自制带压力感受器神经根安全拉钩在腰椎后路椎体间融合术中的应用

Application of self-made nerve root retractor in posterior lumbar interbody fusion

目的：确立患者腰骶神经根可以耐受的单次最大拉力,制定神经根耐受牵拉的安全阈值,是自行设计神经根安全拉钩的最终意义。方法：于2004-10/2006-12选择南通大学第二附属医院脊柱外科应用自制神经根安全拉钩完成腰椎后路椎体间融合手术患者共56例,其中L4～532例,L5/S124例。实验经医院伦理委员会批准,患者均知情同意。术中应用Keypoint型诱发肌电仪进行节段性皮神经刺激体感诱发电位的监测,同时记录牵拉神经根的力和牵拉时间。结果：术中出血50～320mL,平均约120mL;手术时间90～180min,平均130min;术中12例患者出现潜伏期延长、波幅下降,此时神经根拉力为（4.10±0.25）N。术后有11例患者出现下肢麻木,随访结束时仍有8例下肢残留麻木。其余44例患者术中监护波形稳定,术后有16例患者出现下肢麻木,随访结束时仍有5例下肢残留麻木。结论：应用自制神经根安全拉钩可以最大程度牵拉神经根,更精确的计算需暴露的手术野,降低神经根牵拉性损伤的概率,提高治疗质量。

AIM： To confirm the tolerant maximal tensile force for the lumbar sacral nerve root of patient and formulate the safe threshold value, so as to investigate the applying value of self-made nerve root retractor in lumbar interbody fusion operation from posterior approach. METHODS： Fifty-six patients underwent lumbar interbody fusion performed with posterior approach using the self-made nerve root retractor were selected from the Department of Spinal Surgery, Second Affiliated Hospital of Nantong University between October 2004 and December 2006, including 32 cases of L4-5 and 24 of L5/S1. The experiment was permitted by the Hospital Ethics Committee, and agreed by the patients, The force and time of dragging nerve root were showed on the display device, while the latency and amplitude of the Dermatomal Somatosensory Evoked Potential （DSEP） wave were measured with Keypoint to investigate the status of the neural function. RESULTS： The blood loss during operation was 50-320 mL, with the average of 120 mL; the mean operative time was 90-180 minutes, with the average of 130 minutes, Latency prolongation and wave amplitude degression occurred in 12 cases during the operation, at which the tensile strength to nerve root was （4.10±0.25） N. Among the patients, 11 cases felt limb numbness after operation, and 8 cases remained limb numbness after follow-up. The rest 44 cases had stable waveform during monitoring, and among them 16 cases felt limb numbness after operation, but 5 cases remained limb numbness after follow-up. CONCLUSION： This self-made nerve root retractor with pressoreceptor may drag the nerve root to the maximum degree, calculate the operating fields needed to expose accurately, reduce the probability of traction injury and improve the treatment quality.