自由肌电图监测在脊柱内镜下经维板间入路腰椎间盘切除术中的初步应用

The preliminary application of free-run electromyography in percutaneous endoscopic interlaminar discectomy

中文关键词:  自由肌电图  经皮内镜下椎板间入路腰椎间盘切除术  全身麻醉  术中监测

英文关键词:Free-run electromyography  Percutaneous endoscopic interlaminar discectomy(PEID)  General anesthesia  Intraoperative monitoring

中文摘要:

  【摘要】 目的：探讨自由肌电图监测在全麻脊柱内镜下经椎板间入路腰椎间盘切除术（percutaneous endoscopic interlaminar discectomy，PEID）中应用的可行性和效果。方法：回顾性分析2016年3月～2017年6月共86例接受全麻下PEID手术的腰椎间盘突出症患者，男62例，女24例；年龄平均41.2±8.1岁（23～64岁）。所有患者术中持续应用自由肌电图进行神经根功能监测，观察肌电图波形、峰值和运动单元数量。如果出现任何形式的肌电反应，均提示神经根受到一定激惹，而连续爆发性肌电反应则提示神经根受到持续的牵拉或者压迫。若手术结束时仍有明显异常的肌电反应存在，则预测为神经根损伤，并与术后患者症状比较。结果：术中在触碰、推挤及牵拉神经根时，相应的自由肌电图监测均出现肌电反应，记录阳性率为100%。共有79例患者术后症状明显缓解，6例患者术后出现下肢神经灼性疼痛症状，1例患者术后出现下肢肌力下降和麻木加重。以上患者中有1例术中出现明显肌电反应，手术结束时为正常，术后出现明显下肢神经灼性疼痛，假阴性预测率1.16%；有2例手术结束时肌电图监测仍有明显异常患者术后症状明显缓解，未有明显神经痛，假阳性预测率2.32%。结论：自由肌电图监测能比较准确地反映全麻下PEID手术中神经根干扰情况，从而起到减少神经损伤的目的。

英文摘要:

  【Abstract】 Objectives: To investigate the application feasibility and outcomes of free-run electromyography(Free-EMG) in percutaneous endoscopic interlaminar discectomy(PEID) under general anesthesia. Methods: From March 2016 to June 2017, total 86 patients with lumbar disc herniation received PEID under general anesthesia were retrospectively analyzed, including 62 males and 24 females with an average of 41.2±8.1 years old(23 to 64 years). Free-EMG was used for continuous nerve root function monitoring in all cases, and the waveform, peak and number of motor units were observed. Any type of myoelectric response indicated that the nerve root was provoked, and the continuous explosive electromyographic response indicated that the nerve root was subjected to continuous tension or compression. If there was a significant abnormality of myoelectric response at the end of operation, it was predicted to be nerve root injury, which would be compared with the postoperative symptoms. Results: Free-EMG monitoring showed an electromyographic response at intraoperative touch, push and pull on the nerve root, with a recordpositive rate of 100%. The postoperative symptoms of 79 patients were significantly released, 6 cases had symptoms of lower limb scorching pain, and the lower limb muscle strength was decreased and numbness was increased in 1 case. There was an obvious intraoperative myoelectric response in 1 case and it was normal at the end of operation. The false negative rate was 1.16%. In 2 cases with postoperative symptoms released, there were obvious intraoperative myoelectric responses at the end of operation. The false positive rate was 2.32%. Conclusions: The Free-EMG monitoring can accurately indicate the nerve root disturbance in the operation of PEID under general anesthesia, thus reducing the probability of nerve injury.