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神经电生理监测在脊髓背根入髓区毁损术中的应用
付萌萌孟祥红陈富勇李瑞麒杜世伟魏明怡冯刚陶蔚
0
()
摘要:
目的 探讨神经电生理监测在脊髓背根入髓区(DREZ)毁损术治疗慢性神经病理性疼痛 中的应用。方法 回顾性分析2018 年9 月至2019 年3 月,深圳大学总医院神经外科在术中神经电生理 监测下接受DREZ毁损术治疗慢性神经病理性疼痛的患者10 例,应用运动诱发电位(MEP)、体感诱发电 位(SEP)和肌电图(EMG)行术中神经电生理监测并收集临床资料。结果 10 例患者中,6 例为脊髓损伤 后疼痛,均监测双下肢SEP、MEP 及EMG,均经过神经根牵拉刺激确认神经根或马尾;其中2 例患肢SEP 未引出,2 例患肢MEP未引出。4 例为臂丛神经撕脱伤后疼痛患者,其中2 例患侧上肢截肢,监测双下 肢SEP、MEP;未截肢者监测四肢SEP、MEP,1 例患肢SEP 未引出。所有患者中,术中电生理监测一过性 MEP波幅下降> 50%者3 例,SEP波幅一过性下降> 50% 者2 例。10 例患者术后疼痛均得到显著改善, 缓解程度70%以上。术后4 例患者有轻微感觉减退、肢体肌力减退,2 例患者轻度排尿困难,均为一过 性改变,未见明显术后并发症。结论 行DREZ毁损术的患者病情复杂,术中神经电生理监测难度较大, 但MEP、SEP 及EMG 联合应用可有效提高手术成功率,降低手术并发症。
关键词:  电生理学  监测,手术中  疼痛,神经病理性  脊髓背根入髓区
DOI:10.3969/j.issn.1009-6574.2019.06.006
基金项目:深圳市科技创新委员会基础研究学科布局项目(JCYJ20160428164548896,JCYJ20170412111316339); 深圳大学总医院科技人才助推计划(SUGH-301)
Application of intraoperative neuroelectrophysiological monitoring in spinal dorsal root entry zonelesioning
Fu Mengmeng, Meng Xianghong, Chen Fuyong, Li Ruiqi, Du Shiwei, Wei Mingyi, Feng Gang, Tao Wei
()
Abstract:
Objective To explore the application of intraoperative neurophysiological monitoring (IONM) in dorsal root entry zone( DREZ) lesioning for chronic neuropathic pain. Methods A total of 10 patients with chronic neuropathic pain were treated with DREZ lesioning with IONM were analyzed retrospectively. Motor evoked potential( MEP), somatosensory evoked potential( SEP) and electromyography( EMG) were used for intraoperative neuroelectrophysiological monitoring. Clinical data were collected. Results Among the ten patients, six of them had pain after spinal cord injury. SEP, MEP and EMG of both lower limbs were monitored,and nerve roots or cauda equina were confirmed by nerve root traction stimulation. SEP was unrecordable in two patients and MEP was unrecordable in two patients. Four patients suffered from pain after brachial plexus avulsion. Two of them had upper limb amputated, and SEP and MEP of both lower limbs were monitored. SEP and MEP of all the limbs were monitored in unamputated patients, and SEP of the affected limb was unrecordable in one case. Among the ten patients, three patients had transient and more than 50% reduction in MEP, and 2 patients had transient and more than 50% reduction in SEP. Postoperative pain was significantly alleviated in all the ten patients, and the pain relief was greater than 70%. After the operation, four patients had mild hypoesthesia and decreased limb muscle strength. Two patients had mild dysuria. All the postoperative symptoms were transient changes, and no obvious postoperative complications were found. Conclusions The condition of patients undergoing DREZ lesioning is complex, and it is difficult to monitor neuroelectrophysiology during operation. However, the combination of MEP, SEP and EMG can effectively improve the success rate of operation and reduce the complications.
Key words:  Electrophysiology  Monitoring, intraoperative  Neuropathic pain  Dorsal root entry zone

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