非创伤性脊髓传导速度测定在脊髓病变诊断中的应用

Application of noninvasive spinal cord conduction velocity in the diagnosis of spinal cord diseases

目的:为使脊髓疾病的诊断在电生理方面有更加充实的依据,探讨脊髓传导速度(spinalcordconductionvelocity,SCCV)的非创伤性测量方法(表面电极法)在脊髓疾病诊断中的临床价值。方法:对1997/2003大连友谊医院神经内科住院确诊脊髓病变患者57例进行非创伤性脊髓传导速度测定,采用表面电极法,记录T2～L4间8个刺激点皮质电位的潜伏期,以潜伏期差值和距离计算T2～T12,T12～L4以及T2～L4的传导速度,对其结果进行分析。结果:①脊髓全切组11例,SCCV异常率100%;脊髓半切组46例,SC-CV异常率59%(27/46)。两者比较差异有显著性意义(χ2=6.815,P<0.01)。②不同脊髓疾病之间SCCV异常率比较:脊髓炎组92%,多发性硬化组78%,脊髓肿瘤组67%,椎管狭窄组46%,脊髓血管病组50%,脊髓创伤组25%,结果显示脊髓炎组与椎管狭窄组之间差异有显著性意义(χ2=6.331,P<0.05),脊髓炎组与脊髓外伤组相比差异有显著性意义(χ2=7.702,P<0.01),其他各组之间比较异常率差异无显著性意义。结论:非创伤性(表面电极法)SCCV测定无创、安全、患者易于接受,本研究显示此法阳性率高,同临床病损程度相一致,对脊髓疾病的诊断有辅助作用。

AIM:To explore the clinical value of noninvasive measurement of spinal cord conduction velocity(SCCV)(surface electrode method) in the diagnosis of spinal cord diseases. METHODS:Noninvasive SCCV measurement was performed by means of surface electrode method in 57 patients diagnosed as spinal cord disease at the Department of Neurology of Dalian Friendship Hospital from 1997 to 2003 to record latencies of cortex electric potential at 8 stimulant points from T2 to L4.CV of T2-T12,T12-L4 and T2-L4 was calculated through latency difference and distance for comparative results. RESULTS:①The abnormal rates of SCCV were 100%and 59%(27/46) for 11 patients with spinal cord transection and 46 patients with spinal cord hemisection,respectively.There was significant difference between the two groups(χ2=6.815,P< 0.01).②The abnormal rates of SCCV were 92%for patients with myelitis,78%for patients with multiple sclerosis,67%for patients with spinal cord tumor, 46%for patients with spinal stenosis,50%for patients with spinal cord angiopathy and 25%for patients with spinal cord trauma.The results showed that significant differences were only present between the patients with myelitis and the patients with spinal stenosis(χ2=6.331,P< 0.0), and between the patients with myelitis and the patients with spinal cord trauma(χ2=7.702,P< 0.01). CONCLUSION:Noninvasive measurement of SCCV(surface electrode method) is noninvasive,safe,and easily acceptable to patients.The results of the present study show highly positive rate which was accordant with the clinical manifestation.SCCV might be helpful in the diagnosis of the spinal cord disease.