经颅磁刺激运动诱发电位在脊柱脊髓损伤的临床应用研究

目的评价经颅磁刺激运动诱发电位（ＴＭＳＭＥＰ）在脊柱脊髓损伤诊断中的作用。方法测定２１例完全性脊髓损伤患者、３５例不完全性脊髓损伤患者双侧胫前肌与腓肠肌的ＴＭＳＭＥＰ,随访６个月～２年,以２０例正常成人ＴＭＳＭＥＰ作对照。结果２１例完全性脊髓损伤患者中,１９例双侧胫前肌及腓肠肌ＴＭＳＭＥＰ消失,随访截瘫无恢复;２例圆锥损伤有异常ＴＭＳＭＥＰ,截瘫及ＴＭＳＭＥＰ基本恢复。３５例不完全性脊髓损伤患者中,每例均可记录到１块以上靶肌的ＴＭＳＭＥＰ,随访３３例,截瘫及ＴＭＳＭＥＰ均有不同程度的恢复,其中术前２５块靶肌肌力０级而有异常ＴＭＳＭＥＰ,术后肌力除２块无恢复外,其余均有明显恢复或正常。术后ＴＭＳＭＥＰ的恢复时间和程度均较体检所见早且明显。结论ＴＭＳＭＥＰ测定对于脊髓损伤的诊断和预后的估计,有重要的临床应用价值

Clinical application of TMS-MEP in spinal cord injury

Objective To evaluate transcranial magnetic stimulation motor evoked potential (TMS MEP) in the diagnosis of spinal cord injury. Method 56 patients with injury of the spinal cord and cauda equina were examined using TMS MEP and followed up. Result In 21 patients with complete paralysis, TMS MEP of bilateral tibialis anterior and gastrocnemius disappeared and paralysis did not recover. Abnormal was noted TMS MEP and paralysis not recovered in 2 patients with injury of conus medullaris and cauda equina. Incomplete paralysis occurred in 35 patients.TMS MEPs of more than one muscle in every patient were recorded. Paralysis and TMS MEPs recovered in different degree in the 33 patients, in which the strength was 0 class and TMS MEPs were abnormal in 25 target muscles before operation whereas their strength obviously recovered or even normalized after operation except two muscles. Conclusion TMS MEP is an effective method for diagnosis and prognosis of spinal cord injury.