比目鱼肌H反射监测在全麻下经皮椎板间入路内窥镜下手术中的应用价值

发布时间：2018-11-15 13:34

【摘要】：目的 :观察全麻下经皮椎板间入路内窥镜下手术各操作步骤中使用H反射监测S1神经根功能的变化情况,明确该神经电生理参数在监测全麻下脊柱内窥镜手术中的应用价值。方法:14例单侧L5/S1椎间盘突出症(S1神经根损伤)患者被纳入本研究,男7例,女7例;年龄25~53岁;身高160~177cm。均行全麻下经皮椎板间入路内窥镜下单纯髓核摘除术。术前、术中各操作步骤(通道置入、神经根暴露、突出髓核摘除及内窥镜系统退出)及术后分别记录双侧下肢比目鱼肌H反射,测量并对比潜伏期及波幅(基线-负向波峰)等参数,并对结果进行统计学分析。结果:以术前完成全麻插管后、在手术体位所测得的H反射参数作为术中H反射的基线值。术中,患侧H反射波幅自神经根暴露(通道触碰或挤压神经根)阶段开始便出现明显下降(P0.05),在剥离推移神经根时H反射波幅下降幅度最为明显[平均下降(43.9±20.5)%,P0.05],而后虽有回升,但较基线值仍存在统计学差异(P0.05);手术结束时,所有患者患侧H反射都得以保留,但波幅仍较基线值下降约(15.1±9.0)%(P0.05)。术后第2日,所有患者VAS评分(Visual analogue scale)明显好转(术前vs.术后:6.4±1.3 vs.0.6±0.6,P0.05);12例患者复测患侧H反射,各项参数相较于术前无明显差异(P0.05)。2例患者术中出现H反射波幅下降超过85%的情况,在停止操作、放松牵拉神经根后数十秒,H反射都得以部分恢复,术后未出现明显的感觉或运动障碍。结论:比目鱼肌H反射波幅能有效反映经皮椎板间入路内窥镜手术各操作步骤中S1神经根的电生理传导功能,术中应用H反射监测技术可为全麻下脊柱内窥镜手术提供额外的、可靠的辅助监护手段。
[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 卤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 卤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 卤1.3 vs.0.6 卤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.
【作者单位】：复旦大学附属华山医院骨科;
【基金】：上海卫生系统第二批重要疾病联合攻关重点项目(编号:2014ZYJB0008) 上海市科学技术委员会项目(编号:14140903800) 上海市卫生计生委科研课题(编号:201540263)
【分类号】：R687.3

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