神经电生理监测下显微手术治疗成人脊髓栓系综合征

Intraoperative electrophysiological monitoring-guided microsurgery on tethered spinal cord syndrome in adults

目的分析手术治疗成人脊髓栓系综合征患者的疗效,评价脊髓栓系综合征显微手术中运用神经电生理监测的作用和意义。方法 2004年1月至2011年12月收治成人脊髓拴系综合征患者112例,98例获得完整随访资料纳入研究,其中63例患者术中采用神经电生理监测(监测组),35例未采用神经电生理监测(对照组)。采用超声测定膀胱残尿量评价膀胱功能,术后6个月残尿量/术前残尿量≤50%为改善;采用Fugl-meyer下肢评分评价下肢运动功能,术后6个月评分增加3分以上改善。结果对照组术后6个月膀胱功能改善率为28.5%,监测组术后6个月改善率达56.5%;监测组膀胱功能恢复明显优于对照组(P<0.05)。对照组术后6个月下肢运动功能改善率为62.5%,监测组术后6个月改善率为78.9%;两组下肢功能改善率无明显差异(P>0.05)。结论脊髓拴系综合征显微手术中,神经电生理监测技术有助于防止术中误伤神经,从而使神经外科医生比较精准的剪断终丝获得最大程度的松解,改善患者生活质量。

Objective To explore the value of intraoperative electrophysiological monitoring （IEPGM） to microsurgery for the tethered spinal cord syndrome （TSCS） in adults. Methods Of 98 patients with TSCS, who underwent the microsnrgery from January, 2004 to December, 2011 and were followed up from 8 to 54 months after the operation, 63 （observed group） received the electrophysiological monitoring and 35 （control group） not. The functions of urination and lower limb movements were assessed and analyzed during the following up. Results The improvement rate of urination function （23.8%, 5/21） in 21 patients with preoperative urination dysfunction who did not received IEPGM was significantly lower than that （56.5%, 13/23） in 23 patients with preoperative urination dysfunction who received IEPGM （P〈0.05）. There was insignificant difference in the improvement rate of lower extremity motor function between both the groups. Conclusions IEPGM is helpful to the prevention of the intraoperative accidental nerve injury, increase in the degree of releasing the tethered spinal cord and improvement of the quality life in the patients with TSCS.