神经电生理技术在腰椎间盘突出症诊疗中的应用进展-现代医学

神经电生理技术在腰椎间盘突出症诊疗中的应用进展

单位：1. 东南大学医学院, 江苏南京 210000;
2. 东南大学附属中大医院脊柱外科中心, 江苏南京 210000

分类号：R681.5⁺3

出版年·卷·期（页码）：2020·48·第一期（125-129）

摘要：

腰椎间盘突出症是腰椎退变疾病中的常见病种。临床上一些腰椎间盘突出症患者仅基于临床表现和影像学检查不易诊断，需借助神经电生理技术以减少漏诊、误诊；同时，该技术能指导患者治疗方式的选择和方案的推进，降低神经损伤的发生率和客观及定量地评估治疗效果；在患者康复治疗过程中可观测机体相关机能系数，动态调整，为最好的康复预后提供策略，提高患者生存质量。文章就神经电生理技术在腰椎间盘突出症的诊断、治疗和康复中应用的最新进展进行综述，为该疾病的诊疗提供参考。

Lumbar disc herniation is a common kind disease in lumbar degenerative disorders. Some patients with lumbar disc herniation are not easy to diagnose only based on clinical manifestations and imaging examinations, and neuro-electrophysiological techniques are needed to reduce missed diagnosis and misdiagnosis. At the same time, the technique can provide reference in choosing therapy methodsand advancement of programs, and reduce the incidence rate of nerve damage, and assess objectively and quantitatively treatment outcomes. It can observe the body related function coefficient in the rehabilitation process, and doctors can adjust treatment dynamically and provide strategies for the best rehabilitation prognosis, improving the quality of life of patients at last. This article reviews the recent advances in the application of neuro-electrophysiological techniques in the diagnosis, treatment and rehabilitation of lumbar disc herniation, and provides guidance for the diagnosis and treatment of this kind disease.

