Czapla Norbert, Bargiel Piotr, Petriczko Jan, Kotrych Daniel, Krajewski Piotr, Prowans Piotr
Department of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland.
Department of Orthopaedics, Traumatology and Motor System Oncology, Pomeranian Medical University, Szczecin, Poland.
Open Med (Wars). 2020 Jun 13;15(1):556-562. doi: 10.1515/med-2020-0143. eCollection 2020.
Many factors contribute to successful nerve reconstruction. The correct technique of anastomosis is one of the key elements that determine the final result of a surgery. The aim of this study is to examine how useful an electromyography (EMG) can be as an objective intraoperative anastomosis assessment method.
The study material included 12 rats. Before the surgery, the function of the sciatic nerve was tested using hind paw prints. Then, both nerves were cut. The left nerve was sutured side-to-side, and the right nerve was sutured end-to-end. Intraoperative electromyography was performed. After 4 weeks, the rats were reassessed using the hind paw print analysis and electromyography.
An analysis of left and right hind paw prints did not reveal any significant differences between the length of the steps, the spread of the digits in the paws, or the deviation of a paw. The width of the steps also did not change.Electromyography revealed that immediately after a nerve anastomosis (as well as 4 weeks after the surgery), better nerve conduction was observed through an end-to-end anastomosis. Four weeks after the surgery, better nerve conduction was seen distally to the end-to-end anastomosis.
The results indicate that in acute nerve injuries intraoperative electromyography may be useful to obtain unbiased information on whether the nerve anastomosis has been performed correctly - for example, in limb replantation.When assessing a nerve during a procedure, EMG should be first performed distally to the anastomosis (the part of the nerve leading to muscle fibers) and then proximally to the anastomosis (the proximal part of the nerve). Similar EMG results can be interpreted as a correct nerve anastomosis.The function of the distal part of the nerve and the muscle remains intact if the neuromuscular transmission is sustained.
许多因素有助于成功的神经重建。正确的吻合技术是决定手术最终结果的关键因素之一。本研究的目的是检验肌电图（EMG）作为一种客观的术中吻合评估方法的有用性。
研究材料包括12只大鼠。手术前，使用后爪印测试坐骨神经的功能。然后，切断双侧神经。左侧神经进行侧对侧缝合，右侧神经进行端端缝合。进行术中肌电图检查。4周后，使用后爪印分析和肌电图对大鼠进行重新评估。
对左右后爪印的分析未发现步长、爪中趾展或爪偏斜之间存在任何显著差异。步宽也没有变化。肌电图显示，在神经吻合后立即（以及手术后4周），端端吻合的神经传导更好。手术后4周，端端吻合远端的神经传导更好。
结果表明，在急性神经损伤中，术中肌电图可能有助于获得关于神经吻合是否正确的客观信息——例如，在肢体再植中。在手术过程中评估神经时，应首先在吻合口远端（通向肌纤维的神经部分）进行肌电图检查，然后在吻合口近端（神经的近端部分）进行。相似的肌电图结果可解释为神经吻合正确。如果神经肌肉传递得以维持，则神经和肌肉远端部分的功能保持完整。
