肌电图监测经皮内镜下腰椎间盘切除术治疗腰椎间盘突出症
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摘要
目的分析经皮内镜下腰椎间盘切除术中应用肌电图监测结果,以预防神经损伤。方法对27例L_(4～5)及14例L_5～S_1椎间盘突出症患者采用侧路经皮椎间孔镜下髓核切除术,对12例L_5～S_1椎间盘突出症患者采用后路经皮椎板间入路髓核切除术。对L_(4～5)节段椎间盘突出症手术患者监测术侧的L_4和L_5神经的自发肌电图,对L_5～S_1手术患者监测术侧的L_5和S_1神经的自发肌电图。结果 53例患者术前自发肌电图均表现为波幅很低的波浪线。在通道建立过程中,46例出现异常肌电波;在髓核摘除过程中,5例出现异常肌电波;在显露减压神经根时,所有患者出现异常肌电波。腰痛时肌电图为中等宽幅的异常肌电波;下肢放射痛时为成串的、高波幅的异常肌电波。53例VAS评分术前为(7.34±1.54)分,术后1个月为(1.53±0.81)分,差异有统计学意义(P<0.01)。结论术中进行肌电图监测有助于对神经损伤进行预防,提高手术安全性。
Objective To analyse the results of electromyographical monitoring in percutaneous endoscope lumbar discectomy,in order to prevent nerve damage. Methods The 27 patients with L_(4 ～ 5) disc herniation and 14 patients with L_5～ S_1 disc herniation underwent percutaneous transforaminal lateral endoscope lumbar discectomy. The 12 patients with L_5～ S_1 disc herniation underwent percutaneous posteral endoscope lumbar discectomy via interlaminar approach. The operation side L_4 and L_5 nerve function were monitored by spontaneous electromyography for L_(4 ～ 5) disc herniation. The operation side L_5 and S_1 nerve function were monitored by spontaneous electromyography for L_5～ S_1 disc herniation. Results The spontaneous electromyography showed a wavy line with low amplitude before operation in all 53 patients. In the process of operation channel placed,abnormal muscle wave occurred in 46 patients. In the process of discectomy,abnormal muscle wave occurred in 5 patients. Abnormal muscle wave occurred in all 53 patients during the exposure and decompression of nerve roots. The amplitude of electromyography was middle when back pain happened. When leg pain appeared,the amplitude of electromyography was large and cluster. The 53 patients' VAS were 7. 34 ± 1. 54 and 1. 53 ± 0. 81 before and 1 month after operation,respectively,which was significantly difference( P < 0. 01). Conclusions Intraoperative electromyographical monitoring may contribute to prevent nerve injury and improve the surgical safety.
Objective To analyse the results of electromyographical monitoring in percutaneous endoscope lumbar discectomy,in order to prevent nerve damage. Methods The 27 patients with L_(4 ～ 5) disc herniation and 14 patients with L_5～ S_1 disc herniation underwent percutaneous transforaminal lateral endoscope lumbar discectomy. The 12 patients with L_5～ S_1 disc herniation underwent percutaneous posteral endoscope lumbar discectomy via interlaminar approach. The operation side L_4 and L_5 nerve function were monitored by spontaneous electromyography for L_(4 ～ 5) disc herniation. The operation side L_5 and S_1 nerve function were monitored by spontaneous electromyography for L_5～ S_1 disc herniation. Results The spontaneous electromyography showed a wavy line with low amplitude before operation in all 53 patients. In the process of operation channel placed,abnormal muscle wave occurred in 46 patients. In the process of discectomy,abnormal muscle wave occurred in 5 patients. Abnormal muscle wave occurred in all 53 patients during the exposure and decompression of nerve roots. The amplitude of electromyography was middle when back pain happened. When leg pain appeared,the amplitude of electromyography was large and cluster. The 53 patients' VAS were 7. 34 ± 1. 54 and 1. 53 ± 0. 81 before and 1 month after operation,respectively,which was significantly difference( P < 0. 01). Conclusions Intraoperative electromyographical monitoring may contribute to prevent nerve injury and improve the surgical safety.
引文
[1]胡楷,熊梅,王言,等.神经电生理监测在经皮内窥镜下腰椎间盘切除术中的应用[J].中国脊柱脊髓杂志,2015,25(7):602-606.
[2]朱司阳,魏祥品.术中神经电生理监测在椎管肿瘤手术中的应用[J].立体定向和功能性神经外科杂志,2012,25(6):372-376.
[3]Li F,Gorji R,Allott G,et al.The usefulness of intraoperative neurophysiological monitoring in cervical spine surgery:a retrospective analysis of 200 consecutive patients[J].J Neurosurg Anesthesiol,2012,24(3):185-190.
[4]金掌,张立岩,叶亚云,等.神经电生理监测技术在胸腰椎骨折微创椎弓根螺钉置入术中的应用[J].脊柱外科杂志,2015,13(3):158-160.
[5]Haghighi S S.Evoked potential monitoring during spine surgery[J].J Spine,2012,1(2):1-2.
[6]田胜兰,谭伟,冯丹,等.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床观察[J].华中科技大学学报(医学版),2015,44(4):472-475.
[7]杨湘江,张洪,曾月东,等.椎板间入路椎间孔镜下摘除L5/S1椎间盘突出髓核技术改进探讨[J].中国内镜杂志,2015,21(3):326-329.
[8]Teli M,Lovi A,Brayda-Bruno M,et al.Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy[J].Eur Spine J,2010,19(3):443-450.
[9]Ahn Y,Lee H Y,Lee S H,et al.Dural tears in percutanerous endoscopic lumbar discectomy[J].Eur Spine J,2011,20(1):58-64.
[10]柳百炼,熊鹰,顾邵,等.经皮椎间孔镜治疗腰椎间盘突出症的临床结果[J].实用医学杂志,2015,31(6):981-983.
[2]朱司阳,魏祥品.术中神经电生理监测在椎管肿瘤手术中的应用[J].立体定向和功能性神经外科杂志,2012,25(6):372-376.
[3]Li F,Gorji R,Allott G,et al.The usefulness of intraoperative neurophysiological monitoring in cervical spine surgery:a retrospective analysis of 200 consecutive patients[J].J Neurosurg Anesthesiol,2012,24(3):185-190.
[4]金掌,张立岩,叶亚云,等.神经电生理监测技术在胸腰椎骨折微创椎弓根螺钉置入术中的应用[J].脊柱外科杂志,2015,13(3):158-160.
[5]Haghighi S S.Evoked potential monitoring during spine surgery[J].J Spine,2012,1(2):1-2.
[6]田胜兰,谭伟,冯丹,等.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床观察[J].华中科技大学学报(医学版),2015,44(4):472-475.
[7]杨湘江,张洪,曾月东,等.椎板间入路椎间孔镜下摘除L5/S1椎间盘突出髓核技术改进探讨[J].中国内镜杂志,2015,21(3):326-329.
[8]Teli M,Lovi A,Brayda-Bruno M,et al.Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy[J].Eur Spine J,2010,19(3):443-450.
[9]Ahn Y,Lee H Y,Lee S H,et al.Dural tears in percutanerous endoscopic lumbar discectomy[J].Eur Spine J,2011,20(1):58-64.
[10]柳百炼,熊鹰,顾邵,等.经皮椎间孔镜治疗腰椎间盘突出症的临床结果[J].实用医学杂志,2015,31(6):981-983.