皮层体感诱发电位在脊柱脊髓疾患诊治中的应用  

Applications of cortical somatosensory evoked potentials in the diagnosis and treatment of spinal disorders

作　　者：丁宇[1] 阮狄克[2] 陈波[2] 冀桂珍[2] 

机构地区：[1]第二军医大学99级研究生队 [2]海军总医院骨科,北京100037

出　　处：《临床骨科杂志》2002年第1期20-23,共4页Journal of Clinical Orthopaedics

摘　　要：目的　评价皮层体感诱发电位 (CSEP)在脊柱脊髓疾患诊治中的临床应用价值。方法　 12 0例患者用Frankel分级判断脊髓功能 ,行CSEP术前检查、术中监护以及术后疗效评估 ,并分析应用不同标准的监测结果。结果　①CSEPⅠ型表现者全部为FrankelA级 ;Ⅱ型主要为B、C级 ;Ⅲ型主要为C、D级 ;Ⅳ型主要为D、E级。②Ⅰ Ⅳ型CSEP表现者临床疗效分别为 0、5 4 2 %、82 8%、84 2 %。③行椎体肿瘤切除、椎管内肿瘤切除、脊柱侧凸凹侧撑开及颈椎后路“单开门”时最易引发CSEP变化。④应用不同标准行术中监测灵敏度均为 10 0 % ,特异度分别为 85 6 %、93 3% ,误诊率分别为14 4 %、6 7% ,漏诊率均为 0。结论　CSEP与Frankel分级、临床疗效有良好的相关性 ;CSEP灵敏度高 ,可及时反映出脊髓功能的变化 ,提高脊髓手术的安全性 ;CSEP术中监测标准具有一定弹性 ,常因病情。Objective To evaluate the value of cortical somatosensory evoked potentials (CSEP) in the diagnosis and treatment of spinal disorders. Methods Frankel grades were used to judge the function of spinal cords in 120 patients. Preoperative examinations, intraoperative monitoring and postoperative assessment of outcomes were performed. In addition, the results were analyzed using various criteria in intraoperative monitoring of CSEP. Results ① The patients with(CSEP) type Ⅰ were ones with Frankel A in paraparetic grade. And the patients with type Ⅱ were mainly consisted of grade B and C, type Ⅲ were grade C and D, and type Ⅳ were grade D and E. ② The patients with type Ⅰ to Ⅳ also had the different outcomes with 0,54 2%,82 8%,84 2% improvement. ③ While monitoring, the changes of CSEP were easily induced by the operations like resection of spinal tumor, correction of scoliosis or laminectomy for cervical spondylotic myelopathy. ④ Both the results using criteriaⅠand Ⅱin operative monitoring had the same sensitivity(100%) and omission diagnostic rate(0), but the specificity(85 6%,93 3%) and mistake diagnostic rate(14 4%,6 7%) were different. Conclusion CSEP has good relations with Frankel grades and outcomes. Besides, it has a satisfied sensitivity which reflects the changes of spinal cord function instantly and increases the safety of surgery. The criterion of CSEP in monitoring should be changed according to various conditions like pathology, posture of the patient or operative techniques.

关 键 词：脊柱疾病 脊髓疾病 诱发电位 躯体感觉 

分 类 号：R681.5[医药卫生—骨科学] R744[医药卫生—外科学]