自由描记肌电图应用于腰椎手术中神经根监测的临床价值

Clinical value of free electromyography in nerve root monitoring during lumbar spine surgery

目的探讨腰椎手术中应用自由描记肌电图(free-run electromyography,F-EMG)进行神经根监测的临床价值。方法自2015-11-2016-11,在132例腰椎手术中应用F-EMG进行实时监测,包括后路病灶清除、融合内固定术9例,后路减压融合内固定术106例,后路椎弓根钉内固定手术17例。对患者术中F-EMG表现情况及术后转归进行统计分析。结果 (1)132例中,共发生F-EMG报警28例,其中连续性肌电活动17例,爆发性肌电活动9例,自发性肌电活动2例;探明术中F-EMG异常原因有25例,均予以调整手术操作;未探明原因3例,其中2例为假阳性。未发生F-EMG报警104例,其中1例术后发生神经损伤(为假阴性)。(2)经证实,F-EMG术中监测的真阳性26例,假阳性2例;真阴性103例,假阴性1例。其敏感度为96.3%,特异度为98.1%,阳性预测值为92.9%,阴性预测值为99.0%。结论腰椎手术中予以F-EMG监测,具有较高的敏感度和特异度,起到可靠的预警作用,降低了神经根损伤的发生率,可作为一项较佳的腰椎手术配备方案予以考虑。

Objective To evaluate the clinical value of free-run electromyography(F-EMG)in nerve root monitoring during lumbar spine surgery.Methods From November 2015 to November 2016,real-time monitoring of F-EMG was performed in 132 cases of lumbar surgery,including posterior debridement,fusion and internal fixation in 9 cases,posterior decompression and internal fixation in 106 cases,posterior pedicle screw fixation in 17 cases.The intraoperative F-EMG findings and postoperative outcomes were statistically analyzed.Results(1)In the 132 cases,there were FEMG alarm in 28 cases,including 17 cases of continuous EMG activity,9 cases of explosive electromyographic activity,2 cases of spontaneous myoelectric activity.Those proved intraoperative FEMG abnormal 25 cases,were treated with adjustment of operation.The unproved cause was 3 cases,including 2 cases of false positive.There were no F-EMG alarms in 104 cases,of which 1 case developed nerve injuries(false negative).(2)It was proved that 26 cases were true positive in F-EMG,2 cases were false positive,103 cases were true negative,1 case was false negative.The sensitivity was 96.3%,the specificity was 98.1%,the positive predictive value was 92.9%,and the negative predictive value was 99%.Conclusion Application of F-EMG monitoring in lumbar surgery has high sensitivity and specificity,plays a warning role in reducing the nerve root injury,it can be used as a better solution during lumbar surgery.