臂丛神经损伤后疼痛患者脊髓后角自发场电位的监测及意义

INTRAOPERATIVE MONITORING AND SIGNIFICANCE OF SPONTANEOUS FIELD POTENTIALS OF BRACHIAL PLEXUS AVULSION PAIN PATIENTS' DORSAL HORNS

目的:应用脊髓电图技术记录臂丛神经损伤后疼痛患者受损脊髓节段后角的自发场电位,观察脊髓后根入髓区(Dorsal Root Entry Zone,DREZ)切开前、后的电位变化,对结果进行描述性研究,并分析其临床意义。方法:使用Medcare Da Vinci数字信号采集系统,在每个患者记录3段脊髓电图,分别在DREZ切开前的健侧和患侧脊髓、DREZ切开后的患侧脊髓记录1段。共采集到15例患者的可供分析的脊髓电图,对其频率和特殊放电形式进行分析。结果:DREZ切开前的患侧和健侧脊髓以及DREZ切开后患侧脊髓的后角自发场电位背景电活动频率之间无统计学差异。DREZ切开前的患侧脊髓后角的脊髓电图比健侧更多出现尖波,存在统计学差异。DREZ切开后,患侧脊髓这种电活动全部消失。术后止痛疗效优秀率为93.3%。结论:尖波是患侧脊髓相对特异的异常电活动,是相对特异的监测指标;成功的DREZ切开术后,患侧脊髓的这种特殊电活动不再出现,尖波消失可以提示术后止痛效果良好。

Objective：Electrospinogram was used for recording spontaneous spinal cord field potentials of patients who underwent DREZ-tomy for brachial plexus avulsion pain.The purpose of the study was to conduct preliminary descriptive research,and analyze it.Methods：Potentials were recorded with Medcare Da Vinci signal collection system from tow sides of spinal cord before DREZ-tomy,from the abnormal side of spinal cord after DREZ-tomy.We gained 15 patients＇ complete and legible records.Then we analyzed the frequency and characteristic of the potentials.Results：There was no statistically significant difference in the frequencies of electrospinogram between the abnormal,normal side of spinal cords before DREZ-tomy, and abnormal side after DREZ-tomy.The difference between the presence of sharp waves of normal and abnormal side of spinal cord was significant.This kind of potential disappeared after DREZ-tomy. 93.3%of the patients received good results.Conclusion：Our study seems to suggest that the frequencies of spontaneous field potentials of brachial plexus avulsion pain patients＇ dorsal horns have no specificity. Sharp wave is relatively characteristic and valuable.This kind of potential disappears after successful DREZ-tomy and it seems to suggest that the result of operation is good.