体感诱发电位与运动诱发电位在颈椎病术中的联合应用

Spinal somatosensory evoked potential combined with motor evoked potential in monitoring patients undergoing surgery for cervical spondylosis

目的分析皮层体感诱发电位（ cortical somatosensory evoked potential, CSEP ）与经头颅电刺激肌源性运动诱发电位（ myogenic motor evoked potential, MMEP ）在颈椎病术中监护的联合应用价值。方法对35例脊髓型颈椎病患者（C3-Ce）行术中CSEP与MMEP联合监护。在不同阶段分别记录信号，与术后功能相结合，判断CSEP和MMEP的准确性。结果CSEP检出率为100％，MMEP检出率为85．7％；术中CSEP监护达报警标准1例，及时提醒医生，暂停手术操作，去除影响因素，CSEP波幅逐渐恢复；2例术中出现MMEP短暂消失；28例减压后即CSEP波幅上升；3例术前、术中、术终几乎无变化。以上病人术后均无神经症状加重。结论颈椎病患者术中联合运用csEP和MMEP监测，排除各种干扰因素后，能准确地反映脊髓生理和病理状况，提高监护效果，保障患者安全。

Objective To explore the value of cortical somatosensory evoked potential （ CSEP ） combined with myogenic motor evoked potential （ MMEP ） in monitoring patients undergoing surgery for cervical spndylosis. Methods CSEP and MMEP were simultaneously performed on 35 patients with spinal type cervical spndylosis during spinal surgery. The accuracy of CSEP and MMEP were assessed according to the signal recording at different stages combined with postoperative spinal cord function. Results The success rate was 100% for CSEP and 85.7% for MMEP recording. CSEP reached the warning standards in one patient intraoperatively, warning the surgeons to discontinue the procedure temporarily until the influencing factors were eliminated and the amplitudes of CSEP returned gradually. The wave tape of MMEP disappeared in 2 patients transitorily. The amplitudes of CSEP increased in 28 patients after decompression; CSEP and MMEP had little change in 3 patients. No nerve injury symptoms were worsened in all the patients postoperatively. Conslusions During cervical spinal surgery, CSEP and MMEP can reflect the physiological and pathological conditions of the spinal cord after the interfering factors are excluded. The combined application of CSEP and MMEP improve the monitoring effect and guarantee patient safety.