术中肌电刺激对肘管综合征手术疗效的影响

Effect of intraoperative electromyogram stimulation on surgical effectiveness of cubital tunnel syndrome

目的观察术中肌电刺激（EMG）对肘管综合征疗效的影响。方法纳入288例确认为肘管综合征保守治疗无效的病例，根据入院顺序奇偶数分成术中肌电刺激治疗组（实验组）和对照组，各144例。所有病例在术中松解前进行1次术中电生理监测，记录小指展肌复合肌肉动作电位（CMAP）的潜伏期及波幅；松解后再次进行1次相同的术中电生理监测；实验组在松解完毕后对神经卡压最严重处进行肌电刺激，刺激参数为100 mA，2 Hz，10 min，然后再进行电生理监测；对比术中松解前后的CMAP潜伏期和波幅差异。术后每隔2个月随访1次，所有病例完成至少8个月随访，统计每次随访达到不同评价标准的病例数，对比分析采用χ2检验。结果实验组波幅的差值为（3.4±0.4） mV，潜伏期的差值为（10.1±0.2） ms，对照组波幅的差值为（2.5±0.4） mV，潜伏期的差值为（14.4±0.6） ms，差异有统计学意义（P＝0.007和P＝0.001）。在术后2个月时实验组达到痊愈标准和好转标准的病例数明显高于对照组（P＝0.000），这种优势在术后4个月时更加明显，在术后6个月时实验组和对照组的痊愈和好转病例比率基本相同（P＝0.054），但是在术后8个月时，差异再次出现，实验组无效病例数明显低于对照组（P＝0.000）。结论肘管综合征术中松解后给予肌电刺激，对小指展肌的CMAP波幅和潜伏期有快速的改善；实验组术后恢复速度更快，有更多的病例达到痊愈和好转标准。

ObjectiveTo observe the effect of intraoperative electromyogram （EMG） stimulation on surgical effectiveness of cubital tunnel syndrome.MethodsA total of 288 patients with cubital tunnel syndrome and confirmed as invalid conservative treatment cases were divided into intraoperative EMG stimulation treatment group （experimental group） and control group, 144 cases in each. All cases were monitored by intraoperative electrophysiological examination 1 time before operation, and by recording the latency and amplitude of compound muscle action potential （CMAP） in the abductor muscle of the little finger. After release again the same intraoperative electrophysiological monitoring was done. In the experimental group after the release of nerve compression at the most serious site, electrical stimulation was done, and the stimulation parameters were as follows： 100 mA, 2 Hz, 10 min. The latency and amplitude of CMAP before and after the intraoperative release were compared. The patients were followed up every 2 months, and all cases were followed up for at least 8 months. The number of cases with different evaluation criteria was evaluated at each follow-up visit. The chi square test was used for the comparative analysis.ResultsThe amplitude difference was （3.4±0.4） mV, and the latency difference was （10.1±0.2） ms in the control group, and those were （2.5±0.4） mV and （14.4±0.6） ms in the experimental group, with the difference being statistically significant （P=0.007 and P=0.001）. At 2nd month after operation, the number of cases obtaining recovery and improvement in the experimental group was significantly greater than in the control group （P=0.000）, more significant at 4th month after operation. At 6th month after operation, the recovery rate and improvement in experimental group and control group showed no significant difference （P=0.054）. At 8th month after operation, the number of ineffective cases in experimental group was significantly less than in the control group （P=0.000）.ConclusionIntraoperative EMG stimulation after surgical release of cubital tunnel syndrome can quickly improve the CMAP amplitude and latency of abductor muscle of the little finger.