SEP联合TES-MEP监测对脊柱手术患者手术成功率和安全性的影响
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摘要
目的探讨脊柱手术中经颅电刺激运动诱发电位(TES-MEP)和体感诱发电位(SEP)联合监测手术的成功率和安全性。方法选择2015年12月至2016年12月在我院进行脊柱手术的患者98例,根据术中监护方法分为观察组和对照组,每组49例。观察组术中采用SEP联合TES-MEP监测,对照组术中仅采用SEP监测。术中所有患者采用全静脉麻醉维持,持续观察并记录SEP及TES-MEP的波幅和潜伏期变化。将2组患者术中监测的结果及其与术后脊髓运动和感觉功能的符合情况和并发症发生情况进行比较和分析。结果术中观察组和对照组监测的成功检出率分别为100%和91.84%,差异有统计学意义(P<0.05);术中观察组判断脊髓运动功能的灵敏度、特异性和约登指数均明显高于对照组,差异有统计学意义(P<0.05);术中观察组判断感觉功能的灵敏度、特异性和约登指数均高于对照组,差异有统计学意义(P<0.05)。患者术后的并发症发生率,2组患者差异无统计学意义(P>0.05)。结论 SEP和TES-MEP联合监测脊柱手术中脊柱功能变化的灵敏度和特异性均高于单一使用SEP监测,能准确反映手术中脊柱的功能状态,为手术的进行提供了较好的参考。
Objective To investigate the success rate and safety of transcranial electrical stimulation motor evoked potentials( TESMEP) and somatosensory evoked potential( SEP) in the monitor of the spinal operation. Methods A total of 98 patients with spinal surgery in our hospital from December 2015 to December 2016 were selected and divided into observation group and control group according to the intraoperative monitoring method,49 cases in each group. SEP conbined with TES-MEP were used in the observation group,and SEP monitoring was used in the control group. Intravenous anesthesia was used in all patients to observe and record the amplitude and latency of SEP and TES-MEP. The results of the two groups were compared with those of the postoperative spinal motor and sensory function and the complications. Results The successful detection rate of the observation group and the control group were respectively 100% and 91. 84%,and the difference was statistically significant( P < 0. 05). The sensitivity,specificity and Youden index of the spinal cord movement were significantly higher in the observation group than those in the control group,the difference was not significant( P > 0. 05). In addition,the sensitivity,specificity and Youden index of the sensory function were higher than those in the control group,and the differences were statistically significant( P < 0. 05). There was no significant difference in postoperation complication between the two groups( P > 0. 05). Conclusion SEP combined with TES-MEP in monitoring function changes of the spine during spinal surgery on sensitivity and specificity are higher than the SEP monitoring,which can accurately reflect the function of the spine in the operation state,and provide a good reference for surgery.
Objective To investigate the success rate and safety of transcranial electrical stimulation motor evoked potentials( TESMEP) and somatosensory evoked potential( SEP) in the monitor of the spinal operation. Methods A total of 98 patients with spinal surgery in our hospital from December 2015 to December 2016 were selected and divided into observation group and control group according to the intraoperative monitoring method,49 cases in each group. SEP conbined with TES-MEP were used in the observation group,and SEP monitoring was used in the control group. Intravenous anesthesia was used in all patients to observe and record the amplitude and latency of SEP and TES-MEP. The results of the two groups were compared with those of the postoperative spinal motor and sensory function and the complications. Results The successful detection rate of the observation group and the control group were respectively 100% and 91. 84%,and the difference was statistically significant( P < 0. 05). The sensitivity,specificity and Youden index of the spinal cord movement were significantly higher in the observation group than those in the control group,the difference was not significant( P > 0. 05). In addition,the sensitivity,specificity and Youden index of the sensory function were higher than those in the control group,and the differences were statistically significant( P < 0. 05). There was no significant difference in postoperation complication between the two groups( P > 0. 05). Conclusion SEP combined with TES-MEP in monitoring function changes of the spine during spinal surgery on sensitivity and specificity are higher than the SEP monitoring,which can accurately reflect the function of the spine in the operation state,and provide a good reference for surgery.
