术中肌电图监测在全身麻醉下腰椎椎间孔镜手术中的应用  

Application of electromyography monitoring in percutaneous endoscope lumbar discectomy under general anesthesia

作　　者：徐勇[1] 李锋[1] 熊伟[1] 方忠[1] 廖晖[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《骨科》2016年第1期22-26,共5页ORTHOPAEDICS

基　　金：国家自然科学基金资助项目(81472133);卫生行业科研专项项目基金(201002018)

摘　　要：目的评估术中肌电图监测在全身麻醉下腰椎椎间孔镜手术中的可行性以及安全性。方法回顾性分析我院2013年10月至2015年8月使用全身麻醉下联合自发肌电图监测行椎间孔镜手术治疗腰椎间盘突出症的145例患者,其中椎间孔入路93例,椎板间入路52例。记录术中异常肌电图信号的发生情况、术后新发神经功能障碍;采用疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)评价手术疗效。结果 145例患者手术均顺利完成。术中有21例(14.5%,21/145)出现异常肌电反应,经椎间孔入路14例,其中发生于穿刺及放置工作通道过程者4例(4.3%,4/93),在椎间盘切除过程的有12例(12.9%,12/93),2例在上述过程中均有异常肌电反应;经椎板间入路的有7例出现异常肌电反应,其中发生于穿刺及放置工作通道过程的有1例(1.9%,1/52),切除椎间盘过程中的有7例(13.4%,7/52),1例在上述过程中均有异常肌电反应。术后2例(1.4%,2/145)患者麻木症状加重,2周后缓解。手术前后VAS评分及ODI的差异均有统计学意义(均P<0.05)。结论全身麻醉联合肌电图监测下行椎间孔镜手术可取得与局部麻醉同样的手术效果,可减轻患者术中紧张及痛苦,患者易于接受;术中使用神经电生理监测可保证手术安全性,避免神经并发症的发生。Objective To evaluate the feasibility and safety of percutaneous endoscope lumbar discec-tomy（PELD） using electromyography（EMG） monitoring under general anesthesia. Methods The clinical dataof 145 patients with lumbar disc herniation treated in our institution by PELD using electromyography monitor-ing under general anesthesia from October 2013 to August 2015 were retrospectively, including 93 cases via thetransforaminal approach and 52 cases via the interlaminar approach. Abnormal EMG changes, postoperativeneurological complications, visual analogue scale（VAS） and Oswestry disability index（ODI） were recorded. Results PELD was successfully performed on all 145 cases. There were no severe complications during and afteroperation except for 2 cases（1.4%） of postoperative dysthesia. Abnormal EMG changes were recorded in 21 ofthe 145 cases（14.5%, 21/145）, which occurred during puncture and placement of the endoscopic working chan-nel in the area of the neuroforamen in 4 cases（4.3%, 4/93） and during removal of the herniated disc in 12 cases（12.9%, 12/93） via the transforaminal approach, while 1 case（1.9%, 1/52） and 7 cases（13.4%, 7/52） via the in-terlaminar approach. VAS scores and ODI revealed statistically significant improvement when they were com-pared with preoperative values（all P〈0.05）. Conclusion PELD combined with electromyography monitoringunder general anesthesia is safe and effective in the treatment of lumbar disc herniation, and can achieve goodoutcomes and high patient satisfaction. General anesthesia can reduce intraoperative stress and pain so that alarger number of patients may benefit from it.

关 键 词：肌电图监测 全身麻醉 外科手术 微创性 内窥镜 椎间盘切除术 

分 类 号：R687.3[医药卫生—骨科学]