Mochida K, Komori H, Okawa A, Shinomiya K
Department of Orthopaedic Surgery, Tokyo Medical and Dental University School of Medicine, Japan.
Spine (Phila Pa 1976). 1997 Jun 15;22(12):1385-93. doi: 10.1097/00007632-199706150-00018.
Using compound muscle action potentials after train spinal stimulation, intraoperative motor functional monitoring was performed during thoracic and thoracolumbar spinal surgery.
This study was designed to clarify the clinical usefulness of train spinal stimulation and to determine the critical point of compound muscle action potential change at which neurologic injury during surgery occurs.
In 1995 the authors reported that train spinal stimulation allows for the recording of compound muscle action potentials, even in animals and humans under general anesthesia. The facilitative effect of train stimulation overcomes the suppressive effects of anesthetics and allows potentials to pass through synapses, thereby enabling a reliable recording of lower extremity compound muscle action potential.
Multisegmental recording of compound muscle action potentials after train spinal stimulation was conducted on 34 patients Undergoing surgical treatment for thoracic or thoracolumbar lesions. During surgery, train stimuli (5 pulse, Interstimular Interval: 1 ms) were administered using an epidural electrode introduced transcutaneously. Compound muscle action potentials were recorded from a total of 128 muscles. Anesthesia was maintained using fentanyl and propofol or nitrous oxide with or without isoflurane. Muscle relaxation was attained mainly by controlled infusion of vecuronium bromide. The percent occurrence of recordable compound muscle action potentials was determined, and the potential changes were correlated with changes in muscle strength.
Compound muscle action potentials could be recorded from at least one muscle in 94% of the patients, even in most patients with severe motor dysfunction. The compound muscle action potential changes before and after surgical maneuver were divided into four grades. All compound muscle action potential changes in deteriorated muscles belonged to Grade 2 (a 10% latency delay) or Grade 3 (disappearance).
The success rate in obtaining muscle potentials was greatly enhanced when all of the following methods were used: train spinal stimulation, anesthetic with weak suppressive effect, multiple muscle recording, and percutaneous introduction of epidural electrode. The critical point of compound muscle action potential change should be defined as a 10% latency delay or disappearance. Multisegmental muscle potential after train spinal stimulation is the most appropriate method for thoracic and thoracolumbar spinal surgery.
通过在经皮脊髓刺激后使用复合肌肉动作电位，在胸椎和胸腰段脊柱手术期间进行术中运动功能监测。
本研究旨在阐明经皮脊髓刺激的临床实用性，并确定手术期间发生神经损伤时复合肌肉动作电位变化的临界点。
1995年，作者报告经皮脊髓刺激即使在全身麻醉的动物和人类中也能记录复合肌肉动作电位。经皮脊髓刺激的促进作用克服了麻醉剂的抑制作用，使电位能够通过突触，从而能够可靠地记录下肢复合肌肉动作电位。
对34例接受胸椎或胸腰段病变手术治疗的患者进行经皮脊髓刺激后复合肌肉动作电位的多节段记录。手术期间，使用经皮插入的硬膜外电极施加经皮刺激（5个脉冲，刺激间隔：1毫秒）。共从128块肌肉记录复合肌肉动作电位。使用芬太尼和丙泊酚或一氧化二氮维持麻醉，可加用或不加用异氟烷。主要通过控制输注维库溴铵实现肌肉松弛。确定可记录复合肌肉动作电位的发生率，并将电位变化与肌肉力量变化相关联。
即使在大多数严重运动功能障碍的患者中，94%的患者至少有一块肌肉可记录到复合肌肉动作电位。手术操作前后复合肌肉动作电位的变化分为四级。恶化肌肉中所有复合肌肉动作电位变化均属于2级（潜伏期延迟10%）或3级（消失）。
当使用以下所有方法时，获得肌肉电位的成功率大大提高：经皮脊髓刺激、抑制作用较弱的麻醉剂、多块肌肉记录以及经皮插入硬膜外电极。复合肌肉动作电位变化的临界点应定义为潜伏期延迟10%或消失。经皮脊髓刺激后的多节段肌肉电位是胸椎和胸腰段脊柱手术最合适的方法。
