神经电生理监测在经皮后凸成形手术中的应用

The Application of Neurophysiological Monitoring in Percutaneous Kyphoplasty

目的探讨在全麻下行经皮椎体后凸成形术中,体感诱发电位(somatosensory evoked potential,SEP)、运动诱发电位(motor evoked potential,MEP)和肌电图(electromyography,EMG)联合监测的应用价值。方法采用3种方式联合监测下行经皮后凸成形术53例,所有手术均在静脉合并吸入麻醉下完成。记录术中神经电生理监测结果。结果经单因素方差分析,VAS评分、ODI、Cobb角和椎体前缘高度与术前比较差异有统计学意义(P<0.05)。4例患者推注骨水泥时MEP波幅下降超过50%,SEP正常,透视反复确认无骨水泥渗漏后继续完成手术,术后无神经系统并发症。1例患者出现EMG阳性而SEP、MEP正常,更换另一侧穿刺完成手术,术后第一次穿刺侧神经根损伤,经对症处理后症状缓解。其余48例患者术中电生理监测无异常。结论 SEP、MEP、EMG联合监测可减少全麻下PKP手术中脊髓、神经根损伤发生,从而提高手术安全性。

Objective To study the application value of somatosensory evoked potential （ SEP ） , motor evoked potential （MEP）and electromyography（EMG）in monitoring percutaneous kyphoplasty（PKP）. Methods 53 patients who underwent the PKP were monitored by SEP,MEP and EMG. All of these patients received intravenous anesthesia and inhalation anesthesia. The outcomes of the neurophysiological monitoring were recorded. Results Via one-way ANOVA we found that the difference of VAS, ODI,Cobb angle and the height of the anterior vertebral body before and after PKP are statistically significant. 4 patients’ MEP de-creased over 50% during the procedure of injecting bone cement. After inspecting by the X-ray,no leakage of the bone cement was confirmed and the PKP was completed. No neurological complications were reported. 1 patient’s EMG was positive but SEP and MEP were normal. Then the patient was operated on the other side to complete the surgery. During the first puncture after PKP,the patient’s nerve root of nervuslateralis was injured. The symptoms were relieved after expectant treatment. The rest 48 patients’neurophysiology was normal during the PKP. Conclusion The combination of SEP,MEP and EMG in monitoring PKP can reduce the incidence of injuring the spinal cord and nerve root as well as improve the safety of PKP.