神经电生理在脊圆锥马尾病变手术中的临床应用.pdfVIP

摘 要 神经电生理在脊髓圆锥马尾病变手术中的临床应用 研究生：王兴克 导师：党木仁 教授 指导老师：汪永新 副主任医师 摘 要 目的：了解神经电生理在脊髓圆锥马尾病变手术中的临床应用，避免神经根的 医源性损伤或加重原有损伤。方法：在涉及到脊髓圆锥马尾病变的手术中使用美国 nicolet 公司生产的 viasis 16 导肌电诱发电位仪监测双侧肛门括约肌和腓肠肌，术中 出现肌电反应时提醒术者谨慎操作，在脊髓栓系终丝切断时通过刺激器进行电刺激 辨别终丝神经根，切断终丝。结果：手术 16 例，共有 14 例患者术中出现自由肌电 反应，13 例出现诱发肌电反应，11 例脊髓栓系患者终丝切断时有 8 例出现诱发肌电 反应。结论：通过应用自由及诱发肌电图进行术中监测，可以较为准确地判断马尾、 终丝、圆锥、周围组织的关系，为手术者提供一定的参考。 关键词：神经电生理；术中监测；脊髓圆锥马尾病变 —1— 新疆医科大学医学硕士学位论文 Clinical applicition of neuroelectrophysiology for spinal cord cone and cauda equina surgery Postgraduate wangxingke Supervisor prof.dangmuren Abstract Obiective:To evaluate the clinical application of neuroelectrophysiology for spinal cord cone and cauda equina surgery, and thus prevent damages from surgery or sharpening the original damages. Methods:In spinal cord cone and cauda equina surgeries, we use the viasis monitor produced by America nicolet company which can provide 16 ways to monitor the bilateral anal sphincters and bilateral gastrocnemius, if there were electromyography responses we award the operator operating carefulluy, in cutting down the filum terminale, we use the stimulator to distinguish the nerve root from filum terminale. Results: 14 patients of the 16 had free run electromyography responses, 13 of the 16 had stimulated electromyography responses, 8 of the 11 which had filum terminale been cutted had stimulated electromyopraphy responses. Conclusion:Free run electromyography and stimulated electromyography in spinal cord cone and cauda equina surgeries can distinguish the spinal cord cone from cauda equina nerve root and tissue