Jung Seon Min, Tae Kyung, Song Chang Myeon, Lee Seung Hwan, Jeong Jin Hyeok, Ji Yong Bae
Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2020 Nov;13(4):422-428. doi: 10.21053/ceo.2019.01529. Epub 2020 Jun 5.
This study was conducted evaluate the efficacy of electromyography (EMG) using transcartilaginous (TC) electrodes through the thyroid cartilage and perichondrium.
We prospectively collected EMG data from intraoperative neuromonitoring (IONM) of 54 nerves at risk in 38 patients during thyroidectomy. We followed standardized IONM procedures in all operations. EMG signals from both endotracheal tube (ET) electrodes and TC needle electrodes were recorded simultaneously. We compared the characteristics of the EMG signals and the efficacy of both methods.
Significantly higher mean EMG amplitudes were recorded by TC electrodes than by ET electrodes in all four-step procedures (V1-R1-R2-V2, P<0.001). Loss of signal (LOS) occurred in five patients in ET electrodes, but in only two patients in TC electrodes. Postoperative laryngoscopy revealed recurrent laryngeal nerve palsy in the two patients who showed LOS from both the ET and TC electrodes, and vocal cord movement was intact in the other three patients. Therefore, the positive predictive values of LOS in ET and TC electrodes were 40% and 100%, respectively.
EMG recording using TC needle electrodes is feasible and effective, making it a good alternative technique for IONM.
本研究旨在评估经甲状腺软骨和软骨膜使用经软骨（TC）电极进行肌电图（EMG）检查的有效性。
我们前瞻性收集了38例甲状腺切除术患者术中54条有风险神经的神经监测（IONM）肌电图数据。所有手术均遵循标准化的IONM程序。同时记录气管内导管（ET）电极和TC针电极的肌电图信号。我们比较了肌电图信号的特征以及两种方法的有效性。
在所有四个步骤（V1 - R1 - R2 - V2）中，TC电极记录的平均肌电图振幅显著高于ET电极（P < 0.001）。ET电极有5例出现信号丢失（LOS），而TC电极仅有2例。术后喉镜检查显示，ET电极和TC电极均出现LOS的2例患者有喉返神经麻痹，其他3例患者声带运动正常。因此，ET电极和TC电极中LOS的阳性预测值分别为40%和100%。
使用TC针电极进行肌电图记录是可行且有效的，使其成为IONM的一种良好替代技术。
