脊髓型颈椎病前、后路手术中经颅电刺激运动诱发电位与皮层体感诱发电位的联合监护作用  

Efficacy of combined monitoring with TES-MEP and CSEP during anterior or posterior surgery for cervical spondylitic myelopathy

作　　者：陈裕光[1] 彭新生[1] 郑召民[1] 万勇[1] 杨军林[1] 陈立言[1] 李佛保[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,510080

出　　处：《中华创伤杂志》2011年第6期497-500,共4页Chinese Journal of Trauma

摘　　要：目的探讨脊髓型颈椎病（ cervical Spondylitic myelopathy, CSM ）手术中经颅电刺激运动诱发电位（transcranial electrical stimulation motor evoked potential, TES- MEP）和皮层体感诱发电位（cortical somatosensory evoked potential, CSEP）联合监测脊髓功能的临床应用价值。方法选自CSM手术中同时记录双侧胫前肌、足底躅短屈肌、鱼际肌的TES—MEP和双侧胫后神经和尺神经的CSEP共135例。根据TES—MEP、CSEP和联合监护结果与术后脊髓运动和感觉功能的比较，进行相关的统计学分析。结果术中TES—MEP、CSEP、联合监护的成功检出率分别为87．4％、97．8％和100％。因手术操作引起诱发电位阳性共9例占6．7％。TES—MEP、CSEP判断脊髓运动功能的灵敏度分别为100％和83．3％，而判断脊髓感觉功能的灵敏度分别为77．8％和100％；联合监护的灵敏度和特异度均100％。结论联合监护的成功检出率和准确性明显高于单一方法监护；手术操作引起诱发电位阳性的原因包括：前路椎管内的彻底减压、恢复椎间隙高度和生理弯曲的椎间植骨块或钛网植骨、合并后纵韧带骨化症的后路电磨椎板开槽，以及后路转前路手术时引流管不通的血肿压迫等。Objective To evaluate of the efficacy of transcranial electrical stimulation motor evoked potential （TES-MEP） in combination with cortical somatosensory evoked potential （CSEP） monitoring during the anterior or posterior approach spinal surgery for cervical spondylitic myelopathy （CSM）. Methods TES-MEP on the bilateral anterior tibial muscle and flexor hallucal brevis and thenar muscles and CSEP on the bilateral posterior tibial nerve and ulnar nerve were observed simultaneously in 135 patients during spinal surgery. Intravenous anesthesia was employed in all the patients. The results of TES-MEP, CSEP and combined monitoring were analyzed statistically. Pre-operative and post-operative motor and sensory functions of the spinal cord were compared. Result Success rate of TES-MEP, CSEP and the combined monitoring was 87.4% , 97.8% and 100% , respectively. Out of 135 patients, nine patients （6.7%） were detected with the positive evoked potentials due to surgical operation. The sensitivity of TES-MEP and CSEP in assessing the spinal cord motor function was 100% and 83.3% , respectively, while that in assessing the spinal cord sensory function was 77.8% and 100% , respectively. The sensitivity and specificity of the combined monitoring was both 100%. Conclusion The successful detection rate and accuracy of the combined monitoring for spinal cord function are apparently higher than that of simple TES-MEP or CSEP. The causes for operative maneuvers evoking a positive evoked potential include complete anterior decompression of the spinal canal, intervertebral bone graft, laminoplasty for OPLL and hematoma compression caused by a failed drainage in a posterior-anterior approach surgery.

关 键 词：颈椎病 脊髓型 电刺激 诱发电位 运动 诱发电位 体感觉 联合监护 

分 类 号：R686[医药卫生—骨科学]