CN105769169B - A kind of spinal cord intrtqoperative care device - Google Patents
A kind of spinal cord intrtqoperative care device Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
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- A—HUMAN NECESSITIES
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- A61B5/40—Detecting, measuring or recording for evaluating the nervous system
- A61B5/4058—Detecting, measuring or recording for evaluating the nervous system for evaluating the central nervous system
- A61B5/407—Evaluating the spinal cord
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- A61B5/74—Details of notification to user or communication with user or patient ; user input means
- A61B5/746—Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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Abstract
A kind of spinal cord intrtqoperative care device measures spinal cord surface potential by flexible electrode array, illustrates to be damaged if detecting demarcation potential, then extra electric field utilized to offset demarcation potential, to keep spinal cord microenvironment to stablize relatively.Described device includes flexible array electrode (1a, 1b), stimulating electrode (2a, 2b, 2c), spinal cord surface potential Acquisition Circuit (3), demarcation potential compensation circuit (4), control system (5), damage reason location system (6) and display equipment (7).Flexible array electrode (1a, 1b) can detect demarcation potential, it is passed to control system (5) by spinal cord surface potential Acquisition Circuit (3), and it is alarmed by display equipment (7), damage reason location system (6) calculates accurate damage position simultaneously, stimulating electrode (2c) is placed on injury region and carries out demarcation potential compensation by suggestion device operating personnel, and drug-treated is carried out, improve the prognosis damaged in art.
Description
Technical field
It is the present invention relates to the device that spinal function in a kind of operation for spine and spinal cord is guarded, more particularly to a kind of based on soft
Property array electrode demarcation potential detection and closed loop demarcation potential compensation device.
Background technology
Spinal cord injury is one of damage the most catastrophic of human nervous system's experience, can cause permanent nerve
Defect.It is that spinal cord injury treats most effective means to prevent the generation of secondary lesion, development after acute spinal cord injury in early days,
It is the common recognition of researcher and clinician.
The spine and spinal cords surgical operations such as backbone correcting, tumor of spinal cord, spinal cord tuberculosis and spinal stimulator implantation are ridges
One risk factor of marrow damage.For the spinal stimulator implantation of analgesic, such as performing the operation improper may cause a system
The complication of row, even crural paralysis or paresis.Although most of documents have avoided the complication of spinal stimulator implantation,
Report result is not enough to the neurological complication after reaction spinal stimulator implantation, but the database displaying of manufacturer is refreshing
Incidence through systematic complication reaches 0.54%.Although spinal cord injury incidence is very low caused by spine and spinal cord operation,
It is caused by it the result is that destructive and permanent, including lower limb paralysis, quadriplegia, or even dead.In order to find as early as possible
Unexpected spinal cord injury and early stage processing is carried out in spine and spinal cord operation, the method that intrtqoperative care can be used.Intrtqoperative care can
To carry out continuous electrophysiological function assessment to specific spinal segment, enables patient to find rapidly to damage and handle, keep away
Exempt from the extension of damage.Intrtqoperative care with spinal cord injury early treatment function is important development direction from now on.
Existing intrtqoperative care device is based primarily upon the principle of Evoked ptential detection and analysis.The ridge that the seventies in last century occurs
Marrow Evoked ptential is applied to intrtqoperative care earliest.This method uses Epidural Electrical polar stimulation columna posterior medullae spinalis, remembers on spinal cord surface
Record feels and the composite nerve electric signal of motor fibre, but motor fiber signal is submerged in the sensory fibre of wave amplitude bigger
Among signal, practical application is less.If stimulating peripheral nerve or muscle, the Evoked ptential on endorchis or on scalp is recorded
Somatosensory evoked potentials can be obtained, the amplitude of somatosensory evoked potentials and the incubation period evaluable integrality for feeling access, body are passed through
Sense Evoked ptential is most common columna posterior medullae spinalis monitoring method in spine and spinal cord operation.Relative to baseline, wave amplitude reduces 50%
While incubation period increase by 10% be spinal cord injury pre-warning signal, using somatosensory evoked potentials carry out intrtqoperative care in only
The incidence of postoperative paraplegia can be reduced by 50~60% by 0.063% fault rate.For motor path, it can be used and pierced through cranium electricity
Swash or the method for Neural stem cell keeps zona rolandica excited, detects the Motion Evoked Potential on spinal cord surface or muscle.If
Motion Evoked Potential wave amplitude reduces by 50% or more relative to baseline, then is likely to be that major injury has occurred and causes permanent
Paraplegia, it is on the contrary then show that spinal function is good.In order to which simultaneously to moving and feeling that access is guarded, clinic mostly uses movement and lures
The method that power generation position is combined with somatosensory evoked potentials, this is with higher resolution ratio and preferably more pre- than single monitoring method
Survey value.
