神经电生理分析椎管内肿瘤患者治疗效果及预后评价

Neurophysiological Monitoring and Prognosis Evaluation of Patients with Intraspinal Tumors

目的:为椎管内肿瘤患者神经电生理监测及预后评价提供基础研究数据和支持。方法:选取2015年3月～2017年3月间在德阳市人民医院就诊治疗的椎管内肿瘤患者76例,根据术中是否采用神经电生理监测分为监测组42例和对照组34例,监测组患者术中监测体感诱发电位和肌电图,对患者术后6个月进行随访,统计复发、死亡和再次接受手术情况,并采用评价JOA评分和肌力分级标准分别对患者脊髓神经功能及运动功能进行评定。结果:监测组4例患者术中出现体感诱发电位下降的情况,肿瘤全部切除率达到95.24%,术后肌力分级0级、1级、2级的比例与术前相比较均明显下降(P<0.05),监测组患者术后脊髓神经功能JOA评分改善的比例明显高于对照组(P<0.05),而脊髓神经功能JOA评分加重的比例明显低于对照组(P<0.05),复发、再次手术及死亡的例数也均低于对照组(P<0.05)。结论:神经电生理监测可以监测椎管内肿瘤患者术中情况,提高手术治疗效果。

Objective： to provide basic data and support for neurophysiological monitoring and prognosis evaluation in patients with intraspinal tumors. Methods： From March 2015 to March 2017, 76 patients with intraspinal tumors were selected and divided into two groups： 42 patients in the monitoring group and 34 in the control group according to whether or not neurophysiological monitoring was used during the operation. The patients in the monitoring group Evoked potentials and electromyography were followed up for 6 months after surgery, with statistical relapse, death and reoperation. And the neurological function and motor function of the patients were evaluated by the evaluation of JOA score and muscle strength grading standard. Results： In the monitoring group, there were 4 cases of somatosensory evoked potentials in the monitoring group. The total resection rate of the tumor was 95.24% in the monitoring group. The ratio of grade 0, grade 1 and grade 2 in the postoperative group was significantly higher than that in the preoperative group. The proportion of JOA score improvement in the monitoring group was significantly higher than that in the control group,and the proportion of the spinal cord function JOA score aggravation was significantly lower than that of the control group. The number of recurrence, reoperation and death were also Lower than the control group. Conclusion： Electrophysiological monitoring of nerves can monitor the intraoperative situation of patients with intraspinal tumors, improve the effect of surgical treatment.