体感诱发电位在Chiari畸形合并脊髓空洞症手术后脊髓功能恢复中的作用  

Effect of SEP in functional recovery of spinal cord of microsurgery for Chiari malformation combined with syringomyelia

作　　者：张云东[1] 周济[1] 刘迎春[1] 李兵[1] 张溢华[1] 杨华江[1] 王昊[1] 顾小红[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所神经外科,重庆400042

出　　处：《重庆医学》2013年第3期287-288,291,共3页Chongqing medicine

基　　金：第三军医大学大坪医院临床研究项目(007XG071)

摘　　要：目的探讨体感诱发电位(SEP)在评价后颅窝减压手术治疗小脑扁桃体下疝(Chiari畸形)合并脊髓空洞症后脊髓功能恢复中的作用。方法采用回顾性分析,对该院1997年6月至2011年1月收治的132例Chiari畸形合并脊髓空洞症行后颅窝减压手术治疗的患者近期及远期疗效进行分析。观察患者术前、术后的症状、体征、脊髓空洞及SEP的变化。结果术前132例患者SEP检测均有异常。术后早期,118例临床体征改善的患者中,112例SEP好转;体征稳定的14例中,12例的SEP好转;术后随访6个月至11年,123例体征改善的患者中,121例SEP好转;而体征稳定的7例患者中,6例的SEP好转;2例临床体征加重患者,SPE异常更明显。108例脊髓空洞较术前缩小的患者中,106例患者的SEP也好转;而脊髓空洞无变化的19例患者中,13例的SEP好转;2例脊髓空洞增加的患者,SPE异常更明显。术前、术后SEP的变化与患者症状和脊髓空洞的变化呈正相关(r=0.854、0.747,P<0.01)。结论 SEP可作为Chiari畸形伴脊髓空洞症后颅窝减压手术后评定手术效果及判定脊髓功能恢复相对客观的指标。Objective To investigate the effect of somatosensory evoked potential（SEP） in functional recovery of spinal cord of microsurgery for Chiari malformation combined with syringomyelia.Methods A total of 132 patients with Chiari malformation combined with syringomyelia who underwent the procedure from June 1997 to January 2011 were studied.We presented retrospective analysis to analyze the effect of posterior fossa decompression on short-term and long-term changes of symptoms,clinical signs,the size and location of the cavity,SEP,pre-and post operation.Results SEP was completely abnormal before posterior fossa decompression.In the early period of post-operation,118 patients experienced an clinical signs improvement including 112 with an improvement in SEP.In 14 patients with no alterations of clinical signs,12 had an improvement in SEP;in the 6 months to 11 years′ follow-up period,In 123 cases experienced an clinical signs improved,SEP was improved in 121 patients and 6 cases with SEP improved were found in 7 patients with no alterations of clinical signs respectively.The abnormality of SEP was obvious in 2 patients with clinical signs deterioration.108 of these patients had a decrease in the cavity size,including 106 with SEP improvement.13 cases with SEP improved in 19 patients who had no alterations of the cavity size respectively.SEP was abnormal obviously in 2 patients who had increase in cavity size.The change of SEP before and operation had a positive correlation with clinical signs and cavity size（r=0.854,0.747,P〈0.01）.Conclusion SEP is an effective and sensitive method to evaluate the effect of surgical treatment and the recovery of spinal cord function after posterior fossa decompression.

关 键 词：CHIARI畸形 脊髓空洞症 脊髓功能 体感诱发电位 

分 类 号：R651.1[医药卫生—外科学]