Invention content
The purpose of the present invention is overcoming the prior art, one kind is proposed for being detected based on demarcation potential, and have
The spinal cord intrtqoperative care device of demarcation potential compensation function.
Demarcation potential refer to after spinal cord injury injury region with it is normal between existing DC potential difference, be due to damage
Spinal cord microenvironment changes afterwards, and normal cell membrane and resting potential are destroyed, injury region Na+、Ca2+Born of the same parents are flowed into Deng a large amount of cations
It is interior, anion outflow and formed.As a result, causing intracellular Ca2+Surplus, and then cause a series of biological processes, cause
The secondary lesion of spinal cord.Therefore it keeps the microenvironment in organism to stablize after injury, effectively prevent Ca2+Deng cationic interior stream
It is the effective means for mitigating degree of injury and improving prognosis.Prevent cation in stream can be stimulated by extra electric field, change from
The method in the dynamic direction of subflow is realized.In addition, demarcation potential is closely related with degree of injury, more serious, demarcation potential is damaged
Initial value is bigger, and demarcation potential constantly reduces as time increases, declines at logarithmic relationship.This is just needed after injury immediately
Demarcation potential is compensated, and the intensity of electro photoluminescence is also required to be adjusted in real time according to the size of demarcation potential.
The present invention proposes a kind of new spinal cord intrtqoperative care device, using demarcation potential appearance whether judge damage be
No generation.The present invention detects the distribution of spinal cord surface potential in real time by flexible array electrode, accurately extrapolates damage position, in turn
It determines the electrode position of demarcation potential compensation, and compensated by the demarcation potential of feedback quantity of real-time demarcation potential, it can be most
The normal electro physiology environment of holding injury region of big degree, races against time for earlier damages reclamation activities such as drug-treateds.
Spinal cord intrtqoperative care device of the present invention includes two flexible array electrodes, three stimulating electrodes, spinal cord surface potential
Acquisition Circuit, demarcation potential compensation circuit, control system, damage reason location system and display equipment.First, second flexible array electricity
Pole is arranged in the rostral and caudal of exposed spinal cord.First stimulating electrode is a part for the first flexible array electrode, the
Two stimulating electrodes are a part for the second flexible array electrode, and the first stimulating electrode and the second stimulating electrode are located remotely from exposed
The side of spinal cord, with whole device " " connect, in case of being damaged in art, third stimulating electrode will be attached to injury region table
Face.For spinal cord surface potential Acquisition Circuit there are two input terminal and two output ends, the first of spinal cord surface potential Acquisition Circuit is defeated
Enter end, the second input terminal is connected with the output end of the output end of the first flexible array electrode, the second flexible array electrode respectively, ridge
First output end of marrow surface potential Acquisition Circuit and the first input end of control system connect, second output terminal and damage reason location
The input terminal of system connects.There are three input terminals and two output ends, first input end to be adopted with spinal cord surface potential for control system
First output end of collector connects, and the second input terminal is connect with the output end of damage reason location system, third input terminal and display
The output end of equipment connects, and the first output end is connect with the input terminal of demarcation potential compensation circuit, and second output terminal is set with display
Standby input terminal connection.The input terminal of demarcation potential compensation circuit and the first output end of control system connect, output end and the
Tristimulus electrode connects.
In spine and spinal cord intrtqoperative care device of the present invention, each flexible array electrode channel number is no more than 33, wherein separate
The channel of last row of exposed spinal cord side is " ground electrode ".Spinal cord surface potential Acquisition Circuit acquires flexible array electrode note
The spinal cord surface potential recorded, and the processing such as it is amplified, filters, it is then fed into control system and damage reason location system.If
It is damaged during operation on spinal cord, control system will send order to display equipment, and display on the screen occurs damaging or set
Preparation goes out the alarm signals such as buzzing.Damage reason location system can be pushed away by reverse temperature intensity algorithm from the distribution of spinal cord surface potential simultaneously
The accurate location for exporting spinal cord injury, control system is sent to by damage position information, is then shown on the display device, is prompted
Device operating personnel place third stimulating electrode on the position, and carry out emergent management in the position.Then control system
The output voltage of demarcation potential compensation circuit will be given by its internal digital-analog convertor, i.e., in third stimulating electrode
One DC voltage of upper application, compensates the demarcation potential after spinal cord injury, that is, is offset and damaged with direct current extra electric field
Hinder current potential.Control system will also adjust stimulation voltage size according to spinal cord surface potential distribution situation after extra electric field, make spinal cord
Surface potential forms closed loop demarcation potential compensation system as close possible to normal physiological condition, improve demarcation potential compensation
The more preferable effect for inhibiting secondary lesion is played in accuracy.
