步行负荷试验对腰椎管狭窄症的诊断价值

The diagnostic value of ｇait load test for lumbar spinal stenosis

中文关键词:  腰椎管狭窄  间歇性跛行  步行负荷试验  肌电图

英文关键词:Lumbar spinal stenosis  Intermittent claudication  Gait load test  EMG

中文摘要:

  【摘要】 目的：研究步行负荷试验在诊断腰椎管狭窄症中与腰椎MRI检查及下肢肌电图检查的相符情况，评估其诊断价值。方法：选取2009年10月～2010年10月我院收治的腰椎管狭窄症住院患者35例，临床表现均为症状重但查体定位体征不明显。所有入选病例均对其影像学（腰椎正侧位、腰椎动力位、腰椎MRI、下肢血管多普勒）检查、下肢肌电图及步行负荷试验结果进行双盲检测及评估。观察比较步行负荷试验后出现特定阳性体征（感觉、肌力、反射等变化）所对应的神经受累节段，与腰椎MRI及肌电图检查所反应的腰椎管狭窄部位的相符情况。结果：步行负荷试验后有29例患者主诉出现下肢麻木、酸痛，其中体格检查显示L1/2、L2/3、L3/4、L4/5、L5/S1节段神经根受累节段数分别为1个、1个、12个、23个、16个，其中单节段神经根受累10例（34.5%），双节段神经根受累14例（48.3%），三节段神经根受累5例（17.2%）；影像学检查显示的L1/2、L2/3、L3/4、L4/5、L5/S1节段神经受累节段数分别为2个、2个、15个、25个、18个，其中单节段神经根受累14例（40%），双节段神经根受累15例（42.9%），三节段神经根受累6例（17.1%）。31例（88.6%）患者肌电图检查有阳性发现，4例（11.4%）无异常发现，步行负荷试验阳性发现的患者肌电图均有不同程度的异常（100%）。步行负荷试验在L3/4、L4/5、L5/S1节段诊断椎管狭窄与腰椎MRI检查相比无统计学差异（P>0.05）。结论：步行负荷试验诊断低位节段（L3～S1）的腰椎管狭窄症与腰椎MRI检查及肌电图检查结果具有较好的一致性，临床上对腰椎管狭窄症有重要的诊断价值。

英文摘要:

  【Abstract】 Objective：To assess the clinical efficacy of gait load test in the diagnosis of lumbar spinal stenosis by evaluating its coincidence with the lumbar MRI scan and EMG examination.Method：35 patients with lumbar spinal stenosis between October 2009　and October 2010　in our hospital，had severe symptoms but no obvious signs.All the cases were on the radiological examination（including lumbar X-ray of AP view，lateral view，lateral view of flexion and extension，lumbar MRI and color Doppler of lower limb vessels）.Double blind detection and assessment were performed for lower limb electromyography and gait load test results.The segments of the impaired nerve roots corresponding to specific positive symptoms（sensation，strength，reflexes and other changes） were noted after the gait load test and compared with the sites of lumbar spinal stenosis from lumbar MRI and EMG.Results：29 patients had symptoms after the gait load test.Physical examination demonstrated the number of the impaired segmental nerve roots of L1-2，L2-3，L3-4，L4-5，L5-S1.The number of segments was 1，1，12，23，16 respectively，in which the single level was 10（34.5%），while two-level amounted 14（48.3%）　and three-level 5（17.2%）.Radiological examination showed the number of the stenotic spinal segments of L1/2，L2/3，L3/4，L4/5，L5/S1.The number of segments was 2，2，15，25，18 respectively，in which the single level was 14（40%），while two-level amounted 15（42.9%） and three-level 6（17.1%）.EMG examination showed that 31 patients（88.6%） were positive，while 4 patients（11.4%） were negative.All the patients positive for gait load tests had abnormal findings under EMG（100%）.There was no significant difference in diagnosis of the lower lumbar spinal stenosis（L3/4，L4/5，L5/S1） between gait load test and lumbar MRI（P>0.05）.Conclusions：The gait load test had good coincidence with the lumbar MRI scan and EMG examination in diagnosis of the lower lumbar spinal stenosis.There was an important diagnostic value for lumbar spinal stenosis patients.