引文
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[17]李永新,尹利荣,李燕莉,等.SEP、TES-MEP、EMG监测技术在胸椎结核患者行结核病灶清除及植骨内固定术中联合应用的价值[J].湖南师范大学学报(医学版),2017,14(3):118-122.
[18]陈艺,叶劲,林志雄,等.多模式神经电生理监测在椎管内占位手术中的应用[J].中国临床解剖学杂志,2017,35(3):331-335.doi:10.13418/j.issn.1001-165x.2017.03.020.
[19]Journée HL,Berends HI,Kruyt MC.The percentage of amplitude decrease warning criteria for transcranial MEP monitoring[J].J Clin Neurophysiol,2017,34(1):22-31.doi:10.1097/WNP.0000000000000338.
[20]曾景平,袁志峰,陈绪林.微创脊柱创伤手术治疗脊柱创伤的临床效果观察[J].中国当代医药,2017,24(22):87-89.
[21]黄萍,赵苏丽,太琼志,等.神经电生理监测技术在脊柱外科手术中的应用研究[J].临床医药文献杂志(电子版),2015,2(34):7093-7094.
[22]Huang S,Qi H,Liu J,et al.Alarm value of somatosensory evoked potential in idiopathic scoliosis surgery[J].World Neurosurg,2016,92:397-401.doi:10.1016/j.wneu.2016.05.054.
[23]Urban MK,Fields K,Donegan SW,et al.A randomized crossover study of the effects of lidocaine on motor-and sensory-evoked potentials during spinal surgery[J].Spine J,2017,17(12):1889-1896.doi:10.1016/j.spinee.2017.06.024.
[24]张涛,陶惠人,黄景辉,等.体感诱发电位监测在重度脊柱畸形后路全脊椎截骨术中的应用[J].实用骨科杂志,2015,21(4):297-300.doi:10.13795/j.cnki.sgkz.2015.04.003.
[25]边科砜,张赛,赵永青.神经电生理监测在脊髓损伤手术中的应用进展[J].天津医药,2017,45(8):841-845.doi:10.11958/20170659.
[2]Thirumala PD,Huang J,Thiagarajan K,et al.Diagnostic accuracy of combined multimodality somatosensory evoked potential and transcranial motor evoked potential intraoperative monitoring in patients with idiopathic scoliosis[J].Spine(Phila Pa 1976),2016,41(19):E1177-1184.doi:10.1097/BRS.0000000000001678.
[3]Ye J,Ma M,Xie Z,et al.Evaluation of the neural function of nonhuman primates with spinal cord injury using an evoked potential-based scoring system[J].Sci Rep,2016,6:33243.doi:10.1038/srep33243.
[4]Grover HJ,Thornton R,Lutchman LN,et al.Using transcranial magnetic stimulation to evaluate the motor pathways after an intraoperative spinal cord injury and to predict the recovery of intraoperative transcranial electrical motor evoked potentials:a case report[J].J Clin Neurophysiol,2016,33(3):e8-e11.doi:10.1097/WNP.0000000000000200.
[5]王剑火,陈勇忠,温建锋,等.神经电生理监测在颈椎病变手术中的应用[J].颈腰痛杂志,2017,38(1):93-94.
[6]Berends HI,Journée HL,Rácz I,et al.Multimodality intraoperative neuromonitoring in extreme lateral interbody fusion.Transcranial electrical stimulation as indispensable rearview[J].Eur Spine J,2016,25(5):1581-1586.doi:10.1007/s00586-015-4182-9.
[7]陈雨,李远,李红伟,等.神经电生理监测在脊髓脊柱手术中的应用[J].河南医学研究,2017,26(15):2739-2741.doi:10.3969/j.issn.1004-437X.2017.15.025.
[8]Thirumala PD,Crammond DJ,Loke YK,et al.Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction:a systematic review[J].J Neurosurg Spine,2017,26(3):374-383.doi:10.3171/2015.7.SPINE15466.
[9]Thirumala PD,Cheng HL,Loke YK,et al.Diagnostic accuracy of somatosensory evoked potential monitoring during scoliosis fusion[J].J Clin Neuroscience,2016,30:8-14.doi:10.1016/j.jocn.2016.01.017.Epub 2016 Mar 25.