First flexible array electrode, the second flexible array electrode are located at exposed spinal cord rostral and caudal, and two soft
Property array electrode close to exposure spinal cord.Each array electrode port number is no more than 33, wherein along spinal cord axial direction, far from exposure
The electrode channel of last row of the direction of spinal cord and device " " connection, while also distinguishing the first, second stimulating electrode, it is flexible
The remaining electrode channel of array electrode is with noting down.The flexible electrode base material is the good Parylene of biocompatibility
Or polyimides, conductive material are silver, silver chlorate, platinum or platinumiridio.Electrode contacts and solder joint area are smaller than 1 square of milli
Magnitude of the connection line width of rice, connection welding and contact at tens microns.
The third stimulating electrode is circular single channel membrane electrode, is positive polarity, is attached to injury region surface, third
Magnitude of the contact area of stimulating electrode at several square millimeters, specific size need to be depending on injury region sizes.According to
The spinal cord injury position shown in display equipment, finds corresponding damage position, by third stimulating electrode on exposed spinal cord
It is attached to damage position surface.Third stimulating electrode, spinal cord, " ground electrode " and demarcation potential compensation circuit forming circuit, in spinal cord
Injury region and it is normal between form DC electric field, direction of an electric field is directed toward " ground electrode " by third stimulating electrode.
The spinal cord surface potential Acquisition Circuit port number is the sum of two flexible array electrode channel numbers, spinal cord surface
The each Channel front end of potential acquisition circuit is a DC voltage amplifier, can be amplified surface potential, then be filtered,
Then the surface potential signal in all channels is sent to control system and damage reason location system.
The damage reason location system has prestored patient's spinal cord magnetic resonance image or CT images, and spinal cord is divided into
The region of several different conductivity such as substantia alba medullae spinalis, gray nucleus, cerebrospinal fluid, endorchis, damage reason location system utilize electromagnetic field
The algorithm of reverse temperature intensity calculates damage position, including spinal cord axial position and spinal cord cross section by the distribution of spinal cord surface potential
On position, and this position coordinates is sent to control system, then display equipment is sent to by control system and is shown.
The demarcation potential compensation circuit is mainly made of voltage follower, the input terminal of demarcation potential compensation circuit and
The input terminal and output end of output end i.e. voltage follower.The input terminal of voltage follower and number-mould of control system
Quasi- converter output end connection, the output end of voltage follower are connected with third stimulating electrode.Stimulated current stimulates electricity from third
Pole is flowed out, and demarcation potential compensation circuit is flowed back by the first, second stimulating electrode after spinal cord.Control system passes through inside
The input voltage of digital-analog convertor given voltage follower, and then adjust the voltage swing on third stimulating electrode.Voltage
Follower plays the role of impedance isolation, and the resistance of myeloid tissue will not impact the voltage between stimulating electrode.
The control system completes entire monitor device control function, including following three aspects：
(1) after receiving spinal cord surface signal, control system is electric according to the surface that each flexible array electrode channel measures
Position with " " between potential difference come judge damage whether occur, criterion is that the potential difference between any two channel is more than
Equal to 10mV.After damage occurs, control system will send the signal of " damage occur " to showing equipment；
(2) the damage position information from damage reason location system is received, display equipment is then forwarded to；
(3) stimulus intensity signal, flexible array electrode, spinal cord surface potential acquisition electricity are provided for demarcation potential compensation circuit
Road, control system, cord potential compensation circuit and stimulating electrode constitute closed-loop control system, can be by adjusting in control system
The output voltage of digital-analog convertor changes the output voltage of demarcation potential compensation circuit, and then changes surface potential acquisition
The collected surface potential of circuit.It is set in control system there are one side and calculator, for calculating flexible array electrode used
The spinal cord surface potential that channel is recorded side and.Since control system be gradually increased starting demarcation potential compensation circuit
The output voltage of its internal digital-analog converter, and compare the output of side and calculator, in the stage side and meter of beginning
Calculating the output of device can reduce with the raising of the output voltage of digital-analog convertor, if improving stimulation voltage process
In detect that side and calculator output valve are changed from small to big, then illustrate that side and calculator output have reached minimum value, ridge at this time
Marrow surface potential can reach optimal inhibition secondary damaging effects closest to normal physiological condition.
The display equipment is connect with control system, on the one hand, display equipment is in " the damage for receiving control system transmission
After wound generation " signal, alarm will be sent out, for example sends out flash signal on the screen or voice alarm signal occurs；On the other hand,
After display equipment receives damage position information, damage position will be shown on pre-stored spinal MRI or CT images, and carry
Show the emergency processing after operating personnel damage.Stimulating electrode is attached to the injury region shown by screen by device user of service,
Then " starting to stimulate " button on screen can be clicked, demarcation potential compensation circuit can be started and carry out extra electric field stimulation, simultaneously
Device user of service can carry out other emergency processings.
