肌电图监测经皮内镜下腰椎间盘切除术治疗腰椎间盘突出症  

Electromyographical monitoring in percutaneous endoscope lumbar discectomy in the treatment of lumbar disc herniation

作　　者：王剑火[1] 陈勇忠[1] 温建锋[1] 龚衍丁 王娟美 WANG Jian-huo, CHEN Yong-zhong, WEN Jian-feng, GONG Yah-cling, WANG Juan-mei(Dept of Orthopaedic Center, 476 Clinical Department of Fuzhou General Hospital of Nanjing Military District, Fuzhou, Fujian 350002, China)

机构地区：[1]南京军区福州总医院476临床部骨科中心,福建福州350002

出　　处：《临床骨科杂志》2018年第4期429-432,共4页Journal of Clinical Orthopaedics

摘　　要：目的分析经皮内镜下腰椎间盘切除术中应用肌电图监测结果,以预防神经损伤。方法对27例L_(4～5)及14例L_5～S_1椎间盘突出症患者采用侧路经皮椎间孔镜下髓核切除术,对12例L_5～S_1椎间盘突出症患者采用后路经皮椎板间入路髓核切除术。对L_(4～5)节段椎间盘突出症手术患者监测术侧的L_4和L_5神经的自发肌电图,对L_5～S_1手术患者监测术侧的L_5和S_1神经的自发肌电图。结果 53例患者术前自发肌电图均表现为波幅很低的波浪线。在通道建立过程中,46例出现异常肌电波;在髓核摘除过程中,5例出现异常肌电波;在显露减压神经根时,所有患者出现异常肌电波。腰痛时肌电图为中等宽幅的异常肌电波;下肢放射痛时为成串的、高波幅的异常肌电波。53例VAS评分术前为(7.34±1.54)分,术后1个月为(1.53±0.81)分,差异有统计学意义(P<0.01)。结论术中进行肌电图监测有助于对神经损伤进行预防,提高手术安全性。Objective To analyse the results of electromyographical monitoring in percutaneous endoscope lumbar discectomy,in order to prevent nerve damage. Methods The 27 patients with L_（4 ～ 5） disc herniation and 14 patients with L_5～ S_1 disc herniation underwent percutaneous transforaminal lateral endoscope lumbar discectomy. The 12 patients with L_5～ S_1 disc herniation underwent percutaneous posteral endoscope lumbar discectomy via interlaminar approach. The operation side L_4 and L_5 nerve function were monitored by spontaneous electromyography for L_（4 ～ 5） disc herniation. The operation side L_5 and S_1 nerve function were monitored by spontaneous electromyography for L_5～ S_1 disc herniation. Results The spontaneous electromyography showed a wavy line with low amplitude before operation in all 53 patients. In the process of operation channel placed,abnormal muscle wave occurred in 46 patients. In the process of discectomy,abnormal muscle wave occurred in 5 patients. Abnormal muscle wave occurred in all 53 patients during the exposure and decompression of nerve roots. The amplitude of electromyography was middle when back pain happened. When leg pain appeared,the amplitude of electromyography was large and cluster. The 53 patients＇ VAS were 7. 34 ± 1. 54 and 1. 53 ± 0. 81 before and 1 month after operation,respectively,which was significantly difference（ P 0. 01）. Conclusions Intraoperative electromyographical monitoring may contribute to prevent nerve injury and improve the surgical safety.

关 键 词：腰椎间盘突出症 经皮内镜下腰椎间盘切除术 电生理监测 肌电图 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]