摘要
作者应用ＤｉｓａＮｅｕｒｏ２０００型肌电图仪，检测脊髓损伤３１２例，刺激上下肢周围神经，皮层接收，获得皮层诱发电位（ＣＥＰ）。主要为陈旧性脊髓损伤，上肢刺激正中扫神经与尺神经，部分病例为桡神经；下肢刺激腔后神经、腓总神经与股神经。完全截瘫１７９例，损伤平面以下各神经ＣＥＰ均未引出者９７．８％，假阳性２．２％。不全截瘫１３３例，损伤平面以下各神经ＣＥＰ的潜时与波幅有改变，有２例未查股神经，３例严重不幸瘫，未引出ＣＥＰ，假阴性为３．７５％。颈脊髓损伤中，Ｃ＿５节存在者正中神经ＣＥＰ可引出；Ｃ＿６节存在者桡神经可引出。在中央型脊髓损伤中及全部颈髓损伤中，尺神经ＣＥＰ受损最重，因其起始于Ｃ＿（７．８）与Ｔ＿１节之故。胸腰段损伤，脊髓腰骶段与神经根共在，神经根损伤较脊髓损伤恢复机会为多。股神经ＣＥＰ引出，而胫后、腓总神经ＣＥＰ阴性行为腰神经根恢复。三条神经ＣＥＰ皆引不出者为脊髓与神经根完全损伤，三条神经ＣＥＰ均可引出者，为脊髓不完全损伤。因此，胸腰段损伤，必须查股神经ＣＥＰ，Ｌ＿３以下则仅查胫后与腓总神经ＣＥＰ。癔瘫者ＣＥＰ皆阳性，故可鉴别真假截瘫。但ＣＥＰ也有局限性，脊髓后索与前侧索损伤不一致时，ＣＥＰ与ＭＥＰ的结?
AbstractFrom 1983～1992 CEP monitoring in spinal cordinjury(SCI ) was perfomed in 312 cases,of them 9were acute SCI and 303 chronic(cervical spine 57, dor-sal 88, T_(11)～L_1 136 and lumbar 31). 179 cases werecomplete paraplegia and 133 incomplete paraplegia. CEPwere negative in 175 of 179 complete paraplegia, and thecorrect diagnosis rate was 97.8%. The false positiverate was 2.2%. The changes of CEP in 133 cases of in-complete paraplegia were prolonged latent period and/ordecrease in arnplitude. Negative CEP occurred in 5 cas-ex, making the false negative rate to be 3. 75%, In caseof cervical SCI, the CEP of median nerve was positivewhen C_5 segment was intact, while radial nerve CEPwasp positive as C_6 segment was intact. The ulnar nerveCEP was mostly involved in lower cervical spine injuryand in central type of SCI because it is composed of C_7,C_8 and T_1 segments, In dorso-lumbar junction, therewas the lower end of the spinal cord with its nerve rcots,therefore、the CEP of T_(11)-L_1 SCI was performed bystimulating femoral, posterior tibial and common per-oneaI nerves to decrease false negative rate in incompleteparaplegia. Positive CEP in the femoral nerve and nega-tive in tibial and peroneal neves indicate recovery ofnerve roots of lumbar plexus and no recovery of thespinal cord.Positive CEP in femoral, tibial and peronealnerves represents recovery of the spinal cord and its rootsand negative CEP in all three nerves indicate cornpleteSCI, no recovery of spinal cord and its roots. In case ofbelow L_3 level, CEP of tibial and peroneal nerve weresuitable, The CEP was positive in case of hysteric para-plegia or monoplegia, so it is very valuable in differenti-ating true from false paraplegia. In case of incompleteparaplegia, the destruction is not the same as in the lat-eral and posterior colum of the spinal cord, so monitor-ing by both CEP and MEP should be performed to eval-uate the funct ion of both sensory and motor tracts.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1995年第4期238-242,共5页
Chinese Journal of Surgery
