体感诱发电位和运动诱发电位联合监测在急性脊髓损伤椎管减压术中的应用  

The application of joint monitoring of the somatosensory evoked potential and motion evoked potential in the vertebral canal decompression surgery of acute spinal cord injury

作　　者：李群喜[1] 赵晓晶[1] 朱军[1] 张云鹤[1] 刘刚[1] 付爱军[1] 

机构地区：[1]河北联合大学附属医院神经外科,唐山063000

出　　处：《中华神经外科杂志》2014年第11期1120-1122,共3页Chinese Journal of Neurosurgery

摘　　要：目的 评价体感诱发电位（SEP）和运动诱发电位（MEP）术中联合监测急性脊髓损伤椎管减压术中神经功能损伤的意义.方法 选取24例急性脊髓损伤进行椎管减压手术的患者作为术中监测组,术中均应用SEP和MEP联合监测;并分别于术前及术后3个月进行脊髓神经功能McCormick评分.同时选取既往术前神经功能评分相同的24例作为对照组.结合监测数据对两组神经功能变化进行分析比较.结果 术中监测组椎管减压术后脊髓神经功能改善者10例,未见改变者12例,下降者2例.对照组脊髓神经功能改善者6例,未见改变者14例,下降者4例.术中监测组减压前、后SEP的P40潜伏期和波幅以及MEP的下肢拇展肌（AHB）潜伏期的改变趋势与脊髓神经功能的转归基本相一致.两组术后神经功能改善者的P40潜伏期、波幅、AHB潜伏期的差异均有统计学意义（P＜0.01）.两组脊髓神经功能未见改变者的P40潜伏期、波幅、AHB潜伏期的差异均无统计学意义（P＞0.05）.结论 急性脊髓损伤椎管减压术中采用SEP和MEP联合监测能及时反映脊髓功能的变化,术中电生理指标变化与术后患者神经功能改变的趋势相一致.Objective To evaluate the meaning of the application of joint monitoring of the somatosensory evoked potential（SEP） and motion evoked potential（MEP） in the vertebral canal decompression surgery of acute spinal cord injury.Methods Twenty-four cases of acute spinal cord injury who had been undergoing spinal canal decompression surgery were enrolled as the intraoperative monitoring group.The authors also evaluated and marked respectively spinal cord functional grade according the grading system presented by McCormick during preoperative and postoperative 3 months.Twenty-four cases of acute spinal cord injury who were given the same marks during usual preoperative,were selected as control group.According to monitoring data,the authors also analyzed nerve function changes by two groups of patients.Results In the intraoperative monitoring group,the postoperative spinal cord function of 10 cases has been improved; no change was observed in 12 cases; the function of 2 cases were declined.While,in control group,the spinal cord function in 6 cases has been improved; no change was observed in 14 cases; the function in 4 cases was declined.In the intraoperative monitoring group,the change trends of the P40 latency and amplitude of SEP and the larency of MEP of abductor hallucis brevis （AHB） before and after decompression surgery were basically consistent with the outcome of spinal nerve function in patients.As for P40 latency,amplitude and AHB latency of MEP in cases whose spinal cord function were improved after surgery,the differences between the two goups was statistically significant （P ＜ 0.01）.However,for P40 latency,arnplitude and AHB latency in cases with no change in spinal cord function,there was no statistically significant difference by comparing the two goups （P ＞ 0.05）.Conclusions In the vertebral canal decompression surgery after acute spinal cord injury,the application of joint monitoring can timely reflect the change of the spinal cord function.And also the intraoperative electrophysio

关 键 词：体感诱发电位 运动诱发电位 脊髓损伤 术中监测 

分 类 号：R651.2[医药卫生—外科学]