Tanimoto Katsumasa, Khoury Basma, Feng Ke, Cavanaugh John M
Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, United States.
J Neurol Surg A Cent Eur Neurosurg. 2015 Mar;76(2):93-8. doi: 10.1055/s-0033-1349333. Epub 2013 Aug 8.
Minimally invasive surgery has been developed with various innovative surgical tools. Ultrasonic (US) blades have been introduced as an alternative to conventional electrocautery (EC) monopolar device. The purpose of the present study was to evaluate the effects of surgical devices used for muscle dissection close to peripheral nerves on motor nerve function using electromyographic (EMG) recordings.
A total of 24 rats were used in this study. The rats were assigned to the following three groups: Control (n = 8), EC (n = 8), and US (n = 8). A stimulus electrode was placed under the sciatic nerve at a sciatic notch. A pair of recording electrodes was implanted into the midbelly regions of the gastrocnemius muscle. To evoke compound muscle action potentials (CMAPs), 3-V stimuli with 0.3-ms duration were applied to the sciatic nerve at a frequency of 1 Hz. After the recording of the baseline, a monopolar surgical device (EC or US) was applied to cut the muscle 10 mm in length and 2 mm away on both sides of the sciatic nerve. Amplitude and latency of the evoked CMAPs were measured. CMAPs were monitored until 3 hours after the device application.
The EC device caused a marked drop in the amplitude of CMAP with no recovery at the end of the experiment. In the US group, the amplitude of CMAP was stable and constant CMAP over 3 hours, similar to the control group could be measured. In all three groups, the latency of CMAP showed no significant changes through the experiment.
The study showed that the EC device resulted in injury to several motor units in the sciatic nerve. The US device may be a safe tool for muscle dissection around peripheral nerves.
随着各种创新手术工具的出现，微创手术得到了发展。超声（US）刀已被引入作为传统电灼（EC）单极设备的替代品。本研究的目的是使用肌电图（EMG）记录来评估用于在周围神经附近进行肌肉解剖的手术设备对运动神经功能的影响。
本研究共使用24只大鼠。将大鼠分为以下三组：对照组（n = 8）、电灼组（n = 8）和超声组（n = 8）。在坐骨切迹处将刺激电极置于坐骨神经下方。将一对记录电极植入腓肠肌的肌腹中部区域。为诱发复合肌肉动作电位（CMAP），以1 Hz的频率向坐骨神经施加持续时间为0.3 ms的3 V刺激。记录基线后，使用单极手术设备（电灼或超声）在坐骨神经两侧10 mm长、2 mm远的位置切割肌肉。测量诱发CMAP的幅度和潜伏期。在设备应用后持续监测CMAP直至3小时。
电灼设备导致CMAP幅度显著下降，实验结束时未恢复。在超声组中，CMAP幅度在3小时内稳定且恒定，可测量到与对照组相似的结果。在所有三组中，CMAP的潜伏期在整个实验过程中均无显著变化。
该研究表明，电灼设备导致坐骨神经中的几个运动单位受损。超声设备可能是一种用于周围神经周围肌肉解剖的安全工具。
