A precise identification method of the posterior median sulcus of the spinal cord based on a matrix electrode device

Abstract

The present invention discloses a method for accurately distinguishing the posterior median sulcus of the spinal cord based on a matrix electrode device, wherein the matrix electrode device comprises a silicone body, a matrix electrode sheet, a stainless steel wire, an electrode plug and a nerve monitor, wherein the matrix electrode sheet is composed of a plurality of electrode sheet monomers arranged in a matrix of columns A and rows B; the method for accurately distinguishing the posterior median sulcus of the spinal cord based on the matrix electrode device comprises S1 preoperative preparation, S2 intraoperative positioning, S3 nerve stimulation and evoked potential recording, S4 acquisition of the posterior median sulcus of the spinal cord, etc., thereby completing the entire process of accurately distinguishing the posterior median sulcus of the spinal cord based on the matrix electrode device. The method for accurately distinguishing the posterior median sulcus of the spinal cord based on the matrix electrode device of the present invention is simple and effective, has high precision, and can accurately distinguish, is beneficial to intraspinal surgery of patients, protects the nerve function of patients, reduces surgical risks, is easy to operate, and is safe and reliable.

Description

Technical Field

[0001] The invention relates to the technical field of spinal cord tumor surgical position identification, in particular to a method for accurately identifying the posterior median sulcus of the spinal cord based on a matrix electrode device. Background Art

[0002] The posterior median sulcus of the spinal cord has the least neurological function, and cutting the spinal cord through the posterior median sulcus has the least impact on the patient's neurological function. Therefore, the most commonly used approach for spinal cord tumors is posterior median sulcus myelotomy. Currently, the most commonly used method to identify the posterior median sulcus of the spinal cord is anatomical identification, which includes: 1. Carefully identify the shallow groove in the middle of the posterior spinal cord; 2. The midpoint of the dorsal root entry area on both sides of the spinal cord is the posterior median sulcus.

[0003] When there is a tumor in the spinal cord, the spinal cord will bulge due to the tumor, and the posterior median sulcus is often not obvious and cannot be identified. In addition, due to the compression of the spinal cord by the tumor, part of the spinal cord will twist or bulge unevenly, and the posterior median sulcus of the spinal cord will disappear and shift. Therefore, the midpoint of the dorsal root entry area of ​​the spinal cord on both sides is not the posterior median sulcus. At this time, there will be a certain error in the anatomical identification of the posterior median sulcus, and the deviation of the spinal cord incision from the posterior median sulcus will cause neurological dysfunction in patients. Therefore, the development of a method for accurately identifying the posterior median sulcus of the spinal cord plays a significant role in the surgery of patients with spinal cord tumors and is also very necessary.

[0004] Since the spinal cord tissue on both sides of the posterior median sulcus conducts electrical impulses from nerves on different sides, the functional posterior median sulcus of the spinal cord can be obtained by monitoring the electrophysiological function of the spinal cord. The functional posterior median sulcus of the spinal cord is theoretically more accurate than the anatomical posterior median sulcus and is more in line with clinical practice. However, there is currently no systematic technology and equipment to determine the functional posterior median sulcus of the spinal cord. Summary of the invention

[0005] The purpose of the present invention is to provide a method for accurately identifying the posterior median sulcus of the spinal cord based on a matrix electrode device, which can monitor the electrophysiological parameters of the spinal cord through the matrix electrode device and then identify the functional posterior median sulcus of the spinal cord to solve the above defects.

[0006] In order to achieve the above object, the present invention provides the following technical solutions:

[0007] A method for accurately distinguishing the posterior median sulcus of the spinal cord based on a matrix electrode device, wherein the matrix electrode device comprises a silicone body, a matrix electrode sheet, a stainless steel wire, an electrode plug and a nerve monitor, wherein the matrix electrode sheet is composed of a plurality of electrode sheet monomers arranged in a matrix of columns A and rows B, wherein the plurality of electrode sheet monomers are respectively connected to the electrode plug through stainless steel wires, and the plurality of electrode sheet monomers are all embedded in the lower end surface of the silicone body, and the plurality of stainless steel wires are all embedded in the silicone body, and the electrode plug is finally connected to the nerve monitor;

[0008] The method for accurately identifying the posterior median sulcus of the spinal cord based on a matrix electrode device comprises the following steps:

[0009] S1. Preoperative preparation: Place the stimulation electrodes commonly used in clinical practice near the tibial nerves at the ankle joints on both sides of the spinal cord tumor patients and connect them to the nerve monitor;

