肌电图在选择性脊神经后根切断术中的应用  

Application of Electromyography in Selective Posterior Rhizotomy

作　　者：侯保秋[1] 孙楹 王新军 吴建珩[1] HOU Baoqiu;SUN Ying;WANG Xinjun;WU Jianheng(Department of Neurosurgery,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Neuroelectrophysiology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第五附属医院神经外科,河南郑州450000 [2]郑州大学第五附属医院神经电生理科,河南郑州450000 [3]郑州大学第三附属医院,河南郑州450000

出　　处：《河南医学研究》2023年第11期1976-1979,共4页Henan Medical Research

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190417);河南省2018年科技发展计划项目(182102310158)。

摘　　要：目的比较肌电图法和观察肢动法在脊神经后根切断术中识别神经根的灵敏性和准确性,讨论肌电图法在选择性脊神经后根切断术中的应用价值。方法选取2018—2022年在郑州大学第五附属医院就诊的患者,全麻下,在术中对L_(2)~S_(1)神经根给予电刺激,分别利用肌电图法和肉眼观察肢动法来明确选择神经根,对有异常反应的后根给予适量切除,对正常神经根给予保留,同时保护患者大小便功能,术后定期随访,评价手术效果。结果肌电图出现动作电位的最小刺激阈值(1.93±0.54)mA,而观察肢体震颤的最小刺激阈值(4.29±0.75)mA,两者的差异有统计学意义(P<0.05)。经过电话随访,了解到患者术后肌张力均有不同程度的改善,差异有统计学意义(P<0.05)。术后随访未出现监测部位感染,下肢麻木、沉重感或者高热等并发症,一般1个月内可自行消失。功能改善率高达96%,未见大小便失禁。结论术中神经电生理监测用肌电图方法对异常神经根的识别,以及对保护患者正常生理功能方面提供了重要的参考价值。Objective To compare the sensitivity and accuracy of electromyography and observation of limb activity in the identifiation of nerve roots in posterior rhizotomy,and to discuss the application value of electromyography method in selective posterior rhizotomy.Methods Patients from the Fifth Affiliated Hospital of Zhengzhou University from 2018 to 2022 were selected.Under general anesthesia,L_(2)-S_(1) nerve roots were given electrical stimulation during the operation.Electromyography and observation of limb activity were used to identify the nerve roots.The posterior roots with abnormal reactions were properly excised and the normal nerve roots were preserved.Meanwhile,the defecation and urination functions of patients were protected.Postoperative follow-up was conducted regularly to evaluate the operation effect.Results The minimum stimulation threshold of action potential in electromyography was(1.93±0.54)mA,while the minimum stimulation threshold of limb tremor was(4.29±0.75)mA,and the difference was statistically significant(P<0.05).After telephone follow-up,it was known that postoperative muscle tone of patients had been improved in different degrees,and the difference was statistically significant(P<0.05).Postoperative follow-up showed no monitoring site infection,lower limb numbness,heaviness or high fever and other complications,and they were generally disappeared within a month.Functional improvement rate was as high as 96%,no incontinence.Conclusion Electromyography for intraoperative neurophysiological monitoring provides vital reference value for identification of abnormal nerve roots and protection of normal physiological functions of patients.

关 键 词：神经电生理 肌电图法 肢动法 脊神经后根切断 电刺激 阈值 

分 类 号：R741.044[医药卫生—神经病学与精神病学]