椎旁定位腰骶体感诱发电位在腰椎间盘突出症中的诊断作用

目的探讨椎旁定位腰骶体感诱发电位（LSSEP）在腰椎间盘突出症中的诊断作用.方法对54例有L4、L5和S1神经根损害表现的腰椎间盘突出症患者进行胫后神经体感诱发电位（SEP）、皮节体感诱发电位（DSEP）和椎旁定位LSSEP检查,测定其P40的潜伏期.结果胫后神经SEP检测异常率为40.74%,其中多水平突出的异常率明显高于单水平突出者（P＜0.01）;L5S1 DSEP异常率为87.04%,明显高于胫后神经SEP异常率（P＜0.01）;椎旁定位LSSEP异常率为96.30%,显著高于胫后神经SEP和DSEP异常率（P＜0.01）.在L3～4椎间盘突出中,以L4 LSSEP异常为主,L4～5椎间盘突出中,以L5 LSSEP异常为主.结论椎旁定位LSSEP是诊断腰椎间盘突出症快捷、可靠、敏感的检测方法,其结果与神经根受累水平相一致,对多水平突出手术入路的定位较为准确.

Clinical application of lumbosacral somatosensory evoked potential to patients with lumbosacral disc herniation

Objective To evaluate the role of lumbosacral somatosensory evoked potential (LSSEP) examination in the diagnosis of lumbosacral disc herniation (LDH). Methods Somatosensory evoked potential (SEP) from posterior tibial nerve, L_4, L_5 and S_1 dermatomes SEP, and lumbosacral SEP was recorded in 54 patients with radiculopathy caused by LDH. Results The SEP from posterior tibial nerve was abnormal in 22 cases (40.74%). The SEP from L_5 and/or S_1 dermatome was abnormal in 47 cases (87.04%, P<0.01), and the SEP from lumbosacral nerve was abnormal in 52 cases (96.30%, P<0.01). The abnormality of SEP from lumbosacral nerves (L_ 2-3, L_ 3-4, L_ 4-5 and L_5S_1) was detected mainly in patients with L_3, L_4, L_5 and S_1 LDH. Conclusion The LSSEP was a sensitive method for the diagnosis of the disc herniation.