皮质体感诱发电位与肌电图监测在椎管内疾病手术中的应用

Application of cortical somatosensory evoked potential and electromyographic monitoring in surgery for intraspinal diseases

目的初步探讨神经电生理监测技术在椎管内疾病手术中的临床应用价值。方法回顾性分析30例椎管内疾病病人的临床资料。术前Frankel分级:C级4例,D级16例,E级10例。术中应用皮质体感诱发电位(CSEP)与肌电图(EMG)监测脊髓和神经根功能,分析手术过程并评价其效果。结果肿瘤全切10例,次全切13例,大部切除2例,部分切除2例;另有脊髓栓系综合征3例,术中完全松解黏连病变。术后10 d Frankel分级:改善6例,无变化22例,加重2例;术后1年Frankel分级:改善14例,无变化15例,加重1例。术前Frankel分级3组病人进行比较,术后10 d和1年的疗效差异均无统计学意义(均P>0.05)。结论在椎管内手术中联合应用CSEP与EMG监测可以更好地保护脊髓和神经根功能。

Objective To preliminarily investigate the clinical application of neuroelectrophysiological monitoring in surgery for intraspinal diseases. Methods Clinical data of 30 patients with intraspinal diseases were analyzed retrospectively. According to preoperative Frankel classification, 4 patients were classified as grade C, 16 as grade D and 10 as grade E. The functions of the spinal cord and nerve roots were monitored by using cortical somatosensory evoked potential （CSEP） and electromyography （EMG） during operation. The surgical procedures were analyzed and surgical outcomes were evaluated. Results Total tumor resection was achieved in 10 patients, subtotal resection in 13 and major resection in 2 and partial resection in 2. Additionally, adhesive lesions were completely released in 3 patients with tethered cord syndrome during the operation. According to Frankel grade, improvement occurred in 6 patients, no change in 22 patients and exacerbation in 2 patients 10 d after operation, while improvement occurred in 14 patients, no change in 15 patients and exacerbation in 1 patient one year after operation. There was no significant difference in curative effect among 3 groups in Frankel grade 10 d and one year after operation （both P〉 0.05）. Conclusions The in traspinal surgery combined with CSEP and EMG monitoring can better protect the function of the spinal cord and nerve roots.