It is as follows using the course of work of apparatus of the present invention：
The first step：The rostral and caudal two flexible array electrodes being respectively arranged at exposed spinal cord；
Second step：It performs the operation, if operation is well on, occurs without being damaged in art, then taken out after operation
Then two flexible array electrodes carry out general operation round-off work；If finding spinal cord injury in art in operation, equipment is shown
It can alarm, device user of service executes third step, is handled.
Third walks：By damage position shown in display equipment, the stimulating electrode of appropriate electrode area is selected to be attached to damage
Then " starting to stimulate " button in display device screen is clicked, and carries out other emergency processings in injury.
4th step：After stimulation 30 minutes, " stimulation terminates " will be shown on screen by showing.Then by doctor decide whether by
The original plan is performed the operation, and second step is repeated if "Yes" and takes out stimulating electrode until original operation is completed to the flow of the 4th step
With flexible array electrode, and operation round-off work is carried out；Stimulating electrode and flexible array electrode are taken out if "No", carry out hand
Art round-off work abandons original surgical planning.
The advantages of apparatus of the present invention, is the following aspects：
First, the prior art will often stimulate different muscle detection somatosensory evoked potentials variations when carrying out damage reason location,
Or stimulus movement cortex records the Motion Evoked Potential on different muscle, when this method for replacing target muscles wastes a large amount of
Between, and electrical transcranial stimulation and Neural stem cell can't reach the degree for accurately controlling a certain piece of muscle, i.e., after motor path damage
Positioning be difficult to realize.And device of the present invention uses the principle of demarcation potential detection, only need to detect spinal cord surface potential, no
Cumbersome different muscular irritations must be carried out, the time is saved, are conducive to the prognosis for improving patient.
Secondly, the prior art is to the limitations of certain particular patients ' groups, such as by spinal stimulator for plant person's rush
When waking up, since the brain of Activities of Some Plants people does not react transcranial magnetic stimulation and muscular irritation, this results in being based on exercise induced
The intrtqoperative care thrashing of current potential and somatosensory evoked potentials.And principle of the device of the present invention based on demarcation potential, it is not necessarily to
The participation of brain in patients is also applicable to this specific group of patients.
Third is single-function of the prior art as diagnostic tool, this is because there are no maturations in clinical at present
Caused by acute injury processing method based on electromagnetic field.And device of the present invention can then be damaged after finding to damage
Potential compensation is a kind of device for integrating and examining, treating.
4th is that the prior art is carrying out demarcation potential compensation, needs to open injury region, injury region rostral, injury region caudal
Vertebral plate at three brings additional damage to patient, and influence is also resulted on spinal function.Device of the present invention does not have in application
Additional injuries are easy to be accepted by patients.
Description of the drawings
The schematic diagram of device that Fig. 1 present invention is guarded for spinal function in spine and spinal cord operation；
Fig. 2 is device course of work flow chart of the present invention；
Fig. 3 is device flexible array electrode principle figure of the present invention；
Fig. 4 is stimulating electrode structural schematic diagram of the present invention；
Fig. 5 is control system functional block diagram of the present invention.
Specific implementation mode
It is further illustrated the present invention below in conjunction with the drawings and specific embodiments.
Fig. 1 is the schematic diagram of apparatus of the present invention.As shown in Figure 1, apparatus of the present invention include flexible array electrode 1a and 1b, thorn
Swash electrode 2a, 2b, 2c, spinal cord surface potential Acquisition Circuit 3, demarcation potential compensation circuit 4, control system 5, damage reason location system
6 and display equipment 7.
In Fig. 1,8 be patient spine, and 9 be the spinal cord of exposure in operation, and length is the segment length of vertebrae.1a and 1b is two
A flexible array electrode, the first flexible array electrode 1a are arranged in the rostral of exposed spinal cord 9, the second flexible array electrode 1b cloth
Set the caudal in exposed spinal cord 9.First stimulating electrode 2a and the second stimulating electrode 2b is respectively the first flexible array electrode 1a
With a part of the second flexible array electrode 1b, be located remotely from the side of exposed spinal cord 9, with whole device " " connect.
In Fig. 1, there are two input terminal and two output ends for spinal cord surface potential Acquisition Circuit 3, and first input end is by leading
Line is connect with the first flexible array electrode 1a, and the second input terminal is connect also by conducting wire with the second flexible array electrode 1b, and first
Output end is connect with the first input end of control system 5, and second output terminal is connect with the input terminal of damage reason location system 6.Control
There are three input terminal and two output ends, the first output end and the first output ends of spinal cord surface potential Acquisition Circuit 3 to connect for system 5
It connects, second output terminal portion is connect with the output end of damage reason location system 6, and third input terminal is connect with the output end of display equipment 7.