[0010] S2. Intraoperative positioning: After the vertebral lamina is opened and the spinal cord is exposed during the spinal cord tumor surgery, the tumor position is located according to the intraoperative ultrasound, and then the silicone body of the matrix electrode device is placed on the posterior surface of the spinal cord at the tumor segment, and a number of the electrode sheet monomers are closely covered on the posterior surface of the spinal cord, the electrode sheet monomers in column A are parallel to the long axis of the spinal cord, and the electrode sheet monomers in row B are perpendicular to the long axis of the spinal cord; secondly, the electrode plug of the matrix electrode device is connected to the nerve monitor; finally, the reference needle electrode is placed in the muscle of the surgical area and connected to the nerve monitor through a connector;

[0011] S3. Nerve stimulation and evoked potential recording:

[0012] The tibial nerves at the left and right ankle joints of the patient are stimulated by the stimulation electrodes respectively. The potential after the nerve stimulation is received by a number of electrode pieces in the matrix electrode device. Two groups of 100-200 evoked potential tracings are performed on each electrode piece in the matrix electrode device by a nerve monitor.

[0013] S4. Acquisition of the posterior median sulcus of the spinal cord:

[0014] The evoked potentials are superimposed, and the position of the electrode monomer with the maximum amplitude on the superimposed potential is recorded by a nerve monitor; after stimulation of the left and right tibial nerves, two electrode monomers with the maximum amplitude recording are obtained in each row of electrode monomers perpendicular to the long axis of the spinal cord, and the midpoint between these two electrode monomers is the position of the posterior median sulcus of the spinal cord; the B rows of electrode monomers contained in the matrix electrode sheet can obtain a total of B position points of the posterior median sulcus of the spinal cord, and the true position of the posterior median sulcus of the spinal cord can be obtained by connecting these B position points, thereby completing the entire process of accurate identification of the posterior median sulcus of the spinal cord based on the matrix electrode device.

[0015] Preferably, the A columns and B rows are arranged in a matrix, wherein A=10, B≥5, and B is a natural number.

[0016] Preferably, in step S3, the stimulation intensity of the tibial nerves at the left and right ankle joints of the patient is 40 mA, the duration is 0.2 milliseconds, and the repetition frequency is 13.3 Hz.

[0017] Preferably, the electrode sheet monomer is in the shape of a rectangular sheet with a width of 54 μm, a length of 2 mm, a thickness of 10 μm, and a spacing between two adjacent electrode sheet monomers in the same row is 0.8 mm.

[0018] Preferably, the diameter of the stainless steel wire is 20 μm, and a Teflon coating is provided on the outer wall thereof.

[0019] The beneficial effects of the present invention are:

[0020] The present invention provides a precise identification method of the posterior median sulcus of the spinal cord based on a matrix electrode device. A plurality of electrode sheet monomers arranged in a matrix in the matrix electrode device are tightly covered on the posterior surface of the spinal cord. The tibial nerves near the ankle joints on both sides of the patient are stimulated. The evoked potential is received and recorded by a nerve monitor connected to the rear end of the electrode sheet monomer, thereby obtaining two electrode sheet monomers with maximum amplitude records in each row. The midpoint between the two electrode sheet monomers is the position of the posterior median sulcus of the spinal cord. The line connecting the position points of the plurality of posterior median sulci of the spinal cord is the position line of the posterior median sulcus of the spinal cord. The method is simple and effective, has high precision, and can be accurately identified. It is beneficial to the patient's spinal cord surgery, is beneficial to protecting the patient's spinal nerve function, reduces surgical risks, is easy to operate, and is safe and reliable. BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Figure 1 : Schematic diagram of the structure of the matrix electrode device of an embodiment of the present invention. DETAILED DESCRIPTION

[0022] Embodiment 1:

[0023] Combined with Figure 1 , the specific implementation mode of the present invention is described as follows:

[0024] The present invention provides a method for accurately distinguishing the posterior median sulcus of the spinal cord based on a matrix electrode device, wherein the matrix electrode device includes a silicone body, a matrix electrode sheet, a stainless steel wire, an electrode plug and a nerve monitor. The matrix electrode sheet is composed of a plurality of electrode sheet monomers arranged in a matrix of columns A and rows B, the electrode sheet monomers are rectangular sheets, and have a width of 54 μm, a length of 2 mm, a thickness of 10 μm, and a spacing of 0.8 mm between two adjacent electrode sheet monomers in the same row; and the columns A and rows B are arranged in a matrix, wherein A≥8, B≥2, and B is a natural number.

