摘要
目的探讨多模式神经电生理监测在脊柱手术中评估脊髓神经根功能的价值。方法回顾性分析自2014-06-2016-06完成的116例脊柱手术,术中所有患者均进行多模式神经电生理监测,即体感诱发电位(SEP)、运动诱发电位(MEP)、肌电图(EMG)联合监测。结果术中有21例达到报警标准,一过性电生理改变18例,永久性电生理改变3例。术后3例出现脊髓功能损伤加重,2例术中为一过性改变,1例为永久性改变。6例出现神经根损伤,3例术中为一过性改变,2例为永久性改变(1例为咬骨钳误伤,1例为椎弓根钉误伤),1例为假阴性。随访12个月后,1例脊髓功能及2例神经功能永久性损伤。多模式神经电生理监测中出现永久性预警改变的对脊髓及神经根功能近期及远期阳性预测值为100%,对脊髓及神经根功能阴性预测值为98.9%。结论多模式神经电生理监测在脊柱手术中能及时发现脊髓及神经根损伤,有利于术者及时调整手术进度及方案,最大限度保护脊髓神经功能。
引文
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