脊髓运动诱发电位监测在手术中的应用

Application of spinal motor evoked potential monitoring in operation

目的评价脊髓运动诱发电位监测在脊柱脊髓手术中的作用。方法通过连续短脉冲头皮电刺激,应用硬膜外电极于脊髓记录18例脊柱脊髓疾病患者手术过程中的运动诱发电位。根据日本整形外科协会(JOA)评分标准对患者手术前后神经功能进行评价。结果以手术中首次记录到的脊髓运动诱发电位D1波波幅和潜伏期作为参照值,8例脊柱侧弯患者施行脊柱矫形手术过程中记录到的脊髓运动诱发电位D1波波幅和潜伏期均无异常变化;10例行椎管内及脊髓手术患者,手术中脊髓运动诱发电位D1波波形改变、波幅降低,改变手术方向或经短暂休息后恢复正常。根据JOA评分,手术后所有患者感觉和运动功能均较手术前明显改善,差异有统计学意义(Z=!2.646,P=0.008;Z=!2.828,P=0.005)。结论手术中脊髓运动诱发电位监测可及时、客观地反映神经功能,有效避免手术中神经损伤及手术后神经功能障碍。在监测过程中,头皮电刺激记录到的脊髓运动诱发电位D1波波形清晰、稳定,且不受外界因素的影响。

Objective To investigate the effect of spinal motor evoked potential （MEP） monitoring in spinal column and cord operation. Methods Spinal MEP were recorded with the epidural electrodes within the vertebra canal employing the transcranial electric stimuli in a continuous short-impulse pattern. The find- ings of MEP monitoring were evaluated in 18 patients with either spinal cord disorder or spondylopathy. The Japanese Orthopaedic Association （JOA） score was used to evaluate neural function at pre- and post-operation, Results The reference value of spinal MEP monitoring was the amplitude and latency of the D1 wave record- ed at the first time in operation. Both amplitude and latency of the D1 wave of spinal MEP showed no changes in 8 scoliosis patients treated by spinal column orthopaedic surgery. In 10 patients treated by intraspinal or spinal cord surgery, the waveform of the D1 wave was changed and the amplitude was reduced during operation, and the waveform restored normally after changing of surgery direction or transient rest. In comparison with pre-operative sensory and motor function, JOA scores of the patients increased significantly after operation （Z=-2.646, P= 0.008; Z = -2.828, P=0.005 respectively）. Conclusion Spinal MEP may reflect the neural function promptly and ob- jectively during operation and can be used to avoid operative nerve injury and post-operative nerve dysfunc- tion. During monitor period, the waveform of spinal MEP D~ wave elicited by transcranial electric stimulation is clear and stable, and external factors do not influence the results.