联合IONM对脊髓型颈椎病ACDF术中神经功能损伤的预测效能及影响因素分析  

Analysis of the predictive efficacy and influencing factors of combined intraoperative neurophysiological monitoring for nerve function injury during anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy

作　　者：彭波 彭智恒 曾俏燕 黄维渊 程龙 李广盛 孙欣 PENG Bo;PENG Zhi-heng;ZENG Qiao-yan;HUANG Wei-yuan;CHENG Long;LI Guang-sheng;SUN Xin(Department of Minimally Invasive Spine Surgery,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524001,Guangdong,China)

机构地区：[1]广东医科大学附属医院脊柱微创外科,广东湛江524001

出　　处：《广东医学》2024年第9期1160-1165,共6页Guangdong Medical Journal

基　　金：广东省科技创新战略专项资金项目(2018A0303130105);广东省医学科学技术研究基金项目(A2016536)。

摘　　要：目的探讨联合术中神经电生理监护(intraoperative neurophysiological monitoring,IONM)预测脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者经颈前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)中神经功能损伤的效能及相关影响因素。方法收集45例经ACDF治疗的CSM患者临床资料,分析联合IONM(SEP+MEP)监护结果与术后神经功能变化的关系,以及使用多因素logistics回归分析法探讨年龄、病程、术前神经功能(mJOA评分)、MRI T2像高信号、压迫节段数、最大椎管受压程度(maximal canal compromise,MCC)、脊髓压迫比(spinal cord compression ratio,SCCR)和脊髓横截面积(spinal cord cross-sectional area,SCCA)等因素对其预测效能的影响。结果术中联合监护报警5例,未报警40例;术后mJOA评分改善42例,加重3例,术后神经功能明显改善(P<0.05);监护真阳性2例,假阳性3例,真阴性39例,假阴性1例;敏感度66.67%,特异度92.85%,阳性预测值40%,阴性预测值97.50%。术中联合监护结果与术后神经功能改变的关联性有统计学意义(P<0.05)。多因素logistics回归分析显示年龄、病程、术前mJOA评分、MRI T2像是否高信号、压迫节段数、压迫最严重部位MCC、SCCR和SCCA结果差异无统计学意义(P>0.05)。结论联合IONM可预测CSM患者ACDF术中的神经功能损伤,尽管术前因素对预测效能无显著影响,但术中应注意分辨手术操作、血压波动和低体温等因素的干扰。Objective To investigate the efficacy of combined intraoperative neurophysiological monitoring(IONM)in predicting nerve function injury during anterior cervical discectomy and fusion(ACDF)surgery in patients with cervical spondylotic myelopathy(CSM)and analyze related influencing factors.Methods Clinical data from 45 CSM patients treated with ACDF surgery were collected.The relationship between the combined IONM(SEP+MEP)monitoring results and postoperative nerve function changes was analyzed.Multivariate logistic regression analysis was used to explore the effects of age,disease duration,preoperative nerve function(mJOA score),high signal on MRI T2 images,number of compression segments,maximum canal compression(MCC),spinal cord compression ratio(SCCR),and spinal cord cross-sectional area(SCCA)on predictive efficacy.Results Intraoperative alarms were noted in 5 cases,and no alarms in 40 cases.Postoperative mJOA scores improved in 42 cases and worsened in 3 cases,showing significant improvement in nerve function after surgery(P<0.05).True positive cases:2;false positive cases:3;true negative cases:39;false negative cases:1.Sensitivity:66.67%;specificity:92.85%;positive predictive value:40%;negative predictive value:97.50%.The association between intraoperative monitoring results and postoperative nerve function changes was statistically significant(P<0.05).Multivariate logistic regression analysis showed no statistically significant differences in age,disease duration,preoperative mJOA score,high signal on MRI T2 images,number of compression segments,MCC,SCCR,and SCCA(P>0.05).Conclusion Combined IONM can predict nerve function injury during ACDF surgery in CSM patients.Although preoperative factors do not significantly affect predictive efficacy,attention should be paid to differentiating surgical operations,blood pressure fluctuations,and hypothermia during surgery.

关 键 词：术中神经电生理监护 体感诱发电位 运动诱发电位 经颈前路椎间盘切除减压融合术 脊髓型颈椎病 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]