单模式与多模式神经电生理监测在脊柱手术中保护神经功能价值的研究  

Study on the value of uni-and multimodal intraoperative neurophysiological monitoring in protecting nerve function in spinal surgery

作　　者：陈锡贤 马荣兴 吕金明[1] 刘文譞 CHEN Xixian;MA Rongxing;LYU Jinming;LIU Wenxuan(Department of Neurophysiology,General Hospital of Ningxia Medical University,Yinchuan 750000)

机构地区：[1]宁夏医科大学总医院神经电生理科,银川750000

出　　处：《颈腰痛杂志》2025年第2期286-289,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的通过多模式神经电生理监测与单一测监测对比,研究不同监测方式在脊柱手术中保护神经功能的价值。方法收集2021年2月至9月于宁夏医科大学总医院行脊柱手术的患者113例,术中均行多模式神经电生理监测,根据患者术后是否出现神经功能障碍,对比多模式监测与单一的体感诱发电位(SSEP)、运动诱发电位(MEP)、自由肌电(EMG)监测的灵敏性、特异性、阳性预测值、阴性预测值。结果灵敏性:多模式监测与MEP为100%,SSEP 50%、EMG 25%;特异性:多模式92.66%、MEP 98.17%、SEP 93.58%、EMG 97.25%;阳性预测值:多模式33.33%、MEP 66.67%、SSEP 22.22%、EMG 25%;阴性预测值:多模式100%、MEP 100%、SSEP 98.10%、EMG 97.25%,采用χ^(2)检验进行统计学分析,差异有统计学意义(P<0.05)。结论多模式神经电生理监测与MEP的灵敏性、阴性预测值最高,MEP特异性、阳性预测值最高。MEP是最有用的监测方式,其次为多模式,均能够更有效的保护神经功能,降低术后神经功能障碍的发生。Objective To study the value of different monitoring methods in protecting nerve function in spinal surgery by comparing the uni-and multimodal intraoperative neurophysiological monitoring.Methods 113 patients who underwent spinal surgery in the General Hospital of Ningxia Medical University from February to September 2021 were collected of,multimodal intraoperative neurophysiological monitoring was performed during the operation.According to whether the patient had neurological dysfunction after surgery,the sensitivity,specificity,positive predictive value,and negative predictive value of multimodal monitoring versus single somatosensory evoked potential(SEP),motor evoked potential(MEP),and free electromyography(EMG)were assessed.Results The sensitivity:multi-mode monitoring 100%,MEP 100%,SSEP 50%,EMG 25%;the specificity:multimodal 92.66%,MEP 98.17%,SEP93.58%,EMG 97.25%;the positive predictive value:multimodal 33.33%,MEP 66.67%,SSEP 22.22%,EMG 25%;the negative predictive value:multimodal 100%,MEP 100%,SSEP 98.10%,EMG 97.25%.Statistical analysis was performed with the chi-square test,and the difference was statistically significant(P<0.05).Conclusion Multimodal intraoperative neurophysiological monitoring and MEP have the highest sensitivity and negative predictive value,MEP has the highest specificity and positive predictive value.MEP is the most useful monitoring method,secondary is multimodal intraoperative neurophysiological monitoring,which can more effectively protect nerve function,reduce the occurrence of postoperative neurological dysfunction.

关 键 词：脊柱手术 神经电生理监测 运动诱发电位 体感诱发电位 自由肌电 神经功能 

分 类 号：R687.3[医药卫生—骨科学]