体感诱发电位监测在重度脊柱畸形后路全脊椎截骨术中的应用  

Application of Somatosensory Evoked Potential Monitoring in Posterior Vertebral Column Resection of Severe Spinal Deformities

作　　者：张涛[1,2] 陶惠人[1] 黄景辉[1] 李涛[1] 陈向波[1] 杨卫周[1] 刘明[1] 

机构地区：[1]第四军医大学西京医院骨科,陕西西安710032 [2]新疆生产建设兵团医院脊柱外科,新疆乌鲁木齐830002

出　　处：《实用骨科杂志》2015年第4期297-300,324,共5页Journal of Practical Orthopaedics

摘　　要：目的：探讨体感诱发电位（somatosensory evoked potential，SEP）在重度脊柱畸形后路全脊椎截骨术中的应用价值及影响因素。方法对2007年6月至2013年5月我院收治的97例行Ⅰ期后路全脊椎截骨治疗的重度脊柱畸形患者进行术中 SEP 监测，男性47例，女性50例，平均年龄（17.8±8.2）岁（6~46岁）。先天性脊柱畸形91例，强直性脊柱炎后凸畸形5例，结核后凸 1例。SEP 监测异常的标准为波幅下降大于50%和/或潜伏期延长大于10%。分析体感诱发电位波幅变化率与手术因素的相关性。结果本组患者中，12例患者出现术中 SEP 监测异常，其中10例患者术后出现神经并发症，2例为假阳性病例；1例患者术中 SEP 未见异常，术后出现神经并发症，为假阴性病例。本组资料中 SEP 监测敏感性达90.9%，特异性97.7%，假阳性率2.3%，假阴性率9.1%。手术时间、出血百分比、固定节段与术中 SEP 监测波幅的下降率存在直线相关（P =0.000，P =0.000，P =0.000），出血百分比影响最大。结论SEP 监测敏感性较高，但影响因素多、单独使用SEP 存在缺陷，因此需要合理的联合使用多种监测手段，并注意对各种干扰因素的分析、处理。Objective To study application value and influential factors of somatosensory evoked potential monitoring in posterior vertebral column resection of severe spinal deformities. Methods SEP monitoring in posterior vertebral column re-section of severe spinal deformities were performed in 9 7 cases . There were 4 7 males and 5 0 females ,The average age was 17. 8 years（range,6 ~ 46 years）. The pathogenetic diagnoses of spinal deformities were congenital in 91 cases,ankylosing spondylitis kyphosis in 5 cases,tuberculous kyphosis in 1 case. The abnormal criteria of SEP monitoring was defined as the de-cline of wave amplitude over 50% and/ or the elongation of latent period over 10% . To analysis the correlation between decline rate of SEP wave amplitude and operative factors. Results In all patients,12 cases had abnormal SEP,and of them,10 cases had developed a neurological complications,2 Cases were false positive. 1 case was false negative whom had normal SEP,but had developed a neurological complications after surgical. In this study,SEP monitoring had sensitivity of 90. 9% ,specificity of 97. 7% ,false positive rate of 2. 3% and false negative rate of 9. 1% . There were linear correlations between decline rate of SEP wave amplitude and operation time,blood loss,number of vertebrae fixed（P = 0. 000,P = 0. 000,P = 0. 000）,blood loss had most significant influence to SEP wave amplitude. Conclusion SEP monitoring is an sensitive method to detect the func-tion of spinal cord,but there are many influencing factors. Independent employment of SEP monitority has its own flaw. There-fore,we need to reasonable use a variety of monitoring methods during surgical,and analysis influential factors.

关 键 词：重度 脊柱畸形 后路全脊椎截骨 体感诱发电位 

分 类 号：R682.13[医药卫生—骨科学]