皮层体感诱发电位及经颅电刺激运动诱发电位联合监护在脊柱畸形矫正术中的应用

Combined monitoring of motor and somatosensory evoked potentials in spinal deformity surgery

目的:探讨脊柱畸形矫正术中皮层体感诱发电位(CSEP)及经颅电刺激运动诱发电位(TES-MEP)联合监护在脊柱畸形矫正手术中的应用。方法:对我院收治的脊柱畸形患者根据术中监护方法分为两组:A组37例,其中男25例,女12例,年龄13～42岁,平均26.1岁,术中进行CSEP及TES-MEP联合监护;B组29例,其中男10例,女19例,年龄13～20岁,平均15.8岁,单纯采用CSEP监护作为对照组。术中持续观察CSEP及TES-MEP波幅及潜伏期变化,出现波幅下降50%、潜伏期延长10%或刺激强度高于初始刺激强度100V仍未引出者,停止手术并对症处理,术后给予激素治疗。结果:A组术中出现CSEP异常者4例(10.8%),TES-MEP异常者19例(60%)。术中CSEP及TES-MEP均异常者4例(10.8%),无术中CSEP异常而TES-MEP正常者。2例(陈旧性结核并后凸畸形1例,陈旧性骨折并后凸畸形1例)术中合拢截骨平面时,TES-MEP波形均消失,但仅1例出现CSEP异常,经术中积极处理,至手术结束时波形仍未恢复至术前水平,术后均出现神经功能障碍。余35例患者术后无神经功能损伤(假阴性率0%)。B组9例(21%)术中出现CSEP波形异常,其中2例虽经减少矫形角度及激素冲击治疗,术后仍出现双下肢瘫,余术后未出现神经功能障碍。3例术中监护未见异常者,术后出现重度不可逆性脊髓损伤(假阴性率10%)。结论:CSEP结合TES-MEP联合监护能较可靠、准确的反映术中脊髓功能状态,可降低监护假阴性率,为手术治疗过程提供参考。

Objective：To investigate the efficacy of combined monitoring of motor evoked potentials with trans-cranial electrical stimulation（TES-MEP） and cortical somatosensory evoked potentials（CSEP） for spinal deformity correction surgery.Method：There were 37 patients including 25 males and 12 females（group A）.The average age was 26.1 years old.There were 17 cases of scoliosis,and 20 cases of kyphosis deformity.All patients underwent intra-operative CSEP and MEP monitoring.Twenty-nine cases（10 males and 19 females） who experienced only CSEP monitoring were termed as control group（group B）.The average age was 15.8 years old.For those with amplitude decreasing 50% and latency increasing 10% or remaining no change with stimulate 100V over than primary,surgical approach were changed.Result：Combined motor and sensory monitoring was successfully achieved in 32（86.4%） cases in group A.The abnormality of CSEP was observed in 4 cases（10.8%）,while the abnormality of MEP was observed in 19 cases（60%）.The abnormality of CSEP and TES-MEP occurred in 4 cases（10.8%）,abnormal MEP with abnormal CSEP occurred in 15 cases（40.5%）.No case in group A with normal intra-operative monitoring was complicated with post-operative neurological deficit（0%）.Two cases with kyphosis deformity due to old TB and fracture were noted MEP and/or CSEP abnormality,and the patients had minor neurological deficit after surgery.In group B,9 cases（21%）were noted CSEP abnormal.3 cases（10%）with normal recordings were complicatred with severe motor dysfunction.Conclusion：Combined TES-MEP and CSEP in spinal deformity surgery is safe,reliable and sensitive for monitoring spinal cord function,which can be used to guide surgery.