张秀莉,吴宗耀,邓维维,等.采用磁刺激确定下肢肌肉脊神经支配节段的临床研究[J].中华物理医学与康复杂志,2024,46(10):916-922
扫码阅读全文
|
| 采用磁刺激确定下肢肌肉脊神经支配节段的临床研究 |
|
| |
| DOI：10.3760/cma.j.issn.0254-1424.2024.10.010 |
| 中文关键词: 磁刺激 神经根 电生理 |
| 英文关键词: Magnetic stimulation Nerve roots Electrophysiology |
| 基金项目:国家自然科学基金(U19A2082) |
|
| 摘要点击次数: 1635 |
| 全文下载次数: 1961 |
| 中文摘要: |
| 目的 探讨磁刺激在腰骶神经根定位中的应用。 方法 选取健康受试者30例，采用徒手定位结合超声确定右侧L2～S1椎间孔在体表的投影位置，将磁刺激作用于其不同神经根节段，诱发下肢股内侧肌、胫骨前肌、腓肠肌产生复合肌肉动作电位(CMAP)，观察潜伏期、波幅、运动阈值的变化效应。 结果 将磁刺激作用于L2～3节段，下肢股内侧肌表现出明显的直接兴奋效应；将磁刺激作用于L5～S1节段，下肢腓肠肌及胫骨前肌表现出显著的直接兴奋效应；且上述靶肌出现有效反应（运动阈值均低于40%，波幅均超过1 mV）的例数较多。将磁刺激作用于L4节段，股内侧肌波幅在1 mV以上，各肌群出现有效反应的例数比较，差异无统计学意义（P＞0.05）。不同节段磁刺激诱发同一靶肌出现有效反应的潜伏期呈阶梯性变化，胫骨前肌和腓肠肌CMAP潜伏期12 ms以上、13 ms以上，提示受激活的神经根为L5和L4；股内侧肌的CMAP潜伏期6 ms以上、7 ms以上、8 ms以上，提示受激活的神经根为L4、L3、L2。 结论 根据股内侧肌、胫骨前肌、腓肠肌对L2～S1水平磁刺激的反应（CMAP潜伏期、波幅、运动阈值），可推测出其脊神经支配节段。 |
| 英文摘要: |
| Objective To explore the locations of the lumbosacral nerve roots by use of the magnetic stimulation. Methods Thirty healthy subjects were studied. The projections of the right L2 to S1 intervertebral foramina on their body surfaces were determined manually with ultrasound assistance. Magnetic stimulation was applied to different nerve root segments to induce compound muscle action potentials (CMAP) in the vastus medialis, tibialis anterior, and gastrocnemius muscles of the lower limbs. The changes in latency, amplitude, and motor threshold were observed. Results Magnetic stimulation on the L2-L3 segment resulted in a significant direct excitation of the vastus medialis. That on the L5-S1 segment evoked a significant direct excitatory effect on the tibialis anterior and gastrocnemius, with a motor threshold below 40%, an amplitude exceeding 1mV, and many effective responses. However, during the magnetic stimulation on the L4 segment, the amplitude of the vastus medialis was above 1mV, with no significant differences in the number of effective responses among the muscle groups. Moreover, there was a stepwise change in the latency of effective muscle responses to magnetic stimulation at different segments. The CMAP latencies of 12+ms for the tibialis anterior and 13+ms for the gastrocnemius indicated activation of the L5 and L4 nerve roots, respectively, while those of 6+ms, 7+ms, and 8+ms for the vastus medialis suggested activation of the L4, L3, and L2 nerve roots, respectively. Conclusions Based on the responses (CMAP latency, amplitude and motor threshold) of the vastus medialis, tibialis anterior and gastrocnemius to magnetic stimulation at different L2 to S1 segments, the spinal nerve root segments responsible for innervation can be inferred. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
