足下垂的原因分析及其肌电图鉴别诊断价值

目的回顾性分析引起足下垂的各种可能原因,并探讨肌电图对于足下垂的鉴别诊断价值。方法收集2011年9月至2015年6月因足下垂就诊于我科的患者155例,连续入组,符合足下垂肌力评定标准,分析常规神经传导和针肌电图检测的结果。结果电生理显示腓神经单神经病变70例(45.2%)、坐骨神经病变9例、多发性神经病19例、腰骶丛病变9例、腰_5/骶_1神经根病变42例、运动神经元病变(MND)6例。在腓神经单神经病变患者中,腓骨小头处卡压性病变占72.8%(51/70),其他因素占27.2%(P0.05);电生理显示跨腓骨小头传导阻滞占71.4%、速度减慢2.9%、轴索损害25.7%(P0.05)。在多发性神经病、腰骶丛/根病变患者中,足下垂均为伴随表现;1例运动神经元病患者以足下垂为首发症状。结论就诊神经科的足下垂患者,虽然近半数是腓神经单神经病变所致,但鉴别诊断时,需关注下运动神经元其他水平的病变,尤其是全身性疾病的可能,这对于治疗和预后评估很重要;神经电生理检测可以确定病变水平和分布,从而提示病因线索。

Etiological analysis and value of differential diagnosis by electromyography in patients with foot drop

Objective To retrospectively investigate the various etiologies of foot drop and the value of differential diagnosis by electromyography in patients with foot drop.Methods A total of 155 patients who visited our department due to foot drop from September 2011 to June 2015 were enrolled and met the criteria for muscle strength of foot drop. The findings of conventional nerve conduction examination and needle electromyography were analyzed.Results Electrophysiological results showed 70 cases of peroneal mononeuropathy, 9 cases of sciatic neuropathy, 19 cases of polyneuopathies, 9 cases of lumbosacral plexopathy, 42 cases of L₅/S₁ radiculopathy, and 6 cases of motor neuron disease. Among the cases of peroneal mononeuropathy, 72.8% (51/70) were entrapment lesions at the fibular head, and the other cases (27.2%) were caused by other reasons; electrophysiological results also showed that conduction block across the fibular head, reduced velocity, and axonal damage accounted for 71.4%, 2.9%, and 25.7%, respectively (P<0.05). In the patients with polyneuropathies and lumbosacral plexus radiculopathy, foot drop was the concomitant symptom, and in one patient with motor neuron disease, foot drop was the initial symptom.Objective Although nearly half of the cases of foot drop diagnosed in the department of neurology are caused by peroneal mononeuropathy, it is necessary to pay attention to the lesions at other levels of motor neurons in differential diagnosis, especially the possibility of systemic diseases, which is essential for treatment and prognostic evaluation. Nerve electrophysiology can be used to determine the level and distribution of nerve lesions and thus to provide some clues for etiological analysis.