脊柱侧凸矫形术神经损伤并发症的预防

Prevention of Spinal Cord Injury in Scoliosis Surgery

目的 分析总结脊柱侧凸矫形术中神经损伤的易发因素及预防措施。方法 73例患者 ,男 2 5例 ,女 4 8例 ,年龄 5～ 39岁 ,平均 16 5岁。其中特发性脊柱侧凸 5 4例 ,先天性脊柱侧凸 19例 ,术前Cobb’s角 5 0°～ 135° ,平均 6 8°。术前常规预测矫正度数 ,术后均做唤醒试验 ,其中 2 5例进行SEP及MEP联合监测。结果 术后Cobb’s角平均 2 8° ,平均矫正率为 5 8%。2例神经损伤 ,发生率为 2 7%。诱发电位监测组中CSEP假阳性率为 2 8% ,SubCSEP假阳性率 16 % ;SEP假阴性率为零 ;MEP可靠性为 84 %。结论 术前充分评估 ,术中诱发电位监测并结合唤醒试验 ,及时排除损伤因素 。

Objective\ To analyze the factors influencing the spinal cord injury in scoliosis surgery in order to prevent it Methods\ 73 cases were analyzed with an average of 16 5 years Pre operative Cobb's angle measured from 50° to 135°,with an average of 68° Preoperative evaluation and postoperative wake up test had been done in all cases Of those,25 patients were monitored by somatosensory evoked potential (SEP) and motor ovoked potential (MEP) during operations Resuits\ The average of post operative Cobb's angle was 28°,a 58% curve collection 2 patients developed intraoperative neurological complications (2 7%) False positive rate of CSEP was 28% and Sub CSEP 16% Reliable rate of MEP was 84% Conclusion\ There are some ideal methods to prevent spinal cord from being injured in scoliosis surgery,including preoperative evaluation,SEP and MEP monitor and also wake up test