脊髓造影联合感觉诱发电位检测在下腰段脊神经根性卡压伤治疗中的临床指导意义

目的探讨脊髓造影(myelography,MG)联合感觉诱发电位(somatosensory evoked potential,SEP)检测在治疗下腰段脊神经根性卡压性病变治疗中的临床价值。方法2004年3月~2006年10月对46例患有不同程度腰腿疼痛1年以上且有手术意向的患者常规行MG和双下肢胫神经及L5、S1皮节SEP检测,分别记录硬膜囊受压部分占椎管直径的比例、N40峰潜伏期及H反射延迟状况,综合分析两种检查结果,最终决定是否行手术处理并预测愈后。结果7例单节段硬膜囊受压未超过椎管直径30%的患者,有2例患者SEP检测N40延迟比对照组超出10%,另5例延迟在0.15s之内<10%。前者手术治疗,后者采用非手术治疗处理。34例患者硬膜囊单节段(26例)和双节段(8例)受压程度大于椎管直径的30%,其中MG检查单节段单侧根管不显影21例,双侧不显影5例;多节段8例存在单侧根管不显影2例和双侧不显影6例,而此34例患者SEP检测H反射延迟均>10%,皆选用手术治疗。还有5例患者虽然MG下硬膜囊受压小于椎管直径的30%,其SEP延迟又>10%,但是其振幅却正常,其中2例患者单侧根管显示不清,此2例患者行手术治疗。结论MG和SEP检查可以作为下腰段脊神经受损害的量化指标,二者互为补充,指导临床治疗方式并提示愈后,对尚无CT或MRI设备的基层医疗单位有较高的应用价值。

Clinical significance of MG combined with SEP in treatment of spinal nerve root compression in lower lumbar spine

Objective To discuss the effect of myelography (MG) combined with somatosensory evoked potential (SEP) in treatment of spinal nerve root compression in the lower lumbar spine. Methods From March 2004 to October 2006, a total of 46 consecutive patients suffering from low back pain for more than 1 year and hope to undertake surgical procedure were routinely examined using MG and SEP of tibial nerve and L5 and S1 dermatomes to record N40 peak latency and H reflex latency. Options for treatment and prognosis were judged finally by comprehensive analysis of these two index. Results 7 patients with single segment compression of dural sac less than 30%, 2 of which had a N40 peak latency delay more than 10% were treated by operation, and for the other 5 patients N40 peak latency delayed less than 0.15 and conservative therapy was applied. According to MG examination, single and multi segment compression of dural sac more than 30% were found in 26 patients and 8 patients respectively. In the single segment compression group, 21 patients had no developing of root canal on one side and 5 patients on both sides. Corresponding figures were 2 and 6 in the multi segment compression group. SEP showed that H reflex latency delay was more than 10% in all the 34 patients and they all underwent surgical procedure. In another 5 patients, SEP delayed more than 10%, but multi-segmental dural sac were encroached less than 30%. 2 of them had no developing of root canal on one side and thus underwent surgery. Conclusion Being mutually complementary for each other, MG and SEP may be considered as quantitative index in the diagnosis and treatment of spinal nerve injury of lumbar spine, and are valued for primary hospitals without CT or MRI equipment.