皮层体感诱发电位在脊柱脊髓疾患中的临床应用  

Clinical Applications of CSEP in Spinal Disorders

作　　者：丁宇[1] 阮狄克[1] 陈波[1] 冀桂珍[1] 

机构地区：[1]海军总医院骨科,北京100037

出　　处：《海军总医院学报》2002年第2期75-78,共4页Journal of Naval General Hospital of PLA

摘　　要：目的　了解皮层体感诱发电位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 ,行皮层体感诱发电位术前检查、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　 (1)皮层体感诱发电位Ⅰ型表现者全部为FrankeA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。 (2 )Ⅰ～Ⅳ型皮层体感诱发电位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”时最易引发皮层体感诱发电位变化。 (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　皮层体感诱发电位与Frankel分级、临床疗效有良好的相关性 ;皮层体感诱发电位灵敏度高 ,可及时反映出脊髓功能的变化 ,提高了脊髓手术的安全性 ;皮层体感诱发电位术中监测标准具有一定弹性 ,常因病情、部位及操作不同而变化。Objective To evaluate CSEP in the diagnoses and treatments of spinal disorders.Methods Frankel grades were carried out to judge the condition of spinal cords in 120 patients. Preoperative examinations, intraoperative monitoring of CSEP and postoperative assessment of outcomes were performed. In addition, the results using various criterions in intraoperative monitoring of CSEP were analyzed.Results (1) The patients with type I (CSEP) were all those whose paraparetic grade was Frankel A. And the patients with type Ⅱ mainly consisted of grade B and C, type Ⅲ were grade C and D, type Ⅳ wre grade D and E. (2) The patients with type Ⅰ to Ⅳ also had the different outcomes which were 0?54.2%?82.8%?84.2%. (3) While CSEP 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 criterions Ⅰ and Ⅱ in 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%) are different.Conclusion CSEP has good relations with Frankel grades and outcomes. Besides, it has a satisfied sensitivity which could reflect the changes of spinal function instantly and increase the safety of surgeries. Th criterion of CSEP in monitoring has some variant which may change according to various conditions like pathology, position 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：R741.044[医药卫生—神经病学与精神病学] R74[医药卫生—临床医学]