皮层体感诱发电位信号改善对脊髓型颈椎病手术预后的评价

Relationship between improvement of cortical somatosensory evoked potential and outcome in surgery for cervical spondylotic myelopathy

[目的]研究皮层体感诱发电位(cortical somatosensory evoked potential,CSEP)在脊髓型颈椎病(cervicalspondylotic myelopathy,CSM)手术后出现信号改善(潜伏期缩短,或/和波幅增高)与临床症状恢复的相关性。[方法]对2008年7月～2010年5月本院收治的58例CSM患者,行术前、术中及术后CSEP监护并记录CSEP值,根据脊髓监护手术前后CSEP是否改善分为两组:波形改善组(A组),表现为波幅升高(>50%),或(和)潜伏期缩短(<5%);波形无改善组(B组)。于颈椎手术术前、术后1周和6个月分别行JOA评分(Japanese Orthopaedic As-sociation scoring system)评价神经功能,观察CSEP变化与神经功能恢复之间的关系。[结果]58例患者中36例(62.1%)CSEP出现改善;A组JOA评分术前、术后1周及术后6个月分别为8.42±1.06,14.71±1.31,15.43±1.26;B组分别为8.61±1.13,11.92±1.15,15.21±1.23。术后1周A组恢复高于B组(P<0.05),6个月后JOA评分两组之间比较无差异。[结论]CSM患者减压术后CSEP多出现波形改善,术后CSEP波形出现改善者,术后早期临床症状恢复较快。

[Objective]To study the relationship between improvement of cortical somatosensory evoked potential（CSEP） and outcome in surgery for cervical spondylotic myelopathy（CSM）. [Methods]Fifty-eight patients with CSM received CSEP examination with keypoint electromyography pre-operatively,intra-operatively and post-operatively.Acording to the CSEP variance,the patients were divided into improvement group（group A） and non-improvement group（group B）.The JOA scores before,one week and 6 months after operation were analyzed.The relationship between the changes of CSEP and JOA scores was studied. [Results]JOA scores were 8.4±1.06,14.7±1.31,and 15.4±1.26 in group A,and 8.6±1.13,11.9±1.15,and 15.2±1.23 in group B.Thirty-six patients showing CSEP improvement had a more rapid clinical improvement.Long-term reassessment did not show any difference between the two groups. [Conclusion]Patients with CSEP improvement had a more clinical improvement.