First output end is connect with the input terminal of demarcation potential compensation circuit 4 again, and second output terminal simultaneously connects with the input terminal of display equipment 7
It connects.The input terminal of demarcation potential compensation circuit 4 is connect with the first output end of control system 5, demarcation potential compensation circuit 4 it is defeated
Outlet is connect by arriving conducting wire with stimulating electrode 2c.
In Fig. 1, if damaged during operation on spinal cord, the spinal cord after damage is recorded in flexible array electrode 1a, 1b
Then surface potential the processing such as acquires, and is amplified, filters by spinal cord surface potential Acquisition Circuit 3, be sent into control system later
System 5.Control system 5 will send order after judging damage to display equipment 7, and damaging occurs in display on the screen or equipment is sent out
The alarm signals such as buzzing.Collected spinal cord surface potential is sent to damage reason location by spinal cord surface potential Acquisition Circuit 3 simultaneously
System 6, the system can have the distribution of spinal cord surface potential to extrapolate the accurate location of spinal cord injury by reverse temperature intensity algorithm, carry
Showing device operating personnel place stimulating electrode 2c on the position, and show " starting to stimulate " on the screen of display equipment 7
Button.After operating personnel press the button, control system 5 will give demarcation potential by its internal digital-analog convertor
The output voltage of compensation circuit 4 applies a DC voltage that is, on stimulating electrode 2c, in stimulating electrode 2c and 2b, and thorn
Swash and form DC electric field between electrode 2c and 2a, the demarcation potential after spinal cord injury is compensated.Demarcation potential compensation starts
Afterwards, flexible array electrode 1a, 1b will also continue to acquire spinal cord surface potential signal, and pass through spinal cord surface potential Acquisition Circuit 3
Signal is sent into control system 5, control system 5 adjusts its internal digital-to-analog according to spinal cord surface potential distribution situation and turns
The output voltage of parallel operation, to realize that the stimulation voltage on stimulating electrode 2c adjusts.
As shown in Fig. 2, apparatus of the present invention course of work is as follows：
Step 201：First flexible array electrode 1a is arranged in the rostral of exposed spinal cord 9, the second flexible array electrode
1b is arranged in the caudal of exposed spinal cord 9, does not influence surgical field of view；
Step 202：Two flexible array electrodes 1a and 1b start to work, and spinal cord surface potential Acquisition Circuit 3 is adopted in real time
Collect the current potential on each channels flexible array electrode 1a and 1b, and be amplified and filter, is then sent to control system 5；
Step 203：In the course of surgery, control system 5 judges whether to damage by the spinal cord surface potential detected
Wound, judge damage occur standard for " flexible array electrode 1a and 1b any two channel measurement to surface potential difference be more than
Equal to 10mV ", if operation is well on, occurs without being damaged in art, pass directly to step 207；If finding ridge in operation
Marrow damages, and enters step 204；
Step 204：Control system 5 sends the signal of " damage occurs " to display equipment 7, and display equipment 7 sends out alarm, alert
Report can be audio alarm or screen flicker alarm；
Step 205：The start-up operation of damage reason location system 6, calculating damage position, including spinal cord axial position and spinal cord are transversal
Position on face, and this position coordinates is sent to control system 5, then display equipment 7 is sent to by control system 5, display is set
After standby 7 receive damage position information, damage position will be shown on pre-stored spinal MRI or CT images, will be gone out on screen
Existing " starting to stimulate " button, suggestion device operating personnel damage after emergency processing.
Step 206：Stimulating electrode 2c is attached to the injury region shown by screen by device operating personnel, then can click screen
On " starting to stimulate " button, demarcation potential compensation circuit 4 can be started and carry out extra electric field stimulation, while device operating personnel can
To carry out other emergency trouble shooting measures.
Step 207：Extra electric field is automatically stopped after handling 30 minutes, then decides whether hand according to original plan by doctor
Art returns to step 202 if "Yes", until original operation is completed, then arrives step 208.Step is directly entered if "No"
208。
Step 208：Stimulating electrode 2c and flexible array electrode 1a and 1b are taken out, and carries out operation round-off work.
Fig. 3 is device flexible array electrode principle figure of the present invention.
