骨盆骨折合并骶髂关节脱位术中电生理监测技术的应用

Motor evoked potentials and spontaneous electromyography in reconstruction of pelvic fracture combined with sacroiliac joint dislocation

目的探讨骨盆骨折合并骶髂关节脱位手术中应用电生理监测技术预防神经损伤的效果。方法对需要手术治疗的骨盆骨折合并骶髂关节脱位患者,术中对术侧采用经颅电刺激运动诱发电位(TES-MEP)和自由肌电图(EMG)进行实时监测,观察其对坐骨神经和腰5神经根医源性损伤的预防效果。结果骶髂关节复位固定时,术侧股二头肌、胫前肌、胫后肌MEP波幅下降,但波形均能引出。耻骨复位时,MEP波形稳定。因手术操作引发趾短伸肌、胫后肌短暂、高幅EMG反应,即刻提醒术者,避免频繁,粗暴骚扰神经组织。术后骶髂关节、耻骨复位良好,且未出现医源性神经损伤。结论联合运用MEP和自由EMG实时监测能及时反映骨盆骨折合并骶髂关节脱位切开复位内固定术中坐骨神经及L5神经根受激惹情况和运动功能状态,提高手术精确性,值得在临床推广应用。

Objective To investigate the efficacy of nerve damage prevention using electrophysiological monitoring techniques during reconstruction of pelvic fracture combined with sacroiliac joint dislocation. Methods Intraoperative real-time monitoring by motor evoked potentials with trans-cranial electrical stimulation （TES-MEP） and spontaneous electromyogram （EMG） were performed during surgical treatment for the patient of pelvic fracture combined with sacroiliac joint dislocation. The preventive effects on iatrogenic injury of sciatic nerve and L5 nerve root were observed. Results The TES-MEP volatility of biceps femoris, tibialis anterior muscle and posterior tibial muscle dropped on the surgical side when resetting sacroiliac joint, but the waveform could be elicited. The TES-MEP waveform was stable when resetting pubis. Some short, high-amplitude EMG response appeared in extensor digitorum brevis and posterior tibial muscle due to surgical operation, so that the surgeons could be immediately aware of avoiding irritation for nerve tissues. Sacroiliac joint and pubis were restored well and iatrogenic nerve injury was not observed after operation. Conclusion During reconstruction of pelvic fracture combined with sacroiliac joint dislocation, application of both TES-MEP and EMG can improve surgical accuracy by synchronous monitoring the status of the sciatic nerve and L5 nerve root. This technique is worthy of recommendation in clinic.