多模式神经电生理监测在脊柱手术中的应用
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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[8]Owen JH.The application of intraoperative monitoring during surgery for spinal deformity[J].Spine(Phila Pa 1976),1999,24(24):2649-2662.
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[12]Macdonald DB.Intraoperative motor evoked potential monitoring:overview and update[J].J Clin Monit Comput,2006,20(5):347-377.
[13]Lo YL,Dan YF,Tan YE,et al.Intraoperative monitoring study of ipsilateral motor evoked potentials in scoliosis surgery[J].Eur Spine J,2006,15 Suppl 5:656-660.
[14]Accadbled F,Henry P,De Gauzy JS,et al.Spinal cord monitoring in scolinsis surgery using an epidural electrode.Results of a prospective,consecutive series of 191 cases[J].Spine(Phila Pa1976),2006,31(22):2614-2623.
[15]Sloan TB,Janik D,Jameson L.Multimodality monitoring of the centralnevous systemusing motor evokedpoten tials[J].Curr Opin Anaes thesiol,2008,21(5):560-564.
[16]Eggspuehler A,Sutter MA,Grob D,et al.Multimodal intraoperative monitoring(MIOM)during cervical spine surgical procedures in246 patients[J].Eur Spine J,2007,16 Suppl 2:S209-215.
[17]Malhotra NR,Shaffrey CI.Intraoperative electrophysiological monitoring in spine surgery[J].Spine(Phila Pa 1976),2010,35(25):2167-2179.
[2]Bunch WH,Chapman RG.Patient prefenrences in surgery for scoliosis[J].J Bone Joint Surg Am,1985,67(5):794-799.
[3]Kurita N,Kawaguchi M,Hoshida T,et al.The effects of sevoflurane and hyperventilation on electrocorticogram spike activity in patients with refractory epilepsy[J].Anesth Analg,2005,101(2):517-523.
[4]李群喜,乔慧,李建珉,等.七氟醚和异丙酚对上肢体感诱发电位的影响[J].临床神经电生理杂志,2007,16(4):199-203.
[5]白一冰,王岩,肖嵩华,等.脊髓型颈椎病JOA指数的客观和精确信度调查[J].中国临床康复,2005,9(2):11-13.
[6]Sala F,Palandri G,Basso E,et al.Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors:a historical control study[J].Neurosurgery,2006,58(6):1129-1143.
[7]Weinzierl MR,Reinacher P,Gilabach JM,et al.Combined motor and somatosensory evoked potentials for intraoperative monitoring:intraand postoperative data in a series of 69 operations[J].Neurosurg Rev,2007,30(2):109-116.
[8]Owen JH.The application of intraoperative monitoring during surgery for spinal deformity[J].Spine(Phila Pa 1976),1999,24(24):2649-2662.
[9]Macri S,De Monte A,Greggi T,et al.Intra-operative spinal cord monitoring in orthopaedics[J].Spinal Cord,2000,38(3):133-139.
[10]马薇薇,邱勇,王斌.下腰椎椎弓根螺钉置入时的神经根电生理监护[J].中华创伤杂志,2005,21(12):903-906.
[11]Jones SJ,Buonamassa S,Crockard HA.Two cases of quadriparesis following anterior cervical discectomy,with normal perioperative somatosensory evoked potentials[J].J Neurol Neurosurg Psychiatry,2003,74(2):273-276.
[12]Macdonald DB.Intraoperative motor evoked potential monitoring:overview and update[J].J Clin Monit Comput,2006,20(5):347-377.
[13]Lo YL,Dan YF,Tan YE,et al.Intraoperative monitoring study of ipsilateral motor evoked potentials in scoliosis surgery[J].Eur Spine J,2006,15 Suppl 5:656-660.
[14]Accadbled F,Henry P,De Gauzy JS,et al.Spinal cord monitoring in scolinsis surgery using an epidural electrode.Results of a prospective,consecutive series of 191 cases[J].Spine(Phila Pa1976),2006,31(22):2614-2623.
[15]Sloan TB,Janik D,Jameson L.Multimodality monitoring of the centralnevous systemusing motor evokedpoten tials[J].Curr Opin Anaes thesiol,2008,21(5):560-564.
[16]Eggspuehler A,Sutter MA,Grob D,et al.Multimodal intraoperative monitoring(MIOM)during cervical spine surgical procedures in246 patients[J].Eur Spine J,2007,16 Suppl 2:S209-215.
[17]Malhotra NR,Shaffrey CI.Intraoperative electrophysiological monitoring in spine surgery[J].Spine(Phila Pa 1976),2010,35(25):2167-2179.