下传神经源性诱发电位在重度脊柱畸形矫形手术中的应用  

Application of descending neurogenic evoked potentials monitoring during spinal deformity surgery

作　　者：隋文渊[1] 杨军林[1] 邓耀龙[1] 黄紫房[1] 杨靖凡[1] 王其飞[1] 范恒伟[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510080

出　　处：《中华骨科杂志》2016年第24期1560-1567,共8页Chinese Journal of Orthopaedics

基　　金：【基金项目】中山大学临床研究5010项目（2012003）;广东省科技计划项目（20148020212021）;广州市科技计划项目（201508020031）

摘　　要：目的探讨下传神经源性诱发电位（descendingneurogenicevokedpotentials，DNEP）在重度脊柱畸形截骨矫形术中的安全性和有效性。方法回顾性分析2010年7月至2013年8月接受手术治疗的108例重度脊柱畸形患者（侧凸或后凸Cobb角≥90°）术中电生理监护资料，男43例，女65例；年龄12-50岁，平均（17．5±5．8）岁。所有患者术前均无脊髓神经功能障碍，术前MR检查均显示脊髓发育无异常。脊髓矫形手术中采用体感诱发电位（SOmatosensoryevokedDoten．tials，SEP）、运动诱发电位（motorevokedpotentials，MEP）及DNEP的联合监护模式。分别计算SEP＋MEP和SEP＋MEP＋DNEP监护的敏感性和特异性。结果108例患者均获得满意的手术矫形效果，术后随访时间24~52个月，平均38．6个月。术中电生理监护无假阴性发生，出现监测阳性事件15例（13．9％，15／108），真阳性9例（60％，9／15）、假阳性6例（40％，6／15）。2例在随访期间表现为持久性神经功能障碍，即术后末次随访时神经功能障碍较术后即刻无改善；3例出现术后短暂性神经功能障碍，即在术后6个月内神经功能障碍完全恢复。DNEP在5例术后神经功能障碍患者中均出现阳性报警，包括2例术后表现为持久性神经功能障碍（双下肢运动、感觉完全丧失，感觉平面位于腹股沟区，在末次随访时神经功能较术后无改善），3例表现为短暂性神经功能障碍（2例术后髂腰肌和股四头肌肌力下降合并股前区麻木，均在术后3月恢复正常；1例为术后股神经支配区麻木，术后6个月恢复正常）。SEP＋MEP和SEP＋MEP＋DNEP监护的敏感性和特异性分别为100％、97．98％和100％和98．99％。结论多模式诱发电位监护在重度脊柱畸形矫形术中可有效地预防术后神经系统并发症。DNEP监护在脊柱畸形矫形术中无假阴性发生，具有较高的敏感性和特异性，是一种安全、Objective To elevate the efficacy and safety of descending neurogenic evoked potentials （DNEP） monitoring during severe rigid spinal deformity surgery. Methods All of 108 patients （43 males, 65 females） who underwent surgical treat- ment for spinal deformity in our spinal center from July 2010 to August 2013 were retrospectively reviewed. The average age （17.5± 5.8） ys（range 12-50 ys）, the average following period is 38.6 months（range 24-52 months）. Combined monitoring of SEP, MEP and DNEP model were used during surgery. All subjects with no neurological deficits preoperatively and got satisfied outcomes. Re- spectively evaluate the results of neurophysiological intraoperative monitoring （IOM）. Data were collected to elevate the efficacy and safety of DNEP monitoring. Results All of 108 patients, 15 patients （13.9%, 15/108） showed significant changes of neuro- physiological parameters, of which 9 cases （60%, 9/15） were identified as true positive and 6 cases （40%, 6/15） were identified as false positive. During the following-up period, 2 patients developed permanent neurological deficit, and 3 patients showed tran- sient neurological deficit who got fully recovered within 6 months after operation. DNEP showed alert in all 5 patients with true- positive alarm, of which 2 patients developed permanent neurological dysfunction and 3 cases showed postoperative short nerve dysfunction that got fully recovery within 6 months after operation. The sensitivity and specificity of SEP＋MEP and DNEP were 100% and 97.98%, 100% and 98.99%, respectively. Conclusion Combining use of MEP＋SEP＋DNEP monitoring during surgi- cal treatment of spinal deformities presented to be a highly reliable method for the detection and prevention of iatrogenic injury. The results confirmed a high efficacy and safety of DNEP monitoring during spinal surgery.

关 键 词：脊柱弯曲 截骨术 诱发电位 躯体感觉 诱发电位 运动 

分 类 号：R687.3[医药卫生—骨科学]