体感诱发电位监测在脊柱畸形Ponte截骨矫形手术中的应用

Application of somatosensory evoked potential monitoring in surgical correction of spinal deformities

[目的]探讨体感诱发电位(SEP)监测在脊柱畸形Ponte截骨矫形手术中的应用价值。[方法]对36例因脊柱畸形行Ponte截骨矫形手术的患者进行术中SEP监测,其中男10例,女26例;年龄6.5～45.2岁,平均18.8岁。成人脊柱侧凸8例,青少年特发性脊柱侧凸14例,先天性脊柱侧凸4例。手术均采用后路Ponte截骨矫形。SEPP40波幅下降>50%和(或)潜伏期延长超过10%或波形消失为异常标准。[结果]截骨、减压和矫形过程中8例患者出现SEP P40波异常,立即停止手术操作,寻找原因,并作相应处理。其中2例因术中出血导致血压下降,1例为胸腰段截骨,1例为中胸段截骨;另4例考虑与手术操作因素有关。2例为中胸段,2例为胸腰段。2例同时有波幅下降>50%和潜伏期延长超过10%患者。1例成人脊柱侧凸患者术后出现短期的神经功能障碍,1例成人脊柱侧凸患者术后神经功能正常。[结论]术中体感诱发电位监测可作为指示Ponte截骨矫形术中脊髓功能的重要手段,敏感性较高,对其变化应积极应对并正确处理,以避免脊髓损伤。

[Objective]To study the application value of somatosensory evoked potential（SEP） monitoring during surgical correction of spinal deformities.[Methods]SEP monitoring during surgical correction of spinal deformities were performed for 36 cases.There were 10 males and 26 females.The average age was 18.8 years（range,6.5~45.2 years）.The pathogenetic diagnoses of the adult scoliosis were 18 cases,adolescent idiopathic scoliosis 14 cases and congenital scoliosis 4 cases.The surgical technique was the posterior Ponte osteotomies.The abnormal criteria of SEP monitoring was defined as the decline of wave amplitude over 50% and/or the elongation of latent period over 10%.[Results]Eight cases had abnormal SEP while making the osteotomy decompression and correction and the processes were paused at once until the problems were solved.Two cases suffered blood pressure decline from bleeding during the osteotomy,one was in thoracolumbar segment,the other one was in middle thoracic spine.Four cases were considered as association of inadequate surgical manipulations,2 in middle thoracic spine,and 2 in thoracolumbar segment.Two cases in congenital scoliosis and adult scoliosis respectively,who had abnormal SEP during surgery presented temporary postoperative neurological function impediment.In Adult scoliosis there were 2 cases with abnormal SEP,but the neurological function was normal after surgery.[Conclusion]SEP monitoring during the operation is an important and sensitive method to detect the function of spinal cord.The active and proper management should be considered as soon as occurring of abnormal SEP to avoid spinal cord injury.