周围神经系统在亚急性脊髓损伤后的电生理变化。

Electrophysiological Changes in the Peripheral Nervous System After Subacute Spinal Cord Injury.

机构信息

Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea.

出版信息

Arch Phys Med Rehabil. 2020 Jun;101(6):994-1000. doi: 10.1016/j.apmr.2019.12.019. Epub 2020 Feb 5.

DOI:10.1016/j.apmr.2019.12.019

PMID:32035142

Abstract

OBJECTIVE

To assess factors affecting electrophysiological changes in the peripheral nervous system below the neurologic level of injury (NLI) in patients with subacute spinal cord injury (SCI).

DESIGN

Retrospective observational study.

SETTING

An inpatient rehabilitation center of a university hospital.

PARTICIPANTS

Through reviewing the medical records of 151 subjects with SCI, 42 without any other disease inducing peripheral neurologic abnormalities were included. They were classified into 2 groups, with or without denervation potentials in electromyography (EMG) below NLI.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Demographics and clinical characteristics including NLI, American Spinal Injury Association Impairment Scale (AIS), and Lower Extremity Motor Score were compared. Results of electrophysiological study including nerve conduction study, somatosensory-evoked potential (SSEP), and motor-evoked potential (MEP) were compared.

RESULTS

Denervation potentials in EMG below NLI were observed in 20 subjects, and 10 of them were AIS A or B, but there was none in subjects without denervation potentials (P<.001). The lower extremity motor score was 4.35±7.74 in the group with denervation potentials, lower than 33.64±13.60 of the opposite group (P<.001). In the analysis of electrophysiological study, patients with denervation potentials showed a higher proportion of no response than patients without denervation potentials (60.0% vs 11.4% in peroneal nerve conduction study, 35.0% vs 2.3% in tibial nerve conduction study, 80.0% vs 18.2% in SSEP, 87.5% vs 22.7% in MEP; P<.001, respectively). Additionally, greater axonal loss, based on decrease of amplitude without delayed latency on nerve conduction study, was observed in the group with denervation potentials than the opposite group (P<.001).

CONCLUSION

Among subjects with subacute SCI, cases of peripheral nervous dysfunction below the injury site occur, possibly associated with the severity of SCI.

摘要

目的

评估亚急性脊髓损伤（SCI）患者低于神经损伤水平（NLI）的周围神经系统电生理变化的影响因素。

设计

回顾性观察性研究。

地点

一所大学医院的住院康复中心。

参与者

通过回顾 151 例 SCI 患者的病历，纳入了 42 例无任何其他疾病引起周围神经异常的患者。他们被分为 2 组，一组肌电图（EMG）低于 NLI 有失神经电位，另一组无失神经电位。

干预

不适用。

主要观察指标

比较人口统计学和临床特征，包括 NLI、美国脊髓损伤协会损伤量表（AIS）和下肢运动评分。比较神经电生理研究结果，包括神经传导研究、体感诱发电位（SSEP）和运动诱发电位（MEP）。

结果

在 20 例 EMG 低于 NLI 的患者中观察到失神经电位，其中 10 例为 AIS A 或 B，但在无失神经电位的患者中则无（P<.001）。有失神经电位的患者下肢运动评分（4.35±7.74）低于无失神经电位的患者（33.64±13.60，P<.001）。在电生理研究分析中，有失神经电位的患者比无失神经电位的患者无反应的比例更高（腓总神经传导研究中分别为 60.0%和 11.4%，胫神经传导研究中分别为 35.0%和 2.3%，SSEP 中分别为 80.0%和 18.2%，MEP 中分别为 87.5%和 22.7%；P<.001）。此外，有失神经电位的患者比无失神经电位的患者神经传导研究中振幅下降而潜伏期无延迟，提示存在更大的轴突丢失（P<.001）。