SSEP、MEP和DNEP在重度脊柱畸形截骨矫形术中同时联合监测的意义  

Significance of simultaneous monitoring of SSEP,MEP and DNEP in severe spinal deformity correction

作　　者：杨军林[1] 黄紫房[1] 邓耀龙[1] 李佛保[1] 舒海华[2] 陈裕光[1] 魏明[2] 刘卫锋[2] 孙新锐[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广东510080 [2]中山大学附属第一医院麻醉科

出　　处：《脊柱外科杂志》2011年第6期323-326,共4页Journal of Spinal Surgery

摘　　要：目的探讨在重度脊柱畸形截骨矫形术中,体感诱发电位(somatosensory evoked potential,SSEP)、运动诱发电位(motor evoked potential,MEP)和下传神经源性诱发电位(descending neurogenic evoked potential,DNEP)同时联合监测的安全性和准确性。方法回顾性分析2010年8月～2011年7月采用3种诱发电位同时联合监测的重度脊柱畸形截骨矫形患者16例,所有患者均在全静脉麻醉并小剂量肌松剂泵注维持下行脊柱畸形截骨矫形术,术中均行SSEP、MEP和DNEP同时联合监测。结果 16例患者术中出现3种诱发电位皆阳性5例,唤醒试验也为阳性,术后均出现不同程度的神经并发症。单纯MEP阳性,而SSEP、DNEP正常者4例,术中唤醒试验均为阴性,术后无异常神经体征。单纯SSEP阳性,而MEP、DNEP正常者1例,术中唤醒阴性,术后查体正常。另外6例术中SSEP、MEP和DNEP皆正常,但其中1例考虑因神经根牵拉出现术后一过性股四头肌肌力下降,余5例术后查体均正常。结论术中DNEP与SSEP、MEP同时联合监测可减少传统SSEP和MEP监测产生假阳性对手术的干扰,对重度脊柱畸形截骨矫形术中脊髓损伤监测具有较好的敏感性和准确性,术中如有2种及以上诱发电位异常则出现脊髓损伤的可能性增大。Objective To evaluate the safety and accuracy of simultaneous monitoring of somatosensory evoked potential（SSEP）,motor evoked potential（MEP） and descending neurogenic evoked potential（DNEP） in severe spinal deformity correction.Methods A retrospective study was performed in 16 severe spinal deformity patients who were corrected by spinal osteotomy from August 2010 to July 2011.Total intravenous anesthesia combined with small doses of muscle relaxants were used in operation.Simultaneous monitoring of SSEP,MEP and DNEP was performed.Results There were 5 of 16 cases appeared positive for all 3 evoked potentials during the combined simultaneous monitoring,intra-operative wake-up tests were positive and had neural complications after operation.Four cases had positive finding in MEP,with normal SSEP and DNEP,negative intra-operative wake-up test,and normal neural function post-operatively.One case was positive in SSEP,with normal MEP and DNEP,negative intra-operative wake-up test,and normal neural function postoperatively.The rest 6 cases showed normal finding in 3 evoked potentials,1 showing temporary quadriceps weakness after operation,while the other 5 showing no other complications.Conclusion Intra-operative simultaneous monitoring of SSEP,MEP and DNEP can decrease the false positive results by SSEP and MEP monitoring,and improve the sensitivity and accuracy in severe spinal deformity correction.Abnormity in 2 or 3 evoked potentials indicates possible spinal cord injury.

关 键 词：脊柱侧凸 脊柱后凸 截骨术 诱发电位 监测 手术中 

分 类 号：R682.3[医药卫生—骨科学]