双模式及EMG联合监测在胸椎肿瘤手术中的应用

The value of BIOM and EMG in surgical resection of thoracic tumor

目的:探讨采用双模式及EMG联合监测脊髓功能变化在胸椎肿瘤手术中的应用价值。方法:回顾分析我科行胸椎肿瘤切除术30例,术中采用双模式及EMG联合监测脊髓功能的变化。患者均采用气管插管全麻及后方手术入路。结果:4例术中诱发电位阳性的病例与手术操作直接相关,如剥离肿瘤时对脊髓轻微的牵拉、椎管内静脉丛出血。将明胶海绵塞入椎管内以致继发性脊髓压迫,采取措施后诱发电位即时恢复,术后神经功能正常。2例患者术中无电位变化,术后3h出现双下肢瘫痪(假阴性)。1例行MRI证实椎管内血肿形成,急诊手术证实诊断,行血肿清除后症状消失。1例术后行脱水消肿及营养神经对症处理后截瘫表现无明显缓解,经讨论考虑由缺血再灌注损伤引起。结论:胸椎肿瘤手术应用双模式及EMG联合监测,排除各种干扰因素后,能准确反映术中脊髓功能状态,提高监护效果。

Objective ：To explore the application value of BIOM and EMG in surgical resection of thoracic tumor resection. Methods：Retrospective research was performed for 30 cases in our orthopaedics department. Bimodal intraperative monitoring（BIOM） and EMG were employed in these 30 patients with thoracic tumor during surgical resection. Results：Four cases of intraoperative evoked potential positive cases with surgical operation were directly related to, such as peel tumor of the spinal cord slightly, stop spinal venous plexus bleeding with gelatin sponge. Normal nerve function recovery after taking instant measures. There were no potential changes in two cases during operation, hut the lower limbs paralysis appear after 3h （false negative）. The routine MRI confirmed spinal hematoma formation, emergency surgery confirmed the diagnosis, the symptoms disappeared after hematoma clear. One case with paraplegia performance was no significant relief postoperative afetr dehydration swelling and nerve nutrition symptomatic treatment, due to ischemia - reperfusion injury by clinical discussions. Conclusion： Combined application of BIOM and EMG in surgical resection of thoracic tumor resection can accurately reflect the intraoperative spinal function and improve the monitoring effects, after excluding various interference factors.