| 聂 聪,郑超君,马晓生,夏新雷,朱 巍,金 翔,王洪立,吕飞舟,姜建元.颈椎前路植骨融合内固定术治疗平山病疗效的电生理评估[J].中国脊柱脊髓杂志,2020,(11):977-984. |
| 颈椎前路植骨融合内固定术治疗平山病疗效的电生理评估 |
| 中文关键词: 电生理技术 平山病 颈椎前路植骨融合内固定术 |
| 中文摘要: |
| 【摘要】 目的：通过电生理技术对接受颈椎前路植骨融合内固定手术治疗的平山病患者手术前后神经功能进行评估，探究手术干预对于神经功能恢复的作用。方法：回顾性分析2016年1月~2017年7月于我院骨科接受颈椎前路植骨融合内固定手术的平山病患者43例，其中男性41例，女性2例；手术时年龄14~26岁，平均18.2±2.8岁，病程6~84个月，平均22.3±20.1个月；随访时间3~18个月，平均7.2±4.4个月。所有患者均在术前及末次随访时接受上肢神经传导检查、针肌电图检查和上肢功能障碍评定（disability of arm shoulder hand，DASH）量表评估。通过比较复合肌肉动作电位（compound muscle action potential，CMAP）波幅、肌肉自发电位、运动单位电位形态及肌肉募集情况评估患者术后神经功能改变，并通过DASH量表评分变化评估患者术后上肢功能变化。分别比较术前症状严重侧和轻侧及手术前后电生理检查结果，通过配对样本t检验比较CMAP波幅，Pearson卡方检验比较肌肉自发电位、运动单位电位形态及肌肉募集情况；通过配对样本t检验比较手术前后DASH量表评分变化。结果：患者手术前神经电生理检查结果显示，症状严重侧正中神经及尺神经波幅较轻侧明显降低（P＜0.05），超过半数患者针肌电图检查可见双侧神经源性损害。术前及术后随访结果对比显示，术前症状严重侧正中神经CMAP波幅平均为9.79±4.63mV，术后平均为11.04±4.43mV，差异有统计学意义（P＜0.05）；术前症状严重侧尺神经CMAP波幅平均为4.04±3.25mV，术后平均为6.19±4.30mV，差异有统计学意义（P<0.001）。轻侧正中神经及尺神经CMAP波幅恢复情况无统计学意义（P＞0.05）；针肌电图检查结果显示，患者严重侧上肢被检肌肉自发电位出现比例、MUAP形态宽大比例下降无统计学意义（P>0.05）；部分被检肌肉募集情况有较为显著改善，其中术前42例患者症状严重侧桡侧腕屈肌存在募集减弱（42/43，97.7%），末次随访时32例患者同一肌肉存在募集减弱（32/38，84.2%），差异有统计学意义（P＜0.05）。患者术前DASH量表评分为7.04±7.63分，末次随访时6.89±7.47分，差异无统计学意义（P>0.05）。结论：平山病患者接受颈椎前路植骨融合内固定手术后，上肢CMAP波幅提高，肌肉募集情况改善，该手术对控制病情进展、改善神经功能有积极作用。 |
Evaluation of the surgical efficacy of the anterior cervical fusion and internal fixation for Hirayama disease using electrophysiological techniques |
| 英文关键词:Electrophysiological examination Hirayama disease Anterior cervical fusion and internal fixation |
| 英文摘要: |
| 【Abstract】 Objectives: To evaluate the neurological function of patients with Hirayama disease before and after anterior cervical fusion and internal fixation surgery using nerve conduction study and electromyography (EMG), in order to investigate the effects of surgical intervention on the recovery of neurological function in such patients. Methods: This study enrolled 43 patients with Hirayama disease who underwent anterior cervical fusion and internal fixation in the Department of Orthopedics of Huashan Hospital from January 2016 to July 2017(41 males and 2 females, averaged 18.2±2.8 years old, ranging from 14 to 26 years. The average course of disease was 22.3±20.1 months, ranging from 6 to 84 months. The average follow-up duration was 7.2±4.4 months, ranging from 3 to 18 months). All patients underwent nerve conduction examination and electromyography of the upper limbs before operation and during follow-up, and completed DASH scale at the same time. Bilateral electrophysiological results before and after operation were compared separately. In addition, paired-sample t test was used to compare CMAP amplitude; Pearson chi-square test was used to compare the muscle spontaneous potential, motor potential morphology and, muscle recruitment. DASH score before and after operation was also compared using paired-sample t test. Results: The amplitude of median nerve and ulnar nerve in severe side was significantly lower than that in the other side before operation(P<0.05). Bilateral neurogenic damage could be detected in more than half of the patients in electromyography. The results of nerve conduction examination showed that the mean CMAP amplitude of the median nerve in severe side was 9.79±4.63mV before operation and 11.04±4.43mV after operation, with the difference being statistically significant(P<0.05). The mean CMAP amplitude of the ulnar nerve in severe side was 4.04±3.25mV before operation and 6.19±4.30mV after operation, with the difference being statistically significant(P<0.001). The CMAP amplitude of the medial nerve and ulnar nerve of the mild side was also increased, but the difference was not statistically significant. The results of needle electromyography showed that the decrease of the proportion of spontaneous potential and prolonged MUAP duration in the severe side of the patients was not statistically significant(P>0.05); muscle recruitment in some of the muscles were significantly improved. Among them, 42 patients had decreased muscle recruitment in flexor carpi radialis(42/43, 97.7%) before operation, while only 32 patients had decreased muscle recruitment in the same muscle(32/38, 84.2%), and the difference was statistically significant(P<0.05). The DASH score showed that the average preoperative DASH score was 7.04±7.63, and postoperative one was 6.89±7.47. The difference was not statistically significant(P>0.05). Conclusions: The CMAP amplitude of the upper limbs increased and the muscle recruitment improved in patients with Hirayama disease after anterior cervical fusion and internal fixation. This procedure has a positive effect on controlling the progression of the disease and improving the nerve function. |
| 投稿时间：2019-09-18 修订日期：2020-08-27 |
| DOI： |
| 基金项目:国家自然科学基金（81501909） |
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