Andersen C
Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark.
Acta Cardiol. 1997;52(4):325-33.
Spinal cord stimulation (SCS) has become a well established treatment for ischaemic nociceptive pain condition such as angina pectoris. In patients not suitable candidates for coronary bypass grafting or intraarterial invasive technique (i.e. PTCA and Stent) SCS is an alternative. The purpose was to record the complications: electrode fracture, infection, electrode migration, and technical equipment failure, which occurred during long-term spinal cord stimulation (SCS). Of 60 patients with severe angina pectoris and not candidates for angioplastic or coronary bypass surgery, 22 had monopolar and 38 had quadripolar spinal cord electrodes positioned percutaneously. The patients were followed with 1 to 4 month intervals in a 4 year period, and all complications were recorded. Infection was seen in 5% and electrode fracture was seen in 3% of the patients. The most frequent complication was electrode displacement, which required operation (23%). The incidence of this complication was statistically lower in patients with quadripolar electrodes than in patients with monopolar electrodes (p < 0.003). All displacements occurred within 1 year after implantation. The lower frequency of displacements, which required reoperations, seen among the multipolar electrodes, was due to the possibility of noninvasive changes of electrode combinations to optimize the topography of stimulation. Changes of electrode combination in connection with small migrations were necessary in 29% of the patients with multipolar electrodes. Therefore, there was no significant difference between frequency of migration for patients with monopolar or quadripolar epidural stimulation electrodes (p = 0.31). When SCS was used for treatment of anginal pain, the frequency of electrode tip migrations was high, but the use of multipolar electrodes gave the possibility to compensate for the migration, and to avoid surgical replacement.
脊髓刺激（SCS）已成为治疗诸如心绞痛等缺血性伤害性疼痛病症的一种成熟疗法。对于不适合进行冠状动脉搭桥术或动脉内侵入性技术（即经皮冠状动脉腔内血管成形术和支架置入术）的患者，SCS是一种替代选择。目的是记录长期脊髓刺激（SCS）过程中发生的并发症：电极断裂、感染、电极移位和技术设备故障。在60例患有严重心绞痛且不适合进行血管成形术或冠状动脉搭桥手术的患者中，22例经皮植入了单极脊髓电极，38例植入了四极脊髓电极。在4年期间，对患者进行间隔1至4个月的随访，并记录所有并发症。5%的患者出现感染，3%的患者出现电极断裂。最常见的并发症是电极移位，需要进行手术（23%）。四极电极患者中该并发症的发生率在统计学上低于单极电极患者（p < 0.003）。所有移位均发生在植入后1年内。多极电极中需要再次手术的移位频率较低，这是因为可以通过非侵入性方式改变电极组合来优化刺激地形图。29%的多极电极患者在出现小移位时需要改变电极组合。因此，单极或四极硬膜外刺激电极患者的移位频率之间没有显著差异（p = 0.31）。当SCS用于治疗心绞痛时，电极尖端移位的频率较高，但使用多极电极有可能弥补移位并避免手术更换。
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