术中唤醒试验在严重脊柱黄韧带骨化症手术中的应用

Itraoperative wake-up test during surgery for severe ossification of ligamentum fiavum

目的对全身麻醉下术中唤醒试验（wake—uptest，WUT）在严重脊柱黄韧带骨化症手术中应用的安全性进行评估。方法2004年6月一2010年6月对35例黄韧带骨化症患者在全身麻醉下行术中唤醒后采用后路椎板切除减压治疗，其中男23例，女12例；平均年龄50．5岁（32～71岁）。颈椎4例，胸椎24例，腰椎7例；单节段14例，多节段21例。结果平均手术时间190min（120～260min），平均失血量350ml（220～520m1），平均每例减压2．6个椎板（1～5个）。全部患者随访6—72个月，平均29．5个月。术前日本骨科学会（JOA）评分为（4．286±1．0167）分，术后JOA评分为（8．171±1．0428）分（P〈0．01）。术中有3例出现神经症状加重，采取措施后2例神经功能逐渐恢复，1例未能恢复，其余患者均未出现术后瘫痪等严重并发症。结论全身麻醉下术中唤醒试验在严重黄韧带骨化症手术中的临床应用疗效满意，可有效避免神经症状加重甚至瘫痪等严重并发症发生。

Objective To assess the efficacy and safety of intraoperative wake-up test during surgery for ossification of the ligamentum flavum （OLF）. Methods Between June 2004 and June 2010, 35 patients （23 males and 12 females, at age range of 32-71 years, mean 50.5 years） with OLF underwent posterior decompressive laminectomy and excision of OLF. The operation was performed on the cervical vertebrae in four patients, on the thoracic vertebrae in 24 and on the lumbar spine in seven, with monosegmental OLF in 14 patients and multisegmental OLF in 21. The outcomes were evaluated using Japanese Orthopaedic Association （JOA） scale. Results The operation lasted for mean 190 minutes （120-260 minutes）, with the blood loss for mean 350 ml （220-520 ml） and the mean 2.4 （1-5） lamin receiving decompression. The follow-up period ranged from 6 to 72 months （ mean 29.5 months）. The JOA score was improved from 4. 302 ± 1. 023 preoperatively to 8. 327 ± 1. 032 at the final follow-up （ P 〈 0.01 ）. The neurological symptoms was aggravated during operation in three patients, for whom the muscles force recovered gradually in two patients but one showed no change after special measures. No serious complication was found in the other patients postoperatively. Conclusions The wake-up test can serve as an effective monitoring during the procedure of the decompressive laninectomy in the patients with severe OLF and decrease the occurrence of neurologic deficit complications.