CAJ | 학술논문

目的分析腰骶神经根炎的临床、影像及神经电生理特点,提高对该病的认识.方法回顾性分析2008年7月至2013年9月解放军总医院神经内科确诊为腰骶神经根炎的14例患者临床、影像及神经电生理资料.结果 31 ～40岁年龄段发病最多,每例均有不同程度双侧或单侧下肢麻木、无力,5例肌肉萎缩,9例L4～S1神经根分布区感觉减退,14例腱反射减弱或消失,3例出现尿便障碍.腰骶MRI增强扫描4例存在脊膜及神经根不同程度强化.1例脑脊液白细胞升高(30×106/L),12例脑脊液蛋白升高(7例范围在450 ～1 000 mg/L,3例范围在1 000～2 000 mg/L,2例范围在2 000～3 000 mg/L).神经电生理检查中13例EMG为神经源性受损.运动神经传导检测发现22条腓总神经中5条传导速度减慢,12条复合肌肉动作电位波幅降低,2条右腓总神经、1条左腓总神经未引出复合肌肉动作电位;23条胫神经中6条传导速度减慢,6条复合肌肉动作电位波幅降低,2条右胫神经、1条左胫神经未引出复合肌肉动作电位.11例检测F波,其中6例异常,右侧腓总神经中1条F波潜伏期延长、1条F波出现率减低;胫神经中4条神经(左侧3条,右侧1条)F波潜伏期延长.14例双侧腓肠神经传导检测正常.结论磁共振成像诊断腰骶神经根炎较困难,神经电生理检查对确定病损部位及程度可提供更多有价值的信息.
목적 분석요저신경근염적림상、영상급신경전생리특점,제고대해병적인식.방법 회고성분석2008년7월지2013년9월해방군총의원신경내과학진위요저신경근염적14례환자림상、영상급신경전생리자료.결과 31 ～40세년령단발병최다,매례균유불동정도쌍측혹단측하지마목、무력,5례기육위축,9례L4～S1신경근분포구감각감퇴,14례건반사감약혹소실,3례출현뇨편장애.요저MRI증강소묘4례존재척막급신경근불동정도강화.1례뇌척액백세포승고(30×106/L),12례뇌척액단백승고(7례범위재450 ～1 000 mg/L,3례범위재1 000～2 000 mg/L,2례범위재2 000～3 000 mg/L).신경전생리검사중13례EMG위신경원성수손.운동신경전도검측발현22조비총신경중5조전도속도감만,12조복합기육동작전위파폭강저,2조우비총신경、1조좌비총신경미인출복합기육동작전위;23조경신경중6조전도속도감만,6조복합기육동작전위파폭강저,2조우경신경、1조좌경신경미인출복합기육동작전위.11례검측F파,기중6례이상,우측비총신경중1조F파잠복기연장、1조F파출현솔감저;경신경중4조신경(좌측3조,우측1조)F파잠복기연장.14례쌍측비장신경전도검측정상.결론 자공진성상진단요저신경근염교곤난,신경전생리검사대학정병손부위급정도가제공경다유개치적신식.
Objective To improve the understanding of lumbosacralradiculitis by analyzing the clinical,magnetic resonance imaging (MRI) and neuroeletrophysiological characteristics of disease.Methods The clinical,MRI and neuroeletrophysiological data of 14 patients diagnosed as lumbosacralradiculitis were retrospectively analyzed.Results The predominant age of onset was in the forth decade.Each patient had bilateral or unilateral lower extremity numbness and weakness of variable severity,including muscle atrophy (n =5) and decreased sensation in L4-S1 nerve root territory (n =9).Lower extremity tendon reflexes decreased or became absent in all patients.Urinary and defecation disorders were seen in 3 patients.Lumbosacral MRI showed lumbosacral meninges and nerve root enhancement in 4 patients.Cerebrospinal fluid analysis revealed elevated white blood cell (30 × 106/L) (n =1) and increased protein content (n =12) (450-1 000 mg/L,n=7; 1 000-2 000 mg/L,n=3; 2 000-3 000 mg/L,n =2).Needle electromyography (EMG) demonstrated neurogenic damage in 13 patients.Motor nerve conduction study showed decreased motor never conduction velocity (MCV) (n =5),decreased compound muscle action potential (CMAP) amplitude (n =12),CMAP absent at right side (n =2) and left side (n =1) among 22 peroneal nerves ; decreased MCV (n =6),decreased CMAP amplitude (n =6),CMAP absent at right side (n =2) and left side (n =1) among 23 tibial nerves.F-wave was performed for 11 patients and abnormal in 6 patients,with prolonged latency and reduced occurrence rate in right common peroneal nerve (n =2),left prolonged latency (n =3) and right tibial nerve (n =1) respectively.Bilateral sural nerve conduction study revealed no abnormality.Conclusion Diagnosing lumbosacralradiculitis is not easy based on lumbosacral MRI.And neuroelectrophysiological study may provide more valuable information in verifying the location of lesions and judging the damage extent of lumbosacralradiculitis.