脊髓型颈椎病电生理检测特点及临床评估相关性分析

The correlation between electrophysiological findings and clinical evaluation of cervical spondylotic myelopathy with laminoplasty

目的 探讨皮层体感诱发电位 (CSEP)检测结果与脊髓型颈椎病 (CSM)临床表现、后路“单开门”椎板成形(ODLP)手术疗效间的相关性。方法 选择并随访 31例行ODLP的病例 ,按照CSEP检测波形分类 ,并根据手术前后JOA分值进行病情分度、计算临床改善率 ,进而将各因素相关数据进行统计处理 ,分析彼此间的相关性。结果 CSM患者术前JOA分值为 8.4 2± 2 .94 ,术后为 11.4 6± 2 .85 ,随访时为 12 .13± 3.2 0 ,术后及随访JOA分值明显增加 (P<0 .0 5 ) ,临床改善率为 4 7.80 %± 2 3.4 2 %。CSEP检测Ⅰ型波 3例 ,Ⅱ型波 6例 ,Ⅲ型波 14例 ,Ⅳ型波 8例 ;临床症状严重者 2例 ,重度者 11例 ,中度者 16例 ,轻度者 2例 ;手术疗效优良者 15例 ,一般者 16例。CSEP检测结果与临床病情间进行相关性分析 (Hc=14 .4 8,P <0 .0 1) ,CSEP检测结果与临床改善率间进行相关性分析 (Uc =3.995 ,P <0 .0 5 )。结论 ODLP是治疗CSM一种成熟的外科术式 ,疗效肯定。CSM患者CSEP检测结果与病变程度、临床改善率间存在显著相关性 ,CSEP电生理检测有助于更准确地了解脊髓受损程度 ,预测手术效果 ,为临床提供客观、有价值的信息。

Objective To observe the correlation between cortical somatosensory evoked potentials (CSEP) and clinical outcome in patients with cervical spondylotic myelopathy (CSM) by open-door laminoplasty (ODLP). Methods 31 cases of CSM undergone surgical treatment with ODLP were selected and followed-up. Wave types of CSEP were classified, and the extent of illness and clinical outcome were also graded according to the Japanese Orthopaedic Association (JOA) scoring system. Furthermore, the data were analyzed statistically to explore the correlation of the factors. Results The mean preoperative JOA score was 8.42±2.94, while those of post-operation and follow-up were 11.46±2.85 and 12.13±3.20, respectively. The mean rate of the clinical improvement was 47.80%±23.42%. The results showed that 3 cases were in TypeⅠof CSEP, 6 were in TypeⅡ, 14 were in Type Ⅲ and 8 were in Type Ⅳ. Clinically, there were 2 cases graded as extraordinary severity in the damage of spinal cord, while 11 cases were as severity, 16 cases were as moderate and 2 cases were as light damage of spinal cords. There were 15 cases with good recovery and 16 cases with fair recovery. There was a good correlation between CSEP and the clinical states of illness (Hc=14.48, P<0.01). The analysis between CSEP and the clinical outcome pictures also educed a good correlation (Uc=3.995, P< 0.05 ). Conclusion ODLP is an efficient surgical management for CSM. There's a distinct correlation between CSEP and the rate of clinical improvement in CSM patients with laminoplasty. CSEP is beneficial to the evaluating of the spinal cord lesion and to the prognosticating of the outcome of CSM.