Department of Otorhinolaryngology, Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Otorhinolaryngology, Head and Neck Surgery, Pusan National University and Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam, Republic of Korea.
Surgery. 2022 Feb;171(2):377-383. doi: 10.1016/j.surg.2021.07.037. Epub 2021 Sep 22.
Recently, adhesive skin electrodes have been reported to be useful for recording electromyographic signals from intrinsic laryngeal muscles for intraoperative neuromonitoring in thyroid surgery and have shown good results compared to existing recording methods. In this study, we investigated the optimal attachment location of adhesive skin electrodes for intraoperative neuromonitoring in both porcine models and human cases.
Attachment locations were divided vertically into upper, middle, and lower locations and horizontally into medial and lateral locations to determine the optimal location of placing adhesive skin electrodes preclinically in four porcine models. This study included a total of 78 patients who underwent thyroidectomy under intraoperative neuromonitoring with adhesive skin electrodes. Sixteen patients were monitored using both adhesive skin electrodes and an electromyographic endotracheal tube. Two pairs of skin electrodes were attached to the level of the thyroid cartilage lamina. Evoked electromyographic data, including data on mean amplitude and latency, obtained by stimulating the recurrent laryngeal nerve and vagus nerve, were collected.
Lateral attachment of adhesive skin electrodes showed significantly higher evoked amplitudes than medial attachment in both animal models and human patients. In cases where skin electrodes and an electromyographic endotracheal tube were used together, the electromyographic endotracheal tube showed a significantly higher amplitude than skin electrodes, and laterally attached skin electrodes showed a significantly higher amplitude than medially attached skin electrodes.
Intraoperative neuromonitoring using adhesive skin electrodes was feasible in both animal models and human patients. We suggest that it would be better to attach adhesive skin electrodes to the lateral side of the thyroid cartilage lamina. Lateral attachment closer to the cricoarytenoid joint may be better for measuring muscle movement around the cricoarytenoid joint.
最近，有研究报道，黏附式皮肤电极在甲状腺手术的术中神经监测中，用于记录喉内肌的肌电图信号，与现有的记录方法相比，具有良好的效果。在这项研究中，我们在猪模型和人体病例中研究了黏附式皮肤电极用于术中神经监测的最佳附着位置。
附着位置在垂直方向上分为上、中、下位置，在水平方向上分为内侧和外侧位置，以确定在四个猪模型中进行临床前黏附式皮肤电极放置的最佳位置。本研究共纳入 78 例接受术中神经监测下甲状腺切除术的患者。16 例患者同时使用黏附式皮肤电极和肌电图气管内管进行监测。将两对皮肤电极贴附于甲状软骨板水平。收集通过刺激喉返神经和迷走神经获得的诱发肌电图数据，包括平均振幅和潜伏期数据。
在动物模型和人体患者中，黏附式皮肤电极的外侧附着的诱发振幅明显高于内侧附着。在同时使用皮肤电极和肌电图气管内管的情况下，肌电图气管内管的振幅明显高于皮肤电极，而外侧附着的皮肤电极的振幅明显高于内侧附着的皮肤电极。
黏附式皮肤电极在动物模型和人体患者中均可进行术中神经监测。我们建议将黏附式皮肤电极附着于甲状软骨板的外侧。更靠近环杓关节的外侧附着可能更有利于测量环杓关节周围的肌肉运动。
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