神经电生理技术在腰椎间盘突出症微创手术中的应用价值探讨

Application of neurophysiological techniques in minimally invasive surgery for lumbar discherniation

目的探讨经皮内窥镜治疗腰椎间盘突出症(lumbar disc herniation,LDH)时,应用神经电生理监测技术进行辅助的临床效果。方法自2014-05-2015-05,在经皮内窥镜治疗的41例LDH手术中,尝试应用自发性肌电图技术(spontaneous electromyography,SEMG)进行辅助。若出现一连串的电位波形变化,即为异常指标,立即提醒术者停止操作、查找原因,待异常反应消失后,继续手术。结果 41例患者均顺利完成手术,其中38例在建立工作通道以及进行神经根的分离、减压操作时,均有明显的SEMG异常改变,且有明显腿痛发生,停止手术、再次调整操作后,其肌电反应逐渐趋于正常,且腿痛也逐渐消失;另有3例无明显腿痛,但有SEMG异常改变,予以调整手术操作后,肌电反应趋于正常。41例患者术后,VAS评分较术前显著性下降(P<0.05);末次随访中,优22例、良17例,总优良率达95.1%,取得良好的疗效。结论:在内窥镜技术治疗LDH过程中,予以SEMG监测是更为客观、可靠的指标,可有效避免神经根损伤的发生。

Objective To investigate the clinical efficacy of percutaneous endoscopic technique in the treatment of lumbar disc herniation （LDH） with the aid of etectrophysiological monitoring. Methods From May 2014 to May 2015, 41 cases of LDH undergoing percutaneous endoscopic surgery were treated with spontaneous electromyography （SEMG） technique. If a series of potential waveform changed, which was an abnormal indicator, immediately reminded the operator to stop the operation, and found the cause, and after the abnormal response disappeared, continued the operation. Results 41 patients were successfully completed surgery, including 38 cases of peeling, nerve root in the establishment of the：working channel and decompression operation, abnormal changes were obvipus SEMG, and had.obvious pain, stopped operation, adjusted again after the operation, the EMG responses tended to normal, and the pain gradually disappeared; the other 3 cases without leg pain, but had abnormal SEMG, adjusted after operation, EMG responses tended to be normal. In 41 patients, the VAS score decreased significantly compared with preoperation（P〈0.05）. At the last follow-up, there was excellent in 22 cases and good in 17 cases, and the total excellent and good rate was up to 95.1%, and good results were achieved. Conclusion SEMG monitoring is a more objective and reliable index in the treatmentof LDH by endoscopie technique. It can effectively avoid the occurrence of nerve root injury.