多点递增刺激法运动单位数目估计在脊髓型颈椎病术后效果评价中的应用

Application of motor unit number estimation by multi-point incremental stimulation in the postoperative evaluation of cervical spondylotic myelopathy

关键词:  脊髓型颈椎病  多点递增刺激法  运动单位数目估计  拇短展肌  小指展肌

Key words:  cervical spondylotic myelopathy  multi-point incremental stimulation  motor unit number estimation  abductor pollicis brevis  abductor digiti minimis

摘要:

目的 探讨多点递增刺激法运动单位数目估计（motor unit number estimates，MUNE）对脊髓型颈椎病（cervical spondylotic myelopathy，CSM）术后效果评价的有效性。方法 收集资料完整的8例脊髓型颈椎病后路手术患者，检测术前及术后3个月、1年及2年拇短展肌和小指展肌的MUNE数值，并统计VAS及JOA评分，观察患者术后改善情况。结果 8例患者术前的双侧拇短展肌、小指展肌MUNE值与术后3个月、术后1年、术后2年MUNE值比较结果显示，术后3个月开始较术前MUNE增高，随着时间推移，术后2年MUNE增高更为明显，与术前及术后3个月相比均有显著性差异（P<0.05），各时间段测定的MUNE值与VAS评分及JOA评分变化趋势相符合。结论 多点递增刺激法MUNE 通过量化脊髓前角运动细胞数目，了解神经恢复的细微变化，能准确敏感地反映CSM术后预后情况。

Abstract:

Objective To investigate the validity of motor unit number estimation (MUNE) by multi-point incremental stimulation in the postoperative evaluation of cervical spondylotic myelopathy. Methods MUNE values of abductor pollicis brevis and abductor digiti minimi in 8 patients with cervical spondylotic myelopathy were recorded before and 3 months, 1 year and 2 years after surgery. VAS and JOA scores were counted to observe the improvement of the patients. Results In 8 patients with cervical spondylotic myelopathy, the MUNE values of bilateral abductor pollicis brevis and abductor digiti minimi were increased at the beginning of 3 months after surgery. The MUNE value at 2 years after surgery was significant higher than those before and 3 months after surgery (P<0.05). The MUNE value measured in each time period was consistent with the change trend of VAS score and JOA score. Conclusion MUNE can quantify the number of motor cells in anterior horn of spinal cord, reflect the subtle changes of nerve recovery and accurately and sensitively predict the postoperative prognosis of cervical spondylotic myelopathy.