参考文献：

[1] YOO Y,MOON J Y,YOON S,et al.Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis[J].Medicine (Baltimore),2019,98(15):e15169.
[2] KIM P,JU C I,KIM H S,et al.Lumbar disc herniation presented with contralateral symptoms[J].J Korean Neurosurg Soc,2017,60(2):220-224.
[3] HUANG W T,WENG S F,HSU C C,et al.Comparison of the risk of developing lumbar herniated intervertebral disc between dentists and other occupations:a nationwide population-based study in Taiwan[J].J Occup Health,2019,61(3):227-234.
[4] 怀娟,岳寿伟.腰椎间盘突出症康复治疗进展[J].华西医学,2018,33(10):1311-1315.
[5] DEYO R A,MIRZA S K.CLINICAL PRACTICE.Herniated lumbar intervertebral disk[J].N Engl J Med,2016,374(18):1763-1772.
[6] LI W,LIU Y C,ZHENG C F,et al.Diagnosis of compressed nerve root in lumbar disc herniation patients by surface electromyography[J].Orthop Surg.2018,10(1):47-55.
[7] KIM K Y,KIM Y T,LEE C S,et al.Magnetic resonance imaging in the evaluation of the lumbar herniated intervertebral disc[J].Int Orthop,1993,17(4):241-244.
[8] BJORNSDOTTIR G,BENONISDOTTIR S,SVEINBJORNSSON G,et al.Sequence variant at 8q24.21 associates with sciatica caused by lumbar disc herniation[J].Nat Commun,2017,8:14265.
[9] ZHONG W,WANG J,ZHANG W,et al.Combination of magnetic resonance imaging and electrophysiological studies in lumbar disc herniation[J].Acta Neurochir Suppl,2017,124:271-275.
[10] LENER S,WIPPLINGER C,HARTMANN S,et al.The influence of surface EMG-triggered multichannel electrical stimulation on sensomotoric recovery in patients with lumbar disc herniation:study protocol for a randomized controlled trial (RECO)[J].Trials,2017,18(1):566.
[11] 戴卓伦,廖振华,刘伟强.腰椎间盘突出症特有生理表现研究进展[J].国际骨科学杂志,2018,39(4):228-230,234.
[12] LEE J H,LEE S H.Physical examination,magnetic resonance image,and electrodiagnostic study in patients with lumbosacral disc herniation or spinal stenosis[J].J Rehabil Med,2012,44(10):845-850.
[13] HU Y,KWOK J W,TSE J Y,et al.Time-varying surface electromyography topography as a prognostic tool for chronic low back pain rehabilitation[J].Spine J,2014,14(6):1049-1056.
[14] HENCHOZ Y,TETREAU C,ABBOUD J,et al.Effects of noxious stimulation and pain expectations on neuromuscular control of the spine in patients with chronic low back pain[J].Spine J,2013,13(10):1263-1272.
[15] BEYAZ E A,AKYUZ G,US O.The role of somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies[J].Electromyogr Clin Neurophysiol,2009,49(4):131-142.
[16] PAPE E,ELDEVIK P,VANDVIK B.Diagnostic validity of somatosensory evoked potentials in subgroups of patients with sciatica[J].Eur Spine J,2002,11(1):38-46.
[17] WALK D,FISHER M A,DOUNDOULAKIS S H,et al.Somatosensory evoked potentials in the evaluation of lumbosacral radiculopathy[J].Neurology,1992,42(6):1197-1202.
[18] ALBECK M J,TAHER G,LAURITZEN M,et al.Diagnostic value of electrophysiological tests in patients with sciatica[J].Acta Neurol Scand,2000,101(4):249-254.
[19] 陈香葵,杨红.神经传导速度、H反射、肌电图联合检测对诊断腰骶神经根病变的意义[J].脑与神经疾病杂志,2009,17(1):12,67.
[20] 陈海霞,赵瑞娟.表面肌电图在腰骶神经根病诊断中的价值[J].神经损伤与功能重建,2018,13(4):215-216.
[21] 曾辉,王红丽,王志强.腰椎间盘突出症患者的肌电图分析及临床应用[J].医疗装备,2016,29(6):23-24.
[22] 朱思刚,陈筑,杨澎湃.腰椎间盘突出症患者表面肌电图信号分析[J].山东医药,2007,47(27):158-159.
[23] OGURA T,SHIKATA H,HASE H,et al.Electrophysiologic evaluation of lumbosacral single nerve roots using compound muscle action potentials[J].J Spinal Disord Tech,2003,16(5):487-492.
[24] HEYDARI A,NARGOL A V,JONES A P,et al.EMG analysis of lumbar paraspinal muscles as a predictor of the risk of low-back pain[J].Eur Spine J,2010,19(7):1145-1152.
[25] 张建玲,王新宴,赵城炫,等.108例腰椎间盘突出症患者行肌电图检查结果分析[J].空军医学杂志,2012,28(2):76-77,80.
[26] SABBAHI M A,OVAK-BITTAR F.Electrodiagnosis-based management of patients with radiculopathy:the concept and application involving a patient with a large lumbosacral disc herniation[J].Clin Neurophysiol Pract,2018,3:141-147.
[27] 朱永霞,朱莉.肌电图对腰椎间盘突出症的辅助诊断价值[J].安徽医药,2015,(8):1563-1564.
[28] MONDELLI M,ARETINI A,ARRIGUCCI U,et al.Sensory nerve action potential amplitude is rarely reduced in lumbosacral radiculopathy due to herniated disc[J].Clin Neurophysiol,2013,124(2):405-409.
[29] MONDELLI M,ARETINI A,ARRIGUCCI U,et al.Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc[J].Neurophysiol Clin,2013,43(4):205-215.
[30] BOCCIA G,DARDANELLO D,ROSSO V,et al.The application of sEMG in aging:a mini review[J].Gerontology,2015,61(5):477-484.
[31] DEDERING A,GNOSPELIUS A,ELFVING B.Reliability of measurements of endurance time,electromyographic fatigue and recovery,and associations to activity limitations,in patients with lumbar disc herniation[J].Physiother Res Int,2010,15(4):189-198.
[32] DU W,LI H,OMISORE O M,et al.Co-contraction characteristics of lumbar muscles in patients with lumbar disc herniation during different types of movement[J].Biomed Eng Online,2018,17(1):8.
[33] 朱干,张盛强,何风春,等.腰椎间盘突出症治疗方法与肌电图变化的相关性研究[J].中国骨伤,2004,17(3):167-168.
[34] TELI M,LOVI A,BRAYDA-BRUNO M,et al.Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy[J].Eur Spine J,2010,19(3):443-450.
[35] PRIOLA S M,GANAU M,RAFFA G,et al.A pilot study of percutaneous interlaminar endoscopic lumbar sequestrectomy:a modern strategy to tackle medically-refractory radiculopathies and restore spinal function[J].Neurospine,2019,16(1):120-129.
[36] 王剑火,陈勇忠,温建锋,等.肌电图监测经皮内镜下腰椎间盘切除术治疗腰椎间盘突出症[J].临床骨科杂志,2018,21(4):429-432.
[37] 王丽华,何玉玲.神经电生理技术在腰椎间盘突出症微创手术中的应用价值探讨[J].养生保健指南,2018,(35):348.
[38] 叶红,崔志明,徐冠华,等.自由肌电图监测在脊柱内镜下经维板间入路腰椎间盘切除术中的初步应用[J].中国脊柱脊髓杂志,2018,28(3):213-218.
[39] 穆景颂,倪朝民,夏清,等.表面肌电图在腰椎间盘突出症治疗中应用价值的研究[J].颈腰痛杂志,2010,31(3):206-209.
[40] 姜志强,张盾,李颖,等.经椎间孔脊柱内窥镜下治疗对腰椎间盘突出症患者64层螺旋CT成像及肌电图表现的影响[J].中国医学创新,2018,15(23):115-118.
[41] 卢惠苹,宋林,陈昕,等.肌电图联合MRI定位多节段腰椎间盘突出脊柱减压的疗效观察[J].世界复合医学,2016,2(1):36-39.
[42] 张海存,李展振,吴沧陆,等.表面肌电图在指导腰椎间盘突出症治疗的应用研究[Z].青岛:中国医院药学杂志学术年会,2017:307.
[43] LI Y,ZHANG X,DAI J,et al.Changes in the flexion-relaxation response after percutaneous endoscopic lumbar discectomy in patients with disc herniation[J].World Neurosurg,2019.
[44] 刘宝平,何强,李铁军,等.对肌电图在经皮椎间孔镜技术治疗腰椎间盘突出症的评价研究[J].中国矫形外科杂志,2012,20(16):1513-1514.
[45] 王心刚,陈永明,时鸿杰,等.腰椎间盘突出症患者远期疗效的神经肌电图观察[J].临床神经电生理学杂志,2008,17(4):238-239,242.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录