踝阵挛试验在脊柱侧凸矫形术中脊髓功能监测的应用价值

The Ankle Clonus Test for the Monitoring of the Spinal Cord Function during Corrective Surgery of Scoliosis

目的 :探讨踝阵挛试验在脊柱侧凸矫形手术中脊髓功能监测的应用价值。方法 :对 4 9例脊柱侧凸矫形手术的患者 ,在唤醒试验减浅麻醉时进行踝阵挛试验 ,并与唤醒试验结果相比较。结果 :4 9例患者中 ,4 5例双侧引出踝阵挛 ,1例单侧引出 ,3例双侧均未引出踝阵挛。而所有受试者唤醒试验的结果均为阳性 ,术后亦无脊髓损伤。因此在本观察中 ,踝阵挛试验无真阳性和假阴性结果 ,4例假阳性结果 (8.16 % )。踝阵挛出现的时间明显早于唤醒试验 (P <0 .0 0 1)。结论 :踝阵挛试验对脊柱侧凸矫形术中脊髓功能的监测具有应用价值 ,且出现较早、简单易行 ,应作为常规监测 ,甚至可取代唤醒试验。

Objective: To evaluate the ankle clonus test for the monitoring of the spinal cord function during corrective surgery of scoliosis. Methods: The ankle clonus test and the wake-up test were performed in 49 patients who underwent corrective surgery of scoliosis, when the level of anesthesia was lightened after distraction or correction of the curve. Results: The bilateral transient ankle clonus was observed in 45 patients. However, the positive result defined as absence of transient ankle clonus occurred in the other 4 patients of which, 1 was unilateral and 3 were bilateral. All patients had normal wake-up test result without any neurological deficit when alert. Therefore, the ankle clonus test had no false-negative or true-positive result and 4 false-positive results(8.16%). The ankle clonus test appeared significantly earlier than the wake-up test (P<0.001). Conclusion:The ankle clonus test is a safe, easily performed and early parameter for intraoperative monitoring the spinal cord function during corrective surgery of scoliosis and should be routinely scrutinized.