Objective: To determine the diagnostic value of motor evoked potentials (MEPs ) in the diagnosis of lumbosacral cord disorders. Methods: MEPs in 37 patients with sensory and motor deficits in the lower limbs were stud...Objective: To determine the diagnostic value of motor evoked potentials (MEPs ) in the diagnosis of lumbosacral cord disorders. Methods: MEPs in 37 patients with sensory and motor deficits in the lower limbs were studied. MRI demonstrated spinal cord involvement in 10 patients and cauda equina lesions in 27 patients. A double determination of cent ral motor conduction time (CMCT), calculated as the difference between the laten cies of responses evoked by cortical and paravertebral magnetic stimulation and as the difference between the latency of cortical MEP and the total peripheral c onduction time calculated from the F-wave latency, enabled discrimination betw een a delay along the proximal root and a delay along the corticospinal tract. A n abnormality of the CMCT calculated with both techniques is indicative of centr al motor pathway damage, whereas an abnormality of the CMCT calculated from the latency of responses evoked by paravertebral magnetic stimulation associated wit h a normal CMCT calculated from the F-wave latency suggests a cauda equina les ion. Results: Neurophysiologic findings strongly correlated with the lesion site documented by MRI (cauda equina or lumbosacral cord). All patients with MR evid ence of cord involvement had an abnormality of CMCT calculated with both methods , suggesting a lesion of central motor pathways. Clinical examination often fail ed to document a spinal cord lesion, suggesting pure peripheral involvement in 5 of the 10 patients with MR evidence of cord lesion. Conclusion: Motor evoked po tential recording is an accurate and easily applicable test for the diagnosis of lumbosacral spinal cord lesions.展开更多
目的探讨腹腔镜下腰骶干神经松解术治疗骨盆骨折合并腰骶干神经损伤的初步临床疗效。方法回顾性分析6例接受腹腔镜下腰骶干神经松解术的骨盆骨折合并腰骶干神经损伤患者的资料(2019年12月至2020年12月),其中男5例,女1例;平均年龄(36...目的探讨腹腔镜下腰骶干神经松解术治疗骨盆骨折合并腰骶干神经损伤的初步临床疗效。方法回顾性分析6例接受腹腔镜下腰骶干神经松解术的骨盆骨折合并腰骶干神经损伤患者的资料(2019年12月至2020年12月),其中男5例,女1例;平均年龄(36±15)岁(18~53岁);骨盆骨折Tile分型:C1.3型5例,C3型1例;受伤至手术时间:<3 w 2例,3 w~3月1例,>3月3例。术前根据英国医学研究会神经损伤委员会(BMRC)肌力标准:M0级4例,M1级2例。所有患者在术前均通过查体、骨盆增强CT联合磁共振神经成像(MRN)三维图像融合技术确诊为完全性腰骶干神经损伤且性质为软组织卡压。结果6名患者中有4名顺利完成腹腔镜下神经松解,2名患者由于术中神经松解不彻底加行开放手术。腹腔镜手术平均时间(173±8)min;术中平均出血(112±56)ml。末次随访时肌力恢复情况:M4级3例,M3级1例,2例未恢复。结论腹腔镜下神经松解术是一种精准、微创的手术方式,可能是骨盆骨折伴有软组织卡压的腰骶干神经损伤患者的有效治疗方案。展开更多
文摘Objective: To determine the diagnostic value of motor evoked potentials (MEPs ) in the diagnosis of lumbosacral cord disorders. Methods: MEPs in 37 patients with sensory and motor deficits in the lower limbs were studied. MRI demonstrated spinal cord involvement in 10 patients and cauda equina lesions in 27 patients. A double determination of cent ral motor conduction time (CMCT), calculated as the difference between the laten cies of responses evoked by cortical and paravertebral magnetic stimulation and as the difference between the latency of cortical MEP and the total peripheral c onduction time calculated from the F-wave latency, enabled discrimination betw een a delay along the proximal root and a delay along the corticospinal tract. A n abnormality of the CMCT calculated with both techniques is indicative of centr al motor pathway damage, whereas an abnormality of the CMCT calculated from the latency of responses evoked by paravertebral magnetic stimulation associated wit h a normal CMCT calculated from the F-wave latency suggests a cauda equina les ion. Results: Neurophysiologic findings strongly correlated with the lesion site documented by MRI (cauda equina or lumbosacral cord). All patients with MR evid ence of cord involvement had an abnormality of CMCT calculated with both methods , suggesting a lesion of central motor pathways. Clinical examination often fail ed to document a spinal cord lesion, suggesting pure peripheral involvement in 5 of the 10 patients with MR evidence of cord lesion. Conclusion: Motor evoked po tential recording is an accurate and easily applicable test for the diagnosis of lumbosacral spinal cord lesions.
文摘目的探讨腹腔镜下腰骶干神经松解术治疗骨盆骨折合并腰骶干神经损伤的初步临床疗效。方法回顾性分析6例接受腹腔镜下腰骶干神经松解术的骨盆骨折合并腰骶干神经损伤患者的资料(2019年12月至2020年12月),其中男5例,女1例;平均年龄(36±15)岁(18~53岁);骨盆骨折Tile分型:C1.3型5例,C3型1例;受伤至手术时间:<3 w 2例,3 w~3月1例,>3月3例。术前根据英国医学研究会神经损伤委员会(BMRC)肌力标准:M0级4例,M1级2例。所有患者在术前均通过查体、骨盆增强CT联合磁共振神经成像(MRN)三维图像融合技术确诊为完全性腰骶干神经损伤且性质为软组织卡压。结果6名患者中有4名顺利完成腹腔镜下神经松解,2名患者由于术中神经松解不彻底加行开放手术。腹腔镜手术平均时间(173±8)min;术中平均出血(112±56)ml。末次随访时肌力恢复情况:M4级3例,M3级1例,2例未恢复。结论腹腔镜下神经松解术是一种精准、微创的手术方式,可能是骨盆骨折伴有软组织卡压的腰骶干神经损伤患者的有效治疗方案。
