术中神经电生理监测技术在脊柱外科中的应用现状

Current application of intraoperative neuroelectrophysiological monitoring in spinal surgery

我国逐渐步入老龄化社会,脊柱退变性疾病的发病率呈上升趋势,而随着近年脊柱外科技术的飞速发展,越来越多的患者首先选择手术治疗。但术中所造成的神经并发症一直是患者及医生无法回避的问题。为解决这一问题,医生在不断提高其手术技术的同时,术中神经电生理监测技术应运而生,它能为医生提供客观量化的神经检测指标,一定程度上指导术者操作,以最大限度的避免术中神经损伤。术中神经生理技术的使用可以追溯到20世纪30年代怀尔德潘菲尔德和赫伯特·贾斯帕的使用电生理技术切除致癫痫的皮层^([1]),自上世纪70年代,唤醒技术首次应用于脊髓监测开始^([2]),经过几十年的发展,越来越多的监测技术如体感诱发电位、运动诱发电位、肌电图等被广泛应用于各类外科手术中^([3-4]),据国外文献报道:术中电生理监测能有效减少神经系统并发症和患者住院时间^([5])。现就目前术中神经电生理监测各类技术的基础和优缺点及在脊柱外科术中应用现状进行综述。

For avoidance of spinal cord injury, a serious complication of spinal surgery, neuroeleetrophysiological monitoring has been developed while doctors continue to improve the surgical technique. The monitoring techniques can provide objective and quantitative indexes for doctors to avoid nerve injury during operation to the maximum. In recent decades, more and more neurologic monitoring technique has been used, such as somatosensory evoked potential （SEP）, motor evoked potential （MEP） and electromyogram （EMG）, for various spine surgeries to reduce neurological complications and hospital stay effectively. This paper aims to reviews the advantages and disadvantages of various intraoperative electrophysiological monitoring techniques and their current application in spinal surgery.