神经电生理监测辅助全麻经皮脊柱内镜治疗腰椎间盘突出症  

Neurophysiological monitoring in treatment of lumbar disc herniation with percutaneous spinal endoscopy under general anesthesia

作　　者：林世水[1] 高尚君 卢峰[2] 林成 林克凤[1] 周仕国[1] 张宇滨 Lin Shishui;Gao Shangjun;Lu Feng;Lin Cheng;Lin Kefeng;Zhou Shiguo;Zhang Yubin(Department of Orthopedic Surgery,Jinshan Branch of Fujian Provincial Hospital,Provincial Clinic College of Fujian Medical University,Fuzhou 350001,China;Department of Neurosurgery,Jinshan Branch of Fujian Provincial Hospital,Provincial Clinic College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床学院(福建省立金山医院)骨科,福州350001 [2]福建医科大学省立临床学院(福建省立金山医院)神经外科,福州350001

出　　处：《中华神经医学杂志》2020年第10期1035-1039,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨神经电生理监测辅助全麻经皮脊柱内镜下腰椎间盘髓核摘除术(PELD)的临床治疗效果。方法选择自2016年8月至2019年10月福建省立金山医院骨科全麻行PELD治疗的58例患者进入研究,其中椎间孔入路30例,椎板间入路28例。整个手术操作过程在自发性肌电图(SEMG)连续性监测下进行,采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价临床治疗效果。结果58例患者均顺利完成手术。术中共有8例(13.8%)出现异常肌电反应,表现为成串或频发高幅动作电位,其中经椎间孔入路5例(16.7%),椎板间入路3例(10.7%)。除2例患者术后3周、6周复发再次行脊柱内镜手术和腰椎融合内固定术外,余56例患者术后腰腿痛症状均明显缓解,手术前、术后第3天、术后3个月VAS评分分别为(7.43±1.32)分、(2.55±0.87)分和(1.59±0.87)分;手术前、术后3个月ODI指数分别为(67.36±7.13)分和(12.39±5.48)分;差异均有统计学意义(P<0.05)。结论神经电生理监测下全麻行PELD术安全可靠,疗效较好。Objective To investigate the clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)with the aid of neurophysiological monitoring under general anesthesia.Methods From August 2016 to October 2019,58 patients underwent PELD under general anesthesia were selected in our hospital;30 were via transformational approach and 28 were via interlaminar approach.The whole operative procedures were performed under continuous monitoring of spontaneous electromyography(SEMG),and the peak value,waveform and motor unit of SEMG at the surgical side were observed.The clinical outcomes were evaluated by visual analogue scale(VAS)and Oswestry disability index(ODI).Results PELD was successfully performed in all 58 patients.Abnormal SEMG reactions were recorded in 8 patients(13.8%),manifested as clustered or frequent high amplitude action potentials;5 patients(16.7%,5/30)were via transformational approach and 3(10.7%,3/28)were via interlaminar approach.Two patients relapsed at 3 and 6 weeks after surgery,respectively;one was treated with PELD again and the other one was treated with lumbar fusion and instrument fixation.The pain at the lumbago and leg was alleviated obviously after surgery in the 56 patients;the VAS scores were 7.43±1.32,2.55±0.87 and 1.59±0.87 before surgery,and 3 d and 3 months after surgery,respectively,with significant differences(P<0.05);the mean ODI before surgery and 3 months after surgery were 67.36±7.13 and 12.39±5.48,respectively,with significant difference(P<0.05).Conclusion PELD with the aid of neurophysiological monitoring under general anesthesia is safe and reliable,which can achieve good clinical efficacy.

关 键 词：电生理监测 腰椎间盘突出症 微创外科 

分 类 号：R614.2[医药卫生—麻醉学]