脊柱肿瘤手术术中神经生理监测信号改善的临床意义

Clinical significance of intraoperative neurophysiological monitoring signals improvement in spinal tumor surgery

目的探讨脊柱肿瘤手术过程中显示的术中神经生理监测(IONM)信号改善与术后临床疗效的相关性及其临床意义。方法回顾性分析2017年4月至2019年10月期间在郑州大学第一附属医院手术治疗的206例脊柱肿瘤患者的病历资料,分析术中的IONM数据,筛选出IONM信号明显改善的患者,比较这些患者术前和术后的神经功能与主观症状情况。结果在所有的IONM数据中,共发现31例患者的IONM信号较基线明显改善,并完成1 a以上随访。运动诱发电位(MEPs)和体感诱发电位(SSEPs)信号均有改善者8例,仅MEPs信号有改善者11例,仅SSEPs信号有改善者12例。IONM信号明显改善患者的运动指数评分系统评分由术前的(87.68±13.95)分增加到术后的(94.47±9.12)分(t=5.976,P=0.023);健康调查简表-36由术前的(101.33±9.82)分增加到术后的(111.68±9.73)分(t=6.742,P=0.017)。无一例患者出现术后神经功能的恶化。结论脊柱肿瘤患者术中IONM信号的改善可预示术后神经功能状态和主观症状的改善,具有较高的临床价值。

Objective To investigate the correlation between the improvement of intraoperative neurophysiological monitoring(IONM)signals during spinal tumor surgery and postoperative clinical outcomes,and to discuss its clinical significance.Methods A retrospective analysis was performed on 206 patients with spinal tumor who underwent surgery in the First Affiliated Hospital of Zhengzhou University from April 2017 to October 2019.IONM data during surgery were analyzed,and the patients with significantly improved IONM signals were screened out.The neurological function and subjective symptoms of these patients were compared before and after surgery.Results In all IONM data,a total of 31 patients whose IONM signals were significantly improved from baseline were found and were followed up for more than 1 year.Both motor-evoked potentials(MEPs)and somatosensory-evoked potentials(SSEPs)signals were improved in the 8 cases,only MEPs signals were improved in the 11 cases,and only SSEPs signals were improved in the 12 cases.Motor index scoring system of patients with significantly improved IONM signals were increased from(87.68±13.95)points preoperatively to(94.47±9.12)points postoperatively(t=5.976,P=0.023).Short-Form 36 health survey questionnaire were increased from(101.33±9.82)points preoperatively to(111.68±9.73)points postoperatively(t=6.742,P=0.017).No postoperative neurological deterioration occurred in any of the patients.Conclusion The improvement of IONM signals during surgery in the patients with spinal tