术中神经电生理监测在颈椎管内肿瘤手术中的应用  

Application of intraoperative neurophysiological monitoring in cervical intraspinal tumor surgery

作　　者：马泓[1] 王冰[1] 吕国华[1] 阳湘安 

机构地区：[1]中南大学湘雅二医院脊柱外科,长沙410000 [2]广东三九脑科医院,广州510000

出　　处：《中华骨科杂志》2016年第24期1574-1580,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨术中神经电生理监测应用于颈椎管内肿瘤手术的临床意义。方法2010年至2014年颈椎管内肿瘤手术患者46例，23例应用术中神经电生理监测（intraoperativeneumphysi010gicalmonitoring，IONM），为监测组；23例未应用IONM监测（对照组），对两组患者的一般临床资料、手术资料、神经功能改善情况进行比较，分析术中神经电生理监测在预测患者术后神经功能中的作用。结果监测组和对照组在年龄、性别、术前神经功能的差异均无统计学意义。监测组平均手术时间（180．0±36.3）min，短于对照组平均手术时间（225．5±43．6）min，差异有统计学意义，监测组平均术中出血量（423．3±158．5）ml，少于对照组平均术中出血量（587．2±210．5）ml，差异有统计学意义。术前监测组日本骨科协会（JapaneseOrthopaedicAssociationScores，JOA）评分平均为（12．0±2．4）分，对照组为（12．7±2．1）分，差异无统计学意义；术后监测组平均JOA评分为（15．0±1．5）分，对照组为（15．2±1．7）分，差异无统计学意义；监测组颈髓功能改善率（59．2％）高于对照组（54．6％），但差异无统计学意义。监测组中8例患者术中出现阳性报警，1例术后发现脊髓功能损伤，SEP的敏感性为100％，特异性为77．3％；MEP的敏感性为100％，特异性为86．4％。4例患者术中切除肿瘤后SEP波幅有明显上升（较手术开始时提高40％以上），2例有一定程度上升（15％-40％），术后神经功能均获得改善，占所有神经功能得到改善的患者（9例）的66．7％。结论对于颈椎管内肿瘤患者，IONM监测可以减少手术时间和手术出血量，且对患者术后的神经功能具有较好的预测价值。Objective To investigate the efficiency of intraoperative neurophysiological monitoring in cervical spinal tu- mor surgery. Methods Retrospective case-control study comparing 23 cervical spinal tumor patients received surgery under neu- rophysiological monitoring （case） and 23 cases without neurophysiological monitoring （control）. Results All of 46 cases, there were no significant differences of age, gender and preoperative neurological function. Duration of operation and estimated blood loss in the IONM cohort was less than the control group with significant difference. The preoperative JOA score of IONM group and control group were 12.0±2.4 and 12.7±2.1, with no significant difference. The postoperative JOA score of each group were 15.0±1.5 and 15.2±1.7, with no significant difference. The rate of cervical cord neurological improvement of IONM group was high- er than control group, but there was no significant difference. In the IONM cohort, abnormal signal appeared in 8 cases, with 1 case developed new postoperative deficit, and the sensitivity and specificity of SEP were 100% and 77.3%, the sensitivity and specificity of MEP were 100% and 86.4%. Compared with preoperative SEP, 4 cases showed major improvement （baseline in- crease 〉 40%）, 2 cases showed moderate improvement （baseline increase： 15%-40%）. The coincidence rate of the SEP improve- ment and the AISA grade was 66.7%. Conclusion IONM could reduce the duration of operation and intraoperative blood loss. Changes of IONM were correlated with postoperative neurological function improvement.

关 键 词：颈椎 肿瘤 诱发电位 躯体感觉 诱发电位 运动 肌电描记术 

分 类 号：R739.4[医药卫生—肿瘤]