腰部椎間板ヘルニア症の筋電図学的研究
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1. Part I -Ordinary Electromyographic Studies. Electromyographic studies were carried out in 87 patients diagnosed clinically as having lumbar intervertebral disk herniation. The present studies are mainly concerned with the grouping voltage, one of the abnormal wave forms, which was observed in 68 patients (78 %) in voluntary contraction of the muscle. Experiments were first carried out in animals to investigate into the mechanism responsible for its appearance. Then its relation to myographic findings and the results of various clincal tests was examined, and the influence of diskography on its appearance was studied. In determining the location of the disk involved by vsing the grouping voltage as an indication special care was taken in evaluating the result by making a study of anatomical structure of the parts involved. In 33 (89 %) out of the 37 cases in which the diagnosis of hernia of nucleus pulposus was confirmed by surgery, tue surgical findings proved to be in accord with the results of diagnosis by means of the grouping voltage. So it was concluded that the method of diagnosis based on the analysis of the grouping voltage was a useful adjunct to the method of diagnosis in determining the position of the disk involved. 2. Part II-Evoked Electromyographic Studies. Experiments were carried out in 41 patients in whom the diagnosis of lumbar intervertebral disk herniation was entertained clinically, in order to examine the reliability of evoked electromyographic examinations as a method of diagnosing the location of the disk involved in herniation. The raised threshold values for elicited H wave were found in somepatients, but the wave failed to appear in other patients with hernia of nucleus pulposus, while the M wave elicited in these patients was not different from the normal one. The ratio of to threshold value of H wave to that of M wave (H/M) was calculated in an attempt to see if it was possible to use it as a criterion for examination of the cases and follow-up study of them. The normal range of the ratio H/M was found to be 0.5 to 1.4. It shown that, in patients with the so-called nerve root disturbance, the ratio H/M tended to be higher than the normal level, but fell to the normal level with the improvement of clinical conditions. It seems, therefore, that the ratio H/M indicates the degree of nerve root disturbance. The response time of H wave was measured in normal persons and patients with hernia of nucleus pulposus. In the former, the difference between the values found in the right and left lege was less than 1 msec, whereas it was over 1 msec in the latter. This observation led the author to conclude that the response time of H wave was indicative of the degree of pressure applied to the nerve root. The rsult of the present studies seems to show that that the measurements of the threshold values of H and M waves and the response time of H wave are a useful adjunct to the method of diagnosis of the location of the disk involved in herniation.
- 千葉大学の論文
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