【摘要】：目的 :觀察全麻下經(jīng)皮椎板間入路內(nèi)窺鏡下手術(shù)各操作步驟中使用H反射監(jiān)測(cè)S1神經(jīng)根功能的變化情況,明確該神經(jīng)電生理參數(shù)在監(jiān)測(cè)全麻下脊柱內(nèi)窺鏡手術(shù)中的應(yīng)用價(jià)值。方法:14例單側(cè)L5/S1椎間盤突出癥(S1神經(jīng)根損傷)患者被納入本研究,男7例,女7例;年齡25~53歲;身高160~177cm。均行全麻下經(jīng)皮椎板間入路內(nèi)窺鏡下單純髓核摘除術(shù)。術(shù)前、術(shù)中各操作步驟(通道置入、神經(jīng)根暴露、突出髓核摘除及內(nèi)窺鏡系統(tǒng)退出)及術(shù)后分別記錄雙側(cè)下肢比目魚肌H反射,測(cè)量并對(duì)比潛伏期及波幅(基線-負(fù)向波峰)等參數(shù),并對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:以術(shù)前完成全麻插管后、在手術(shù)體位所測(cè)得的H反射參數(shù)作為術(shù)中H反射的基線值。術(shù)中,患側(cè)H反射波幅自神經(jīng)根暴露(通道觸碰或擠壓神經(jīng)根)階段開始便出現(xiàn)明顯下降(P0.05),在剝離推移神經(jīng)根時(shí)H反射波幅下降幅度最為明顯[平均下降(43.9±20.5)%,P0.05],而后雖有回升,但較基線值仍存在統(tǒng)計(jì)學(xué)差異(P0.05);手術(shù)結(jié)束時(shí),所有患者患側(cè)H反射都得以保留,但波幅仍較基線值下降約(15.1±9.0)%(P0.05)。術(shù)后第2日,所有患者VAS評(píng)分(Visual analogue scale)明顯好轉(zhuǎn)(術(shù)前vs.術(shù)后:6.4±1.3 vs.0.6±0.6,P0.05);12例患者復(fù)測(cè)患側(cè)H反射,各項(xiàng)參數(shù)相較于術(shù)前無明顯差異(P0.05)。2例患者術(shù)中出現(xiàn)H反射波幅下降超過85%的情況,在停止操作、放松牽拉神經(jīng)根后數(shù)十秒,H反射都得以部分恢復(fù),術(shù)后未出現(xiàn)明顯的感覺或運(yùn)動(dòng)障礙。結(jié)論:比目魚肌H反射波幅能有效反映經(jīng)皮椎板間入路內(nèi)窺鏡手術(shù)各操作步驟中S1神經(jīng)根的電生理傳導(dǎo)功能,術(shù)中應(yīng)用H反射監(jiān)測(cè)技術(shù)可為全麻下脊柱內(nèi)窺鏡手術(shù)提供額外的、可靠的輔助監(jiān)護(hù)手段。
[Abstract]:Objective: to observe the changes of S1 nerve root function by using H reflex in every procedure of percutaneous interlaminar approach under general anesthesia, and to determine the value of this electrophysiological parameter in monitoring spinal endoscopy under general anesthesia. Methods: fourteen patients with unilateral L5/S1 disc herniation (S1 nerve root injury) were included in this study. All patients were treated with simple nucleus pulposus extirpation by percutaneous interlaminar approach under general anesthesia. Preoperative and operative procedures (channel placement, nerve root exposure, protruding nucleus pulposus excision and endoscope withdrawal) and postoperative recording of H-reflex of the soleus muscle of the bilateral lower extremities were performed. The latency and amplitude (baseline-negative peak) were measured and compared, and the results were analyzed statistically. Results: the parameters of H reflex were taken as the baseline value of H reflex during operation after the intubation of general anesthesia was completed before operation. During the operation, the amplitude of H-reflex wave in the affected side decreased significantly from the stage of nerve root exposure (channel touching or squeezing nerve root) (P0.05). The amplitude of H reflex wave decreased most obviously in the course of peeling the nerve root (43.9 鹵20.5%, P0.05), but there was statistical difference between them (P0.05). At the end of the operation, H reflex was preserved in all patients, but the amplitude was still decreased by (15.1 鹵9.0)% (P0.05) compared with the baseline. On the second day after operation, the VAS score (Visual analogue scale) of all patients improved significantly (vs. before operation). Postoperative: 6.4 鹵1.3 vs.0.6 鹵0.6 (P0.05); There was no significant difference in the parameters between 12 patients and pre-operation (P0.05). The amplitude of H reflex wave decreased by more than 85% in 2 patients during the operation, after the operation was stopped, the nerve root was relaxed for tens of seconds. H reflex was partially recovered and no obvious sensory or motor disturbance was found after operation. Conclusion: the amplitude of H reflex wave in soleus muscle can effectively reflect the electrophysiological conduction function of S1 nerve root in every procedure of percutaneous interlaminar endoscope operation. The application of H reflex monitoring technique in operation can provide additional information for spinal endoscopy under general anesthesia. Reliable means of auxiliary guardianship.
【作者單位】： 復(fù)旦大學(xué)附屬華山醫(yī)院骨科;
【基金】：上海衛(wèi)生系統(tǒng)第二批重要疾病聯(lián)合攻關(guān)重點(diǎn)項(xiàng)目(編號(hào):2014ZYJB0008) 上海市科學(xué)技術(shù)委員會(huì)項(xiàng)目(編號(hào):14140903800) 上海市衛(wèi)生計(jì)生委科研課題(編號(hào):201540263)
【分類號(hào)】：R687.3

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