54.3%,50/92 cases)had L_(5) nerve root damage,16 patients(17.4%,16/92 cases)had S_(1) nerve root damage,and 15 patients(16.3%,15/92 cases)had both L_(5) and S_(1) nerve root damage.Seventy-five cases of nerve root involvement were consistent with the results of EMG,and the localization coincidence rate was 81.5%(75/92 cases).Conclusion:Electromyography can not only understand the neural function of patients with LDH,but also determine the location and scope of nerve root disease.It has important clinical application value for the diagnosis and surgical localization.