神经电生理监测技术在胸椎骨折椎弓根螺钉置入中的应用  

Application of Intraoperative Neurophysiological Monitoring in the Placement of Pedicle Screws in Thoracic Fracture Surgery

作　　者：戴小青 荣国强[1] Dai Xiaoqing;Rong Guoqiang(Department of Orthopedics,Fifth Hospital of Changshu,Changshu 215500,China)

机构地区：[1]常熟市第五人民医院骨科,江苏常熟215500

出　　处：《实用骨科杂志》2018年第4期324-327,384,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨术中神经电生理监测(intraoperative neurophysiological monitoring,IONM)在胸椎手术椎弓根螺钉置入中的应用价值。方法 2015年2月至2017年2月,共18例患者因胸椎骨折在我院行内固定手术治疗,其中男16例,女2例,平均年龄(32.6±12.3)岁;Frankel分级:A级1例,B级2例,C级6例,D级8例,E级1例。术前和术后1周检测18例患者的体感诱发电位(somatosensory evoked potentials,SEP),术中均行SEP和运动诱发电位(motor evoked potentials,MEP)检测胸椎椎弓根螺钉的置入。术后行CT扫描评估置钉精确性。结果平均手术时间(167±36)min,平均出血(423±141)mL。术前局部后凸Cobb角平均(31.2±5.7)°,术后矫正至(10.6±4.9)°。在置入的144枚螺钉中,其中86枚(59.7%)螺钉在置入过程中SEP和MEP未见明显波动,40枚(27.8%)螺钉置入过程中可见SEP和MEP监测变化,但未达到报警标准,其余18枚(12.5%)螺钉在置钉过程中SEP和MEP改变均达到报警标准。术后CT扫描显示置钉满意率为93.1%,穿孔率为6.9%。患者术后1周SEP监测结果较术前显著改善。本组病例术中术后无一例神经症状加重。结论 SEP和MEP监测在胸椎椎弓根螺钉置钉过程中可早期发现可能的神经系统损伤,及时停止正在进行的操作,最大限度降低神经系统损伤程度,改善患者预后。Objective To explore the values of intraoperative neurophysiological monitoring(IONM)in the placement of thoracic pedicle screws in thoracic fracture surgery.Methods From February 2015 to December 2016,a total of 18 patients suffering from thoracic fracture underwent posterior instrumentation and fusion in our hospital.They were 16 males and 2 females,with an average age of(32.6±12.3)years.Preoperative spinal cord function was graded by Frankel criteria.There were 1 case of grade A,2 cases of grade B,6 cases of grade C,8 cases of grade D and 1 case of grade E.Somatosensory evoked potentials(SEP)were tested before and 1 week after surgery.Pedicle screws were inserted under the monitoring of SEP and motor evoked potentials(MEP).The accuracy of pedicle screw placement was assessed according to postoperative CT scans.Results The average operation time was(167±36)min and intraoperative blood loss(EBL)was(423±141)mL.The Cobb angle of segmental kyphosis was corrected from(31.2±5.7)°to(10.6±4.9)°after surgery.A total of 144 screws were inserted in the 18 patients.No significant changes of SEP and MEP were observed in the placement of 86 screws(59.7%).Changes were detected but did not reach the alarm level in 40 screws(27.8%).Changes of 18 screws(12.5%)reached the alarm level.According to CT evaluation,the satisfactory rate of pedicle screw placement was 93.1%,while the perforation rate was 6.9%.The results of SEP evaluation were improved significantly 1 week after surgery.No neurologic0x0E0xFF0xF00xFF倓0x030x0Fdeterioration was found during and after surgery.Conclusion SEP and MEP monitoring can early detect the possible neurologic injury during the placement of thoracic pedicle screws.Neurologic defect could be reduced,if the operation is stopped when the monitoring reaches the alarm level.

关 键 词：体感诱发电位 运动诱发电位 椎弓根螺钉 胸椎骨折 

分 类 号：R683.2[医药卫生—骨科学]