[10]Legatt AD,Emerson RG,Epstein CM,et al.ACNS guideline:transcranial electrical stimulation motor evoked potential monitoring[J].J Clin Neurophysiol,2016,33(1):42-50.doi:10.1097/WNP.0000000000000253.
[11]Cohen J,Sestokas A,Tesdahl E,et al.Utilization rates of transcranial electric motor evoked potential(tce MEP)monitoring during extradural cervical,thoracic and lumbosacral spine surgery in large and small centers[J].Neurology,2016,86(16 Suppl):P6-267.
[12]邓必权,滕宇,胡华,等.TES-MEP和CSEP联合应用评价脊柱手术患者脊髓功能的临床价值[J].东南大学学报(医学版),2017,36(3):399-403.doi:10.3969/j.issn.1671-6264.2017.03.019.
[13]Abboud T,Huckhagel T,Stork JH,et al.Why does threshold level change in transcranial motor-evoked potentials during surgery for supratentorial lesions[J].J Neurosurg Anesthesiol,2017,29(4):393-399.doi:10.1097/ANA.0000000000000336.
[14]黄霖,赵敏,王鹏,等.脊柱手术中多模式神经电生理监测异常的原因分析及处理对策[J].中国脊柱脊髓杂志,2015,25(7):594-601.doi:10.3969/j.issn.1004-406X.2015.07.05.
[15]刘新宇,王芳,原所茂,等.皮层体感诱发电位及经颅电刺激运动诱发电位联合监护在脊柱畸形矫正术中的应用[J].中国脊柱脊髓杂志,2011,21(3):212-215.doi:10.3969/j.issn.1004-406X.2011.03.09.
[16]李晖,田江华,王晓平,等.SEP联合实时EMG在腰骶神经根术中监护的价值探讨[J].实用骨科杂志,2017,23(5):471-472.doi:10.13795/j.cnki.sgkz.2017.05.023.
[17]李永新,尹利荣,李燕莉,等.SEP、TES-MEP、EMG监测技术在胸椎结核患者行结核病灶清除及植骨内固定术中联合应用的价值[J].湖南师范大学学报(医学版),2017,14(3):118-122.
[18]陈艺,叶劲,林志雄,等.多模式神经电生理监测在椎管内占位手术中的应用[J].中国临床解剖学杂志,2017,35(3):331-335.doi:10.13418/j.issn.1001-165x.2017.03.020.
[19]Journée HL,Berends HI,Kruyt MC.The percentage of amplitude decrease warning criteria for transcranial MEP monitoring[J].J Clin Neurophysiol,2017,34(1):22-31.doi:10.1097/WNP.0000000000000338.
[20]曾景平,袁志峰,陈绪林.微创脊柱创伤手术治疗脊柱创伤的临床效果观察[J].中国当代医药,2017,24(22):87-89.
[21]黄萍,赵苏丽,太琼志,等.神经电生理监测技术在脊柱外科手术中的应用研究[J].临床医药文献杂志(电子版),2015,2(34):7093-7094.
[22]Huang S,Qi H,Liu J,et al.Alarm value of somatosensory evoked potential in idiopathic scoliosis surgery[J].World Neurosurg,2016,92:397-401.doi:10.1016/j.wneu.2016.05.054.
[23]Urban MK,Fields K,Donegan SW,et al.A randomized crossover study of the effects of lidocaine on motor-and sensory-evoked potentials during spinal surgery[J].Spine J,2017,17(12):1889-1896.doi:10.1016/j.spinee.2017.06.024.
[24]张涛,陶惠人,黄景辉,等.体感诱发电位监测在重度脊柱畸形后路全脊椎截骨术中的应用[J].实用骨科杂志,2015,21(4):297-300.doi:10.13795/j.cnki.sgkz.2015.04.003.
[25]边科砜,张赛,赵永青.神经电生理监测在脊髓损伤手术中的应用进展[J].天津医药,2017,45(8):841-845.doi:10.11958/20170659.