300 be the substrate of flexible array electrode, is polyimides or parylene film, substrate surface is uniform-distribution with
Array electrode, totally 3 rows 4 row totally 12 channel 301-312, can also use more port numbers, such as 4 rows 4 row, 4 rows 5 row, 6 rows
6 row etc..Electrode material is silver, silver chlorate, platinum or platinumiridio, and each channel electrode contact area is no more than 1 square millimeter, is in
Round, square or rectangular.Channel 310-312 links together, and can also synthesize the electrode contacts of channel 310-312
One rectangular electrode contacts.Conducting wire 313-325 draws the electrode contacts in each channel, is allowed to connect with external circuit.
Magnitude of the line width of conducting wire at tens microns, material are silver, platinum, platinumiridio, copper, aluminium or other metals.
Fig. 4 is device stimulating electrode structure chart of the present invention.As shown in figure 4, the substrate 401 of stimulating electrode 2c is polyamides
Imines or parylene film, substrate surface are stimulating electrode contact 402,402 material of electrode contacts be silver-colored silver chlorate, platinum or
Platinumiridio, contact area is in 1-10 square millimeters of ranges, rounded, square or rectangular.402 He of connection electrode contact
Magnitude of the line width of the conducting wire 403 of external circuit at tens microns, the material of conducting wire 403 be silver, platinum, platinumiridio, copper, aluminium or
Other metals.It is furnished with the stimulating electrode 2c of different contact areas per covering device, device operating personnel show according in display equipment 7
Damage position information selection with equal area, similar shape electrode contacts stimulating electrode 2c.
Fig. 5 is 5 functional block diagram of control system of the present invention.The input terminal of 18 voltage comparator 501-518 is controller
First input end, be connected to 18 Measurement channels of flexible array electrode 1a and 1b, for example voltage comparator 501-509's is defeated
Enter the channel 313-319 that end is connected to flexible array electrode 1a and 1b shown in Fig. 3.The output end of voltage comparator 501-518
It is connected to one or 537 output of input terminal or door 537 is connected to the first input end of computer 539, digital-to-analog
540 input terminal of converter is connected to the first output end of computer 539, and the output end of digital-analog convertor 540 is i.e. in order to control
First output end of system 5.The input terminal of 18 analogue-to-digital converters 519-536 is connected to 18 voltage comparator 501-
518 input terminal namely 18 Measurement channels of flexible array electrode 1a and 1b.18 of analogue-to-digital converters 519-536
Output end is connected to the input terminal of side and calculator 538, and the output end of side and calculator 538 is connected to computer 539
Second input terminal.The third input terminal 542 of computer 539 namely the third input terminal of control system 5 are connected to display equipment 7
Output end.4th input terminal 543 of computer 539 namely the second input terminal of control system 5, are connected to damage reason location system
The output end of system 6.The second output terminal 544 of computer 539 namely the second output terminal of control system 5, are connected to display equipment
7 input terminal.The thresholding of comparator 501-518 is 10mV, input be more than or equal to 10mV when output be high level, it is on the contrary then
For low level.Or as long as 18 input terminals of door 537, there are one high level, output is exactly high level, it is meant that spinal cord injury
Occur.The second output terminal of computer 539, namely control will be passed through after the high level that computer 539 detects or door 537 is sent out
The second output terminal of system 5 is sent to display equipment 7.4th input terminal 543 of computer 539 and the of control system 5
Two input terminals, reception be damage reason location system 6 output, then pass through the second output terminal of computer 539, namely control system
The second output terminal of system 5 is sent to display equipment 7.The third input terminal 542 of computer 539 and the third of control system 5
Input terminal, reception is to show the output end of equipment 7, namely " starting to treat " signal, and computer 526 will be to number after receiving signal
Word-converter 527 sends stimulation voltage value signal, 0~5V of range of signal.Hereafter, 18 road analogue-to-digital converters 519-536
The measurement voltage V1-V18 of two flexible array electrodes 1a and 1b are received, and is input to side and calculator 538, side and calculating
Device 538 calculates this 18 voltage values, obtains side and Vrms, Vrms=V12+V22+…+V182, then the value of Vrms is sent to meter
Calculation machine 539, computer 539 adjust the output voltage of number-converter 540, keep side and Vrms minimum.
