触发式肌电图在青少年特发性脊柱侧凸矫形术中椎弓根置钉过程中神经损伤风险的监测研究

Monitoring risk of nerve injury during pedicle screw placement in adolescent idiopathic scoliosis surgery by trigger electromyography

目的探讨术中触发式肌电图监测对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者矫形椎弓根螺钉置钉过程中神经损伤风险的影响。方法选择2017年6月~2020年9月在本院接受一期手术的68例AIS患者,采用随机数字表法分为对照组和观察组各34例。对照组在O型臂导航下置钉,观察组在对照组的基础上给予肌电图监测。观察两组患者神经损伤风险(at risk for nerve injury,ARNI)发生率。结果轴面评估显示,观察组ARNI发生率显著低于对照组,差异有统计学意义(P<0.05)。矢状面评估显示,观察组ARNI发生率显著低于对照组(P<0.05)。两组患者术前主弯Cobb角、术后主弯Cobb角和主弯矫正率相比,差异均无统计学意义(P>0.05)。结论术中肌电图监测可提高螺钉置入准确性,减少神经损伤风险。

Objective To investigate the effect of intraoperative trigger EMG monitoring on the risk of nerve injury during orthopedic pedicle screw placement in adolescent idiopathic scoliosis(AIS).Methods Sixty-eight patients with AIS who underwent primary surgery in our hospital from June 2017 to September 2020 were selected as the research objects.The patients were randomly divided into control group and observation group with 34 cases in each group.The control group was guided by O-arm,and the observation group was given EMG monitoring on the basis of the control group.The incidence of nerve injury risk(ARNI)in the two groups was observed.Results The results of axial evaluation showed that the incidence of ARNI in the observation group was significantly lower than that in the control group(P<0.05).Sagittal evaluation showed that the incidence of ARNI in the observation group was lower than that in the control group(P<0.05).There was no significant difference in Cobb angle of main curve before operation,Cobb angle of main curve and correction rate of main curve between the two groups(P>0.05).Conclusion Intraoperative EMG monitoring can improve the accuracy of screw placement,reduce the risk of nerve injury,and thus has clinical promotion value.