[0025] Several electrode sheet monomers are connected to the electrode plug through stainless steel wires, wherein several electrode sheet monomers are embedded in the lower end surface of the silicone body, and the conductive surface of the electrode sheet monomer is flush with the surface of the lower end surface of the silicone body, and the other surface is located in the silicone body; the diameter of the stainless steel wire is 20μm, and a Teflon coating is provided on its outer wall, and several stainless steel wires are embedded in the silicone body, and these stainless steel wires do not contact the patient's spinal cord to avoid leakage.

[0026] When the matrix electrode device is used in the later stage, these stainless steel wires are parallel to the long axis of the patient's spinal cord. After being led out of the silicone body, each stainless steel wire is connected to an electrode plug. The electrode plug is wrapped in plastic on the outside and a copper conductive sheet on the inside. It is consistent with the structure and material of the electrophysiological monitoring electrode plug commonly used in the market, and can be adapted to the commonly used nerve monitors. Several electrode plugs can be connected to the nerve monitor.

[0027] like Figure 1 As shown, in this embodiment, A is ten (numbered 1-10 respectively), and B is five (numbered ae respectively), that is, the electrode sheet monomers in the matrix electrode device are arranged in a matrix of ten columns and five rows. Finally, a total of 50 stainless steel wires are led out of the silicone body and then connected to the nerve monitor through the electrode plug.

[0028] The method for accurately identifying the posterior median sulcus of the spinal cord based on a matrix electrode device comprises the following steps:

[0029] S1. Preoperative preparation: Place the stimulation electrodes commonly used in clinical practice near the tibial nerves at the left and right ankle joints of patients with spinal cord tumors and connect them to a nerve monitor.

[0030] S2. Intraoperative positioning: During the spinal cord tumor surgery, the vertebral plate is opened through the skin, subcutaneous tissue, and muscles according to the spinal cord tumor surgery steps, and the dura mater and arachnoid membrane are cut in the middle of the back. After the patient's spinal cord is exposed, the tumor position is located according to the intraoperative ultrasound, and then the silicone body of the matrix electrode device is placed on the posterior surface of the spinal cord at the tumor segment, and a number of electrode sheet monomers are closely covered on the posterior surface of the spinal cord. The ten columns of electrode sheet monomers (numbered 1-10) are parallel to the long axis of the spinal cord, and the five rows of electrode sheet monomers (numbered ae) are perpendicular to the long axis of the spinal cord; secondly, the electrode plug of the matrix electrode device is connected to the nerve monitor; finally, the reference needle electrode is placed in the muscle of the surgical area and connected to the nerve monitor through a connector. The reference needle electrode is a commonly used electrode in clinical practice, and the reference electrode is an electrode placed at the relative zero potential point of the body. The spinal cord electrical signal finally obtained is the difference between the rectangular electrode and the reference electrode. The purpose of the reference electrode is to remove background electrical signals (such as electrocardiographic and other electrophysiological signals from other parts of the body).

[0031] S3. Nerve stimulation and evoked potential recording:

[0032] The tibial nerves at the left and right ankle joints of the patient were stimulated by stimulating electrodes, with a stimulation intensity of 40 mA, a duration of 0.2 milliseconds, and a repetition frequency of 13.3 Hz. The potential after nerve stimulation was received by several electrode sheets in the matrix electrode device, and two groups of 100-200 evoked potential tracings were performed on each electrode sheet in the matrix electrode device through a nerve monitor.

[0033] S4. Acquisition of the posterior median sulcus of the spinal cord:

[0034] 100-200 evoked potentials are superimposed, and the position of the electrode unit with the maximum amplitude on the superimposed potential is recorded by a nerve monitor; after stimulating the tibial nerves on both sides, two electrode units with the maximum amplitude will be obtained in the ten electrode units in each row perpendicular to the long axis of the spinal cord (numbered 1-10 respectively), and the midpoint between these two electrode units is the position of the posterior median sulcus of the spinal cord; the five columns of electrode units contained in the matrix electrode (numbered ae respectively) can obtain a total of five position points of the posterior median sulcus of the spinal cord, and the true position of the posterior median sulcus of the spinal cord can be obtained by connecting these five position points, thereby completing the entire process of accurate identification of the posterior median sulcus of the spinal cord based on the matrix electrode device.

[0035] The present invention discloses a precise identification method of the posterior median sulcus of the spinal cord based on a matrix electrode device. A plurality of electrode sheet monomers arranged in a matrix in the matrix electrode device are tightly covered on the posterior surface of the spinal cord. The tibial nerves near the ankle joints on both sides of the patient are stimulated. The evoked potential is received and recorded by a nerve monitor connected to the rear end of the electrode sheet monomer, thereby obtaining two electrode sheet monomers with maximum amplitude records in each row. The midpoint between the two electrode sheet monomers is the position of the posterior median sulcus of the spinal cord. The line connecting the position points of the plurality of posterior median sulci of the spinal cord is the position line of the posterior median sulcus of the spinal cord. The method is simple and effective, has high precision and accurate identification, is beneficial to the patient's spinal cord surgery, is convenient for protecting the spinal cord nerve function during surgery, reduces surgical risks, is easy to operate, and is safe and reliable.

