肌电图诱发电位仪对骨折内固定手术中神经损伤的监测

Application of electromyographic in monitoring nerve root at fracture fixation process

目的评价国产和进口肌电图诱发电位仪对骨折内固定时避免神经根医源性损伤的非劣效性,了解国产肌电图诱发电位仪用于骨折内固定时神经根监测的方法学、准确性及实用性。方法使用美国Nicolet公司生产的viking select8导肌电诱发电位仪和国产诺诚电气公司生产的Neurocare-C肌电图与诱发电位仪同时监测30例骨折内固定手术患者,比较进口机和国产机的阳性反应变化趋势、肌电发生反应率及肌电反应波幅变化情况。结果通过自发肌电图(EMG)进行术中监测,可以较为准确地判断神经根功能,5例患者术中出现肌电反应,其中3例为椎体骨折内固定,1例为肱骨骨折内固定,1例为骨盆骨折内固定,国产机和进口机均能够检出。国产机和进口机机电反应发生率均为16.67%;进口机和国产机在股四头肌、股二头肌、股直肌、胫前肌的肌电反应的波幅变化差异无统计学意义(P>0.05)。结论肌电图诱发电位仪在骨科手术中能检测到神经电位;无论是国产还是进口肌电图诱发电位仪均能够准确及时地反应神经根功能,避免神经根的损伤,保证骨折内固定手术的安全性。

Objective To evaluate the noninferiority of domestic electomyographic（ EMG） evoked potential instrument utility on avoiding iatrogenic injury of nerve roots compare to the imported ones,and understand the methods,accuracy and practicability of domestic machine on monitoring nerve root at the fracture fixation process. Methods Domestic of Neurocare-C machine and Nicolet Viking select8 concurrent monitoring 30 cases of bone fracture fixation,including 20 cases of spinal fixation and 10 cases of fractures fixation of limbs and pelvic. The trend of positive change,the rate and amplitude variation of electromyographic response between two instruments were compared. Results The nerve root function could be accurately judged by EMG monitoring during operation. Intraoperative EMG could be detected by both domestic and imported instruments occurred in 5 patients,3 cases were internal fixation of vertebral fracture,1 case was humeral fractures fixation,1 case was pelvic fracture. The rate of electromyographic response of both domestic and imported instruments were 16. 67%. There was no significant difference in amplitude variation of electromyographic response of quadriceps femoris,biceps femoris,rectus femoris and tibialis anterior between two instruments（ P〈0. 05）. Conclusion Both domestic and imported EMG evoked potentials can accurately and timely respond to nerve root function,avoid nerve root injury,and ensure the safety of fracture fixation surgery.