CAJ | 학술논문

目的探讨肌电图(EMG)对颈髓髓内肿瘤和炎性脱髓鞘病的鉴别诊断价值.方法选择2008年3月至2013年6月解放军总医院收治的颈椎MRI呈现异常信号,拟诊髓内肿瘤或炎性脱髓鞘病的住院患者为研究对象,于手术等治疗前行电生理检查,结合手术病理结果进行分析,对预后进行随访观察,并比较EMG诊断以及依据病史、症状和体征对髓内肿瘤诊断效能的差异.结果共纳入55例颈髓内病变患者,22例最终诊断为髓内肿瘤,其中15例(68.18％)EMG出现神经源性损害;33例最终诊断为炎性脱髓鞘病,其中仅1例(3.03％) EMG出现神经源性损害.两者EMG异常率比较,差异有统计学意义(P =0.000).出现神经源性损害的肌肉对应的脊髓节段均在影像所见病灶范围内.采用病史、症状和体征进行的临床诊断方法对髓内肿瘤诊断的敏感度为59.09％,特异度为75.76％;采用EMG诊断的敏感度为68.18％,特异度为96.97％.结论 EMG对颈髓髓内肿瘤及炎性脱髓鞘病具有较好的鉴别诊断价值,在髓内肿瘤诊断中EMG诊断优于临床诊断.
목적 탐토기전도(EMG)대경수수내종류화염성탈수초병적감별진단개치.방법 선택2008년3월지2013년6월해방군총의원수치적경추MRI정현이상신호,의진수내종류혹염성탈수초병적주원환자위연구대상,우수술등치료전행전생리검사,결합수술병리결과진행분석,대예후진행수방관찰,병비교EMG진단이급의거병사、증상화체정대수내종류진단효능적차이.결과 공납입55례경수내병변환자,22례최종진단위수내종류,기중15례(68.18％)EMG출현신경원성손해;33례최종진단위염성탈수초병,기중부1례(3.03％) EMG출현신경원성손해.량자EMG이상솔비교,차이유통계학의의(P =0.000).출현신경원성손해적기육대응적척수절단균재영상소견병조범위내.채용병사、증상화체정진행적림상진단방법대수내종류진단적민감도위59.09％,특이도위75.76％;채용EMG진단적민감도위68.18％,특이도위96.97％.결론 EMG대경수수내종류급염성탈수초병구유교호적감별진단개치,재수내종류진단중EMG진단우우림상진단.
Objective To investigate the value of needle electromyography (EMG) in differentiating intramedullary tumor from inflammatory demyelinating disease of cervical region.Methods Patients hospitalized in the Chinese PLA General Hospital from March 2008 to June 2013 with abnormalities on MRI of cervical vertebra and preliminary diagnosed as intramedullary tumor or inflammatory demyelinating disease of cervical region were enrolled in the study.Electrophysiological examination was performed before any treatment.Pathological findings were analyzed and prognosis was evaluated in all the subjects.Results A total of fifty-five patients were enrolled in the study with 33 cases of inflammatory demyelinating disease and 22 cases of intramedullary tumor defined by the postoperative pathological findings.In all the 33 cases with demyelinating disease,only one case (3.03％) presented as neurogenic damage by needle EMG.While in all the 22 cases with intramedullary tumor,needle EMG revealed neurogenic damage in 15 cases (68.18％) and the spinal segments of muscles with neurogenic damage were all within the spinal lesions demonstrated by MRI.The diagnostic sensitivity of EMG for intramedullary tumor was 68.18％ and the diagnostic specificity was 96.97％,while the diagnostic sensitivity and specificity for intramedullary tumor by the medical history,symptoms and signs were 59.09％ and 75.76％ respectively.Conclusion Needle EMG might play an important role in distinguishing intramedullary tumor from inflammatory demyelinating disease of cervical spinal cord.