皮层体感诱发电位监护在胸椎管狭窄症手术中的应用

The intra-operative cortical somatosensory evoked potential monitoring in thoracic stenosis surgery

目的:探讨皮层体感诱发电位(CSEP)监护在胸椎管狭窄症手术中的应用价值。方法:自2000年4月￣2003年11月共有32例胸椎管狭窄症患者接受术中体感诱发电位监护,男21例,女11例,年龄38￣75岁;其中单纯胸椎黄韧带骨化症13例,胸椎间盘突出症合并胸椎黄韧带骨化症10例,胸椎间盘突出症合并胸椎孤立后纵韧带骨化9例。单纯胸椎后路全椎板切除术4例,单纯后路全椎板截骨原位再植、椎管扩大减压术9例,全椎板截骨原位再植、环脊髓减压、椎管扩大减压成形术19例。术中均应用丹迪Key-Point脊髓监护系统进行皮层体感诱发电位监护。结果:23例术中监护无异常,术后未出现神经系统并发症,其中12例患者术中即可见波形改善。4例术中出现波形异常,其中2例术后发生神经功能障碍。4例术中监护未见异常,术后症状加重,假阴性率12.5%。1例术中波形异常,但术后无脊髓损伤表现,假阳性率3.1%。结论:皮层体感诱发电位(CSEP)监护可及时发现术中危及脊髓的因素,但存在一定的假阳性或假阴性率。与其它监测方法合用可提高手术安全性。

Objective：To observe the efficacy of the intra-operative cortical somatosensory evoked potential （CSEP） monitoring in thoracic stenosis surgery.Method：There were 32 patients including 21 males and 11 females.The patients were ranged from 38 to 75 years old（mean 45 years ）.There were 13 cases of ossification of the ligament flavum,10 cases of thoracic disc herniation associated with ossification of the ligament flavum,9 cases of thoracic disc herniation associated with ossification of the posterior longitudinal ligament.We performed the total laminectomy on 4 cases;total laminotomy and canal decompression on 9 cases;total laminotomy and circumstantial canal decompression on 19 cases.All patients accepted intra-operative CSEP monitoring through Key-Point spinal cord monitoring system.Result： 23 cases did not have any intra-operative abnormal CSEP wave,among which 12 cases had CSEP improvement during the surgery.4 cases had CSEP abnormality during the surgery,and 2 of them occurred motor dysfunction after surgery.4 cases （12.5%） with stable recordings occurred motor dysfunction.1 case（3.1%） with abnormal recordings did not have neurological deficit.Conclusions：CSEP can be useful in avoiding paralysis postoperatively and predicting the clinical outcome,it can make the surgery safe combined with other monitoring method.