【晨读】骶神经调控中应用标准化透视引导植入技术可获得理想的电极位置：一项尸体研究（一）
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本次文献选自Müller C, Reissig LF, Argeny S, et al. Standardized fluoroscopy-guided implantation technique enables optimal electrode placement in sacral neuromodulation: a cadaver study. Tech Coloproctol. 2021;25(2):215-221. 本次学习由王珺楠副主任医师主讲。
Abstract
Background Sacral neuromodulation (SNM) is an established treatment option for patients with faecal incontinence. The location of the stimulating electrode is considered to be essential for treatment success. The purpose of this study was to evaluate the position of SNM electrodes after using a standardized fluoroscopy-guided implantation technique.
Methods For this cadaver study, SNM electrodes were implanted bilaterally in 5 lower body specimens. The lower edge of the sacroiliac joint and the medial edge of the sacral foramina were marked using fluoroscopy to draw an 'H’ with the crossing points identifying S3. After electrode placement the pelvis was dissected to describe the exact position of the SNM electrodes.
Results The electrodes were inserted at an angle with a median degree measure of 60° (range 50–65°) to the skin, with a median distance of 9 mm (range 0–13 mm) from the S3 marking. All electrodes entered the third sacral foramen. The median distance of the electrodes to the sacral nerve was 0 mm (range 0–3 mm) for the most proximal, 0.5 mm (range 0–5 mm) for the second, 2.25 mm (range 0–11 mm) for the third and 1.75 mm (range 0–16 mm) for the most distant electrode. There was neither a significant difference in the proximity of the electrodes to the nerve between the right and left side (proximal to distal electrode: p = 0.18, p = 0.16, p = 0.07, p = 0.07) nor between male and female cadavers (p = 0.25, p = 0.21, p = 0.66, p = 0.66).
Conclusions A standardized fluoroscopy-guided implantation technique enables a close contact between electrode and nerve. This can potentially result in an improved clinical outcome.
摘要
背景 骶神经调节（SNM）被用于治疗粪便失禁患者。刺激电极的位置被认为对于治疗成功至关重要。这项研究的目的是评估使用标准透视引导的植入技术后SNM电极的位置。
方法 在尸体研究中，将SNM电极双侧植入5个下半身标本中。用透视标记骶髂关节的下缘和骶孔的内缘，画出一个“ H”，交叉点标识为S3。放置电极后，解剖骨盆以描述SNM电极的确切位置。
结果 电极插入时的中位角度与皮肤之间为60°（范围为50–65°），距S3标记的中位距离为9 mm（范围为0–13 mm）。所有电极进入第三骶孔。电极到t骶神经的中位距离，最近端触点距离为0毫米（范围0–3毫米），第二个触点距离为0.5毫米（范围0–5毫米），第三个触点距离为2.25毫米（范围0–11毫米），最远的触点为1.75毫米（范围为0–16毫米）。左右两侧的电极与神经的距离（近端至远端触点：p = 0.18，p = 0.16，p = 0.07，p = 0.07）均无显着差异，男女尸体之间也无显着差异（ p = 0.25，p = 0.21，p = 0.66，p = 0.66）。
结论 标准化的透视引导下植入技术可使电极与神经紧密接触。该结果可能改善临床效果。