SEP在脊髓脊柱手术中监测的预测价值

The Predictive Value of the Intraoperative SEP Monitoring in the Spinal and Spinal Cord Surgery

目的评价脊髓、脊柱手术中体感诱发电位 (somatosensoryevokedpotentials,SEP)监测的预测价值。方法回顾性分析 4 2例脊髓、脊柱手术监测SEP的结果 ,将术中SEP的变化分为四型 :Ⅰ型没有显著变化 ;Ⅱ型有显著变化 ,但很快恢复至标准水平 ;Ⅲ型有显著变化 ,能部分恢复至标准水平 ;Ⅳ型波形消失 ,不再有改善。 结果10例为Ⅰ型SEP表现 ,术后无神经功能缺损 ;2 5例为Ⅱ型SEP表现 ,1例术后出现神经功能缺损 ;6例为Ⅲ型SEP表现 ,全部出现神经功能缺损。术中SEP变化与术后神经功能存在显著关系。阳性预测价值为 10 0 % ,阴性预测价值为 97%。 结论术中SEP监测能较好预测脊髓。

Objective To assess the predictive value of intraoperative SEP during spinal cord and spine surgery. Methods A retrospective analysis was made in concern of intraoperative SEP monitoring in 42 patients undergoing spinal cord or spinal surgery. The changes of intraoperative SEP waveforms were classified as follows: type Ⅰ , no change; type Ⅱ , significant change, but soon reversible to the baseline; type Ⅲ , significant change, not reversible to the baseline; type Ⅳ , complete flattening of the SEP waveform, without improvement. Results Of 10 patients with type Ⅰ SEP waveforms, none had postoperative deficits. Of 25 patients with type Ⅱ SEP waveforms, one had postoperative neurological deficits. All 6 type Ⅲ SEP waveform patients had postoperative neurological deficits. There is a correlation between the SEP type and the neurological function. The positive predictive value is 100%, and the negative is 97%. Conclusion Intraoperative SEP monitoring has high predictive value during spinal cord and spine surgery.