多种模式与单种模式神经电生理监测在重度颈椎后纵韧带骨化椎体次全切术中的对比研究  

Comparison of multi-mode and single-mode intraoperative neurophysiological monitoring in the treatment of severe ossification of the cervical posterior longitudinal ligament with anterior cervical corpectomy with fusion

作　　者：周琳[1] 张浩 张磊[1] 冯俊涛[1] 蔡雨卫 匡勇[1] ZHOU Lin;ZHANG Hao;ZHANG Lei;FENG Jun-tao;CAI Yu-wei;KUANG Yong(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院,上海200021 [2]上海中医药大学附属龙华医院,上海200032

出　　处：《中国骨伤》2019年第12期1102-1107,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨多种模式神经电生理监测与单种模式神经电生理监护在重度颈椎后纵韧带骨化椎体次全切钛网植骨内固定术中的应用对比。方法:2015年4月至2018年6月在上海中医药大学附属曙光医院骨科住院治疗的重度颈椎后纵韧带骨化患者32例,其中男21例,女11例;年龄45~73岁,中位数59岁;病程6~72个月,中位数39个月。主要表现为四肢麻木疼痛、无力,下肢脚踩棉花感,站立行走不稳,随着症状的逐渐加重出现四肢瘫痪、大小便障碍等,颈椎后纵韧带骨化患者进行多种模式的体感诱发电位、运动诱发电位和肌电图模式监测。结果:术中8例体感诱发电位波幅监测出现异常;其中5例为颈椎前路减压术中出血,放置止血棉过多,导致脊髓受压而出现体感诱发电位波形异常,及时去除止血棉后恢复正常;3例因收缩压下降导致体感诱发电位波形出现异常,由收缩压升高纠正。12例运动诱发电位监测波幅出现异常,9例因术中误触神经根引起,及时调整位置后恢复正常;3例因术中吸入肌松剂干扰引起。11例肌电图波形异常,其中9例经调整手术操作后能恢复正常波形,2例经短暂观察后自行恢复至正常,所有患者术后运动诱发电位波形好转(P<0.05)。术后2例出现脑脊液漏,术后7 d后自行愈合,术后所有患者未出现脊髓神经并发症。结论:在重度颈椎后纵韧带骨化行椎体次全切钛网植骨内固定术中进行多种模式神经电生理监测,可实时了解脊髓和神经功能状态,明显降低术中损伤脊髓、神经的发生率,有效提高手术的安全性。Objective:To compare the application of multi-mode and single-mode intraoperative neurophysiological monitoring in the treatment of severe ossification of posterior longitudinal ligament of cervical spine with anterior cervical corpectomy with fusion.Methods:From April 2015 to June 2018,32 patients with severe ossification of the posterior longitudinal ligament were treated in the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.There were 21 males and 11 females,aged 45 to 73 years old,with a mean age of 59 years old.The duration of the disease ranged from 6 to 72 months,with a mean of 39 months.The main manifestations were numbness,numbness and weakness of limbs,cotton feeling of foot stepping on lower limbs,instability of standing and walking.With the gradual aggravation of symptoms,quadriplegia,dysfunction of urine and defecation may occur.Patients with ossification of posterior longitudinal ligament of cervical spine were monitored by somatosensory evoked potentials,motor evoked potentials and electromyogram patterns.Results:During the operation,8 patients had abnormal amplitude of somatosensory evoked potential(SEP);5 of them had bleeding during anterior cervical decompression procedure and were placed with too much hemostatic cotton,which caused compression of spinal cord and resulted in abnormal SEP waveform.After removal of the hemostatic cotton,SEP waveform returned ot normal;3 patients had abnormal SEP waveform due to decreased systolic pressure,which was corrected by increased systolic pressure.Twelve patients had abnormal amplitude of motor evoked potential during monitoring,9 of which were caused by intraoperative mis-contact with nerve root,and turned to normal after timely adjustment of position,3 of which were caused by intraoperative inhalation of muscle relaxant during surgery.Among 11 patients with abnormal EMG waveform,9 patients recovered to normal waveform after adjusting operation,2 patients recovered to normal waveform after short observation,and all pat

关 键 词：颈椎 后纵韧带骨化 神经电生理监测 诱发电位 运动 肌电描记术 

分 类 号：R686[医药卫生—骨科学]