Claims (9)
1. a kind of spinal cord intrtqoperative care device, it is characterized in that：The device includes two flexible array electrodes (1a, 1b), three
A stimulating electrode (2a, 2b, 2c), spinal cord surface potential Acquisition Circuit (3), demarcation potential compensation circuit (4), control system (5),
Damage reason location system (6) and display equipment (7)；Two flexible array electrodes (1a, 1b) are located at the head of exposed spinal cord (9)
Side and caudal, the first stimulating electrode (2a) are a part for the first flexible array electrode (1a), and the second stimulating electrode (2b) is the
A part for two flexible array electrodes (1b), the first stimulating electrode (2a) and the second stimulating electrode (2b) are located remotely from exposed ridge
The side of marrow (9), with whole device " " connect；There are two input terminal and two are defeated for spinal cord surface potential Acquisition Circuit (3)
Outlet, the first input end of spinal cord surface potential Acquisition Circuit (3) are connect with the first flexible array electrode (1a), and second is defeated
Enter end to connect with the second flexible array electrode (1b)；First output end of spinal cord surface potential Acquisition Circuit (3) and control
The first input end of system (5) connects, the second output terminal and damage reason location system (6) of spinal cord surface potential Acquisition Circuit (3)
Input terminal connection；There are three input terminal and two output ends, first input ends to be acquired with spinal cord surface potential for control system (5)
First output end of circuit (3) connects, the damage reason location system (6) of the second input terminal and spinal cord surface potential Acquisition Circuit (3)
Output end connection, third input terminal connect with the output end of display equipment (7), the first output end of control system (5) and damages
Hinder potential compensation circuit (4) connection, the second output terminal of control system (5) is connected with the input terminal of display equipment (7)；Damage electricity
The input terminal of bit compensation circuit (4) is connect with the first output end of control system (5), the output of demarcation potential compensation circuit (4)
End is connect with third stimulating electrode (2c).
2. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The first flexible array electrode (1a)
It is arranged in the rostral of exposed spinal cord (9), the second flexible array electrode (1b) is arranged in the caudal of spinal cord (9), is close to expose
Spinal cord (9), do not influence operating field；Each array electrode port number is no more than 33, wherein along last axial row of spinal cord, it is separate
The electrode in exposed spinal cord (9) direction be " ground electrode " with the device that is compensated for demarcation potential after spinal cord injury " " even
It connects, rest channels are with noting down；The base material of the flexible array electrode is Parylene or polyimides, and conductive material is
Silver, silver chlorate, platinum or platinumiridio, electrode contacts and solder joint area are less than 1 square millimeter, the connecting line of connection welding and contact
Width be tens microns of magnitude.
3. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The stimulating electrode (2c) is circular
Single channel membrane electrode is positive polarity, is attached to injury region surface, magnitude of the contact area at several square millimeters, with specific reference to
Depending on injury region size；Stimulating electrode is formed into a loop with " ground electrode " in the flexible array electrode of its both sides, thus
Injury region and it is normal between form DC electric field, direction of an electric field is directed toward " ground electrode " by stimulating electrode.
4. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The spinal cord surface potential Acquisition Circuit
(3) it is connect respectively with two flexible array electrod-arrays (1a, 1b), port number is the logical of two flexible array electrodes (1a, 1b)
The sum of road number；Each Channel front end of spinal cord surface potential Acquisition Circuit (3) is a DC voltage amplifier, by surface potential
Amplify and be filtered, then send the surface potential signal in all channels to control system (5) and damage reason location system
(6)。
5. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The damage reason location system prestores
There are patient's spinal cord magnetic resonance image or x-ray computed tomography images, and spinal cord is divided into substantia alba medullae spinalis, gray nucleus, brain
The region of these different conductivity of spinal fluid, endorchis, is distributed, damage reason location system utilizes electricity by the surface potential being recorded
The algorithm of magnetic field reverse temperature intensity calculates the position on damage position, including spinal cord axial position and spinal cord cross section, and will
This position coordinates is sent to control system (5).
6. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The demarcation potential compensation circuit (4)
It is made of voltage follower；The input terminal of demarcation potential compensation circuit (4) is connect with the first output end of control system (5), damage
The output end for hindering potential compensation circuit (4) is connected with stimulating electrode；Stimulated current is flowed out from stimulating electrode (2c) after spinal cord
Demarcation potential compensation circuit is flowed back by " ground electrode "；Control system (5) passes through the given stimulation of internal digital analog converter
Voltage, for adjusting the size of stimulation voltage.
7. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The ridge is controlled by the control system
Marrow intrtqoperative care device, there are three aspect functions for the control system：
(1) after receiving spinal cord surface signal, control system is according between the surface potential and " ground electrode " of each channel measurement
Potential difference come judge damage whether occur, criterion is that potential difference is big between any channel of flexible array electrode and ground electrode
In equal to 10mV；After damage occurs, control system will send the signal of " damage occur " to showing equipment (7)；
(2) the damage position information from damage reason location system (6) is received, display equipment (7) is then forwarded to；
(3) it is that demarcation potential compensation circuit (3) provides stimulus intensity signal, two flexible array electrodes (1a, 1b), spinal cord surfaces
Potential acquisition circuit (3), control system (5), cord potential compensation circuit (4) and stimulating electrode (2c) constitute the control system of closed loop
System changes the defeated of demarcation potential compensation circuit (4) by adjusting the digital-analog convertor output voltage in control system (5)
Go out voltage, and then change surface potential Acquisition Circuit (3) collected surface potential, makes side and the calculator in control system
Output reaches minimum value.
8. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The display equipment (7) and control system
(5) connection of uniting sends out alarm, another party after on the one hand showing " damage occurs " signal that equipment receives control system transmission
After face shows that equipment (7) receives damage position information, damage position will be shown on pre-stored spinal MRI or CT images
It sets, and the emergency processing after prompting medical staff to damage, stimulating electrode is attached to the injury region shown by screen, then point
" starting to stimulate " button on screen is hit, starts demarcation potential compensation circuit and carries out extra electric field treatment, while device operator
Member carries out other emergency trouble shooting measures.
9. spinal cord intrtqoperative care device described in accordance with the claim 1, it is characterized in that：The spinal cord intrtqoperative care device work
Process is as follows：
Two flexible array electrodes (1a, 1b) are started to work, and spinal cord surface potential Acquisition Circuit (3) acquires flexible array in real time
Current potential on electrode (1a) and each channel (1b), and be amplified and filter, it is then sent to control system (5)；In surgical procedure
In, control system (5) judges whether to damage by the spinal cord surface potential detected, judges that the standard that damage occurs is
" the surface potential difference that flexible array electrode (1a, 1b) any two channel measurement arrives is more than or equal to 10mV "；If do not had in operation
It is found spinal cord injury, then takes out two flexible array electrodes after operation, then carries out operation round-off work；If hand
Find that spinal cord injury, control system (5) send the signal of " damage occurs " to display equipment (7) in art, display equipment (7) is sent out
Alarm, damage reason location system (6) are started to work, and the position on damage position, including spinal cord axial position and spinal cord cross section is calculated
It sets, and this position coordinates is sent to control system (5), then display equipment (7) is sent to by control system (5), show equipment
(7) after receiving damage position information, damage position will be shown on pre-stored spinal MRI or CT images, on screen
" starting to stimulate " button, suggestion device operating personnel damage after emergency processing；Device operating personnel are by stimulating electrode
(2c) is attached to the injury region shown by screen, then can click " starting to stimulate " button on screen, starts demarcation potential compensation
Circuit (4) carries out extra electric field stimulation, while device operating personnel carry out other emergency trouble shooting measures；Extra electric field handles 30 points
It is automatically stopped after clock, then decides whether to perform the operation according to original plan by doctor, such as performed the operation, after the completion of operation, take according to original plan
Go out stimulating electrode and flexible array electrode, and carries out operation round-off work；If it is determined that not performing the operation according to original plan, stimulation is taken out
Electrode (2c) and flexible array electrode (1a, 1b), and carry out operation round-off work.
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| CN201610202680.4A CN105769169B (en) | 2016-04-01 | 2016-04-01 | A kind of spinal cord intrtqoperative care device |
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| CN201610202680.4A CN105769169B (en) | 2016-04-01 | 2016-04-01 | A kind of spinal cord intrtqoperative care device |
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| WO2018089950A1 (en) * | 2016-11-14 | 2018-05-17 | Safeop Surgical, Inc. | Systems and methods for placement of spinal cord stimulator leads |
| CN107261328B (en) * | 2017-04-28 | 2020-09-15 | 中国人民解放军第三军医大学第一附属医院 | Special external charging coupling device for spinal cord electrical stimulation |
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| CN102008292A (en) * | 2010-10-29 | 2011-04-13 | 中国人民解放军第二军医大学 | Intraoperative medulla spinalis monitoring system |
| CN102512757A (en) * | 2011-12-12 | 2012-06-27 | 中国科学院电工研究所 | Method and device for injury potential compensation after spinal cord injury |
| CN203524665U (en) * | 2013-10-16 | 2014-04-09 | 中国医学科学院生物医学工程研究所 | Spinal cord monitor |
| CN105030237A (en) * | 2015-07-17 | 2015-11-11 | 中国科学院电工研究所 | Spinal cord injury localization device |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US8328851B2 (en) * | 2005-07-28 | 2012-12-11 | Nuvasive, Inc. | Total disc replacement system and related methods |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102008292A (en) * | 2010-10-29 | 2011-04-13 | 中国人民解放军第二军医大学 | Intraoperative medulla spinalis monitoring system |
| CN102512757A (en) * | 2011-12-12 | 2012-06-27 | 中国科学院电工研究所 | Method and device for injury potential compensation after spinal cord injury |
| CN203524665U (en) * | 2013-10-16 | 2014-04-09 | 中国医学科学院生物医学工程研究所 | Spinal cord monitor |
| CN105030237A (en) * | 2015-07-17 | 2015-11-11 | 中国科学院电工研究所 | Spinal cord injury localization device |
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