神经电生理在微创脊柱外科中的应用
发布时间：2018-10-25 06:11
【摘要】：目的:探讨神经电生理在微创脊柱外科中的应用。方法:回顾性的分析2014年4月-2014年7月第三军医大学新桥医院骨科收治的入院37例腰椎间盘突出症(LDH)患者的临床资料,其中包括单纯腰椎间盘突出症35例,并椎管狭窄症2例。全部患者术中均在局麻下行经皮椎间孔镜腰椎间盘摘除术(PELD),术中使用自由电图(free-EMG)对神经功能进行监测,并纪录患者的主观感觉(疼痛)。以健康人作对照,回顾性分析2014年8月~2015年7月收集的100例单侧L5-S1椎间盘突出症患者的临床资料,所有患者术前和术后均行胫神经H反射、F波潜伏期以及运动神经传导速度(MNCV)检查;分析术前H反射、F波检查结果的在诊断中的敏感性;比较术前、术后H反射、F波以及运动神经传导速度(MNCV)结果的差异。结果:所有患者在手术通道放置过程中均出现腰部疼痛时,自由电图(free-EMG)监测结果没有显著的改变。2例患者在术中自由肌电图(free-EMG)出现明显变化时却无疼痛。35例患者在出现明显的腿部疼痛时,自由肌电图(free-EMG)的监测结果也出现出现显著的变化,立即提醒术者,查找此改变的原因,在调整手术通道以后,患者的腿部疼痛随之消失,同时自由肌电图(free-EMG)监测结果也发生改变,接近于正常。所有的患者在摘除突出的腰椎间盘时,没有明显的疼痛且神经电生理监测也无明显的改变。在剥离、解压粘连的神经根时,所有患者均出明显的自由电图(free-EMG)改变和腿痛,停止操作以后,腿部疼痛消失,神经电生理监测结果也恢复正常。在直视下使用探针刺激神经根的时候,患者出现了明显的腿部疼痛,同时自由电图(free-EMG)也出现明显的电位波形改变。术前H反射潜伏期的异常率为87%,F波潜伏期的异常率为69%;术前、术后患侧的H反射、F波潜伏期有明显的统计学差异(P0.05);术前患侧H反射、F波潜伏期与健康组相比有明显统计学差异(P0.05);术后患侧H反射、F波潜伏期与健康组相比无明显统计学差异(P0.05);术前患侧H反射、F波潜伏期与健侧相比有明显的统计学差异;术后患侧H反射、F波潜伏期与健侧相比无明显的统计学差异;术前健侧H反射、F波潜伏期与健康对照组相比无显著差异;病人患侧的胫神经运动传导速度与健康组相比均无显著统计学差(P0.05)。结论:术中自由肌电图(free-EMG)监测可提高手术安全性;H反射、F波潜伏期检查对评估手术疗效和诊断腰骶神经根病有重要临床意义。
[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.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2292841
[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.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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