MIS-TLIF手术中应用肌电图和运动诱发电位联合监测的安全性及其监测效能分析

Safety and efficacy of EMG combined with motor evoked potential monitoring in MIS-TLIF surgery

目的探讨MIS-TLIF手术中应用肌电图(electromyography,EMG)和运动诱发电位(motor evoked potential,MEP)联合监测的效果,并评价其监测效能。方法自2016年7月-2018年3月,对59例腰椎退行性疾病患者MIS-TLIF手术中应用EMG和MEP联合监测,对其监测效能进行分析。结果43例术中信号正常,且术后未见神经功能障碍;2例首次出现异常预警、但再次调试恢复正常;另有14例异常预警者,均为术中高危操作所致,予以调整手术操作后,仍有3例术后出现神经功能障碍。EMG单独监测的敏感度、特异度、阳性预测值和阴性预测值分别为78.57%,95.56%,84.62%和93.48%;MEP分别为81.25%,97.67%,92.86%和93.33%;联合监测分别为100%,95.56%,87.50%和100%。联合监测的敏感度和阴性预测值均显著高于EMG/MEP的单独监测效果(P<0.05)。结论在MIS-TLIF手术中应用EMG和MEP联合监测,显著提高了手术安全性,其敏感度、阴性预测值均显著高于两者的单独监测效果。

Objective To investigate the effect of electromyography(EMG)combined with motor evoked potential(MEP)monitoring in MIS-TLIF operation,and to evaluate the monitoring effect.Methods From July 2016 to March 2018,59 patients with lumbar degenerative diseases were monitored by EMG and MEP during MIS-TLIF operation.The monitoring effect was analyzed.Results Forty-three cases had normal signal during operation,and no neurological dysfunction was found after operation;2 cases had abnormal early warning for the first time,but recovered to normal after adjustment;another 14 cases of abnormal early warning were all caused by high-risk operation during the operation,after adjusting the operation,there were still 3 cases of postoperative neurological dysfunction.The sensitivity,specificity,positive predictive value and negative predictive value of EMG were 78.57%,95.56%,84.62%and 93.48%respectively.Those of MEP were 81.25%,97.67%,92.86%and 93.33%respectively,and those of the combined monitoring were 100%,95.56%,87.50%and 100%respectively.The sensitivity and negative predictive value of combined monitoring were significantly higher than those of EMG/MEP alone(P<0.05).Conclusion The combined monitoring of EMG and MEP in MIS-TLIF operation can significantly improve the safety of the operation,and its sensitivity and negative predictive value are significantly higher than the effect of the monitoring alone.