發(fā)布時間：2018-10-25 06:11

【摘要】：目的:探討神經(jīng)電生理在微創(chuàng)脊柱外科中的應(yīng)用。方法:回顧性的分析2014年4月-2014年7月第三軍醫(yī)大學(xué)新橋醫(yī)院骨科收治的入院37例腰椎間盤突出癥(LDH)患者的臨床資料,其中包括單純腰椎間盤突出癥35例,并椎管狹窄癥2例。全部患者術(shù)中均在局麻下行經(jīng)皮椎間孔鏡腰椎間盤摘除術(shù)(PELD),術(shù)中使用自由電圖(free-EMG)對神經(jīng)功能進(jìn)行監(jiān)測,并紀(jì)錄患者的主觀感覺(疼痛)。以健康人作對照,回顧性分析2014年8月~2015年7月收集的100例單側(cè)L5-S1椎間盤突出癥患者的臨床資料,所有患者術(shù)前和術(shù)后均行脛神經(jīng)H反射、F波潛伏期以及運(yùn)動神經(jīng)傳導(dǎo)速度(MNCV)檢查;分析術(shù)前H反射、F波檢查結(jié)果的在診斷中的敏感性;比較術(shù)前、術(shù)后H反射、F波以及運(yùn)動神經(jīng)傳導(dǎo)速度(MNCV)結(jié)果的差異。結(jié)果:所有患者在手術(shù)通道放置過程中均出現(xiàn)腰部疼痛時,自由電圖(free-EMG)監(jiān)測結(jié)果沒有顯著的改變。2例患者在術(shù)中自由肌電圖(free-EMG)出現(xiàn)明顯變化時卻無疼痛。35例患者在出現(xiàn)明顯的腿部疼痛時,自由肌電圖(free-EMG)的監(jiān)測結(jié)果也出現(xiàn)出現(xiàn)顯著的變化,立即提醒術(shù)者,查找此改變的原因,在調(diào)整手術(shù)通道以后,患者的腿部疼痛隨之消失,同時自由肌電圖(free-EMG)監(jiān)測結(jié)果也發(fā)生改變,接近于正常。所有的患者在摘除突出的腰椎間盤時,沒有明顯的疼痛且神經(jīng)電生理監(jiān)測也無明顯的改變。在剝離、解壓粘連的神經(jīng)根時,所有患者均出明顯的自由電圖(free-EMG)改變和腿痛,停止操作以后,腿部疼痛消失,神經(jīng)電生理監(jiān)測結(jié)果也恢復(fù)正常。在直視下使用探針刺激神經(jīng)根的時候,患者出現(xiàn)了明顯的腿部疼痛,同時自由電圖(free-EMG)也出現(xiàn)明顯的電位波形改變。術(shù)前H反射潛伏期的異常率為87%,F波潛伏期的異常率為69%;術(shù)前、術(shù)后患側(cè)的H反射、F波潛伏期有明顯的統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)前患側(cè)H反射、F波潛伏期與健康組相比有明顯統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后患側(cè)H反射、F波潛伏期與健康組相比無明顯統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)前患側(cè)H反射、F波潛伏期與健側(cè)相比有明顯的統(tǒng)計(jì)學(xué)差異;術(shù)后患側(cè)H反射、F波潛伏期與健側(cè)相比無明顯的統(tǒng)計(jì)學(xué)差異;術(shù)前健側(cè)H反射、F波潛伏期與健康對照組相比無顯著差異;病人患側(cè)的脛神經(jīng)運(yùn)動傳導(dǎo)速度與健康組相比均無顯著統(tǒng)計(jì)學(xué)差(P0.05)。結(jié)論:術(shù)中自由肌電圖(free-EMG)監(jiān)測可提高手術(shù)安全性;H反射、F波潛伏期檢查對評估手術(shù)療效和診斷腰骶神經(jīng)根病有重要臨床意義。
[Abstract]:Objective: to explore the application of neuroelectrophysiology in minimally invasive spinal surgery. Methods: the clinical data of 37 patients with lumbar disc herniation (LDH) admitted to the Department of Orthopaedics of Xinqiao Hospital of the third military Medical University from April 2014 to July 2014 were retrospectively analyzed, including 35 cases of simple lumbar disc herniation and 2 cases of spinal canal stenosis. All the patients were performed percutaneous foraminal discectomy (PELD),) under local anesthesia. The nerve function was monitored by free electrogram (free-EMG) and the subjective sensation (pain) was recorded. The clinical data of 100 patients with unilateral L5-S1 disc herniation from August 2014 to July 2015 were retrospectively analyzed. All patients underwent (MNCV) examination of tibial nerve H reflex, F-wave latency and motor nerve conduction velocity before and after operation. The difference of H reflex, F wave and motor nerve conduction velocity (MNCV) after operation. Results: all the patients suffered from lumbar pain during the placement of the surgical passage. The results of free electrogram (free-EMG) monitoring were not significantly changed. There was no pain in 2 patients with significant changes in free-EMG during operation, and in 35 patients with significant leg pain. The monitoring results of free electromyography (free-EMG) also showed significant changes, immediately alerting the operator to find out the cause of the change, and after adjusting the surgical channel, the pain in the leg disappeared. At the same time, free electromyography (free-EMG) monitoring results also changed, close to normal. All patients had no significant pain and no significant changes in electrophysiological monitoring of the herniated lumbar disc. When the adherent nerve roots were removed and decompressed, all patients showed obvious changes of free-EMG and leg pain. After stopping operation, the pain of the legs disappeared, and the results of electrophysiological monitoring returned to normal. When the probe was used to stimulate the nerve root under the direct vision, the patient had obvious leg pain, and there was also a significant change in the potential waveform of the free electrogram (free-EMG). The abnormal rate of preoperatively H reflex latency was 87 and the abnormal rate of F wave latency was 69. Postoperative H reflex, F wave latency were significantly different (P0.05); preoperative H reflex, F wave latency were significantly different compared with the healthy group (P0.05); postoperative H reflex, F wave latency was not clear compared with the healthy group. There was significant difference in the latency of H reflex and F wave between the affected side and the normal side before operation (P0.05), and there was significant difference in the latency of F wave between the affected side and the normal side. There was no significant difference in the latency of F-wave between the affected side and the healthy side after operation, but there was no significant difference between the pre-operative H-reflex and the F-wave latency of the healthy side compared with the healthy control group. There was no significant difference in motor conduction velocity of tibial nerve between patients and healthy group (P0.05). Conclusion: intraoperative free electromyography (free-EMG) monitoring can improve the safety of the operation, and the detection of H-reflex and F-wave latency is of great clinical significance in evaluating the curative effect of operation and in diagnosing lumbosacral radiculopathy.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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