[0036] The above is an exemplary description of the present invention in conjunction with the accompanying drawings. It is obvious that the specific implementation of the present invention is not limited to the above-mentioned method. As long as such non-substantial improvements are made by adopting the method concept and technical solution of the present invention, or the concept and technical solution of the invention are directly applied to other occasions without improvement, they are all within the protection scope of the present invention.

Claims

1. A method for accurately identifying the posterior median sulcus of the spinal cord based on a matrix electrode device, characterized in that: The matrix electrode device includes a silicone body, a matrix electrode sheet, a stainless steel wire, an electrode plug and a nerve monitor. The matrix electrode sheet is composed of a plurality of electrode sheet monomers arranged in a matrix of columns A and rows B. The plurality of electrode sheet monomers are respectively connected to the electrode plug through stainless steel wires, and the plurality of electrode sheet monomers are embedded in the lower end surface of the silicone body, the plurality of stainless steel wires are embedded in the silicone body, and the electrode plug is connected to the nerve monitor. The method for accurately identifying the posterior median sulcus of the spinal cord based on a matrix electrode device comprises the following steps: S1. Preoperative preparation: Place the stimulation electrodes commonly used in clinical practice near the tibial nerves at the ankle joints on both sides of the spinal cord tumor patients and connect them to the nerve monitor; S2. Intraoperative positioning: After the vertebral lamina is opened and the spinal cord is exposed during the spinal cord tumor surgery, the tumor position is located according to the intraoperative ultrasound, and then the silicone body of the matrix electrode device is placed on the posterior surface of the spinal cord at the tumor segment, and a number of the electrode sheet monomers are closely covered on the posterior surface of the spinal cord, the electrode sheet monomers in column A are parallel to the long axis of the spinal cord, and the electrode sheet monomers in row B are perpendicular to the long axis of the spinal cord; secondly, the electrode plug of the matrix electrode device is connected to the nerve monitor; finally, the reference needle electrode is placed in the muscle of the surgical area and connected to the nerve monitor through a connector; S3. Nerve stimulation and evoked potential recording: The tibial nerves at the left and right ankle joints of the patient are stimulated by stimulation electrodes respectively. The potential after nerve stimulation is received by a number of electrode sheet monomers in the matrix electrode device. Two groups of 100-200 evoked potential tracings are performed on each electrode sheet monomer in the matrix electrode device by a nerve monitor; S4. Acquisition of the posterior median sulcus of the spinal cord: The evoked potentials are superimposed, and the position of the electrode monomer with the maximum amplitude on the superimposed potential is recorded by a nerve monitor; after stimulation of the left and right tibial nerves, two electrode monomers with the maximum amplitude recording are obtained in each row of electrode monomers perpendicular to the long axis of the spinal cord, and the midpoint between these two electrode monomers is the position of the posterior median sulcus of the spinal cord; the B rows of electrode monomers contained in the matrix electrode sheet can obtain a total of B position points of the posterior median sulcus of the spinal cord, and the true position of the posterior median sulcus of the spinal cord can be obtained by connecting these B position points, thereby completing the entire process of accurate identification of the posterior median sulcus of the spinal cord based on the matrix electrode device.

2. The method for accurately identifying the posterior median sulcus of the spinal cord based on the matrix electrode device according to claim 1, characterized in that: The A columns and B rows are arranged in a matrix, wherein A=10, B≥5, and B is a natural number.

3. The method for accurately identifying the posterior median sulcus of the spinal cord based on the matrix electrode device according to claim 1, characterized in that: In step S3, the stimulation intensity of the tibial nerve at the left and right ankle joints of the patient was 40 mA, the duration was 0.2 milliseconds, and the repetition frequency was 13.3 Hz.

4. The method for accurately identifying the posterior median sulcus of the spinal cord based on the matrix electrode device according to claim 1, characterized in that: The electrode sheet monomer is in the shape of a rectangular thin sheet with a width of 54 μm, a length of 2 mm, and a thickness of 10 μm. The spacing between two adjacent electrode sheet monomers in the same row is 0.8 mm.

5. The method for accurately identifying the posterior median sulcus of the spinal cord based on the matrix electrode device according to claim 1, characterized in that: The diameter of the stainless steel wire is 20 μm, and a Teflon coating is provided on the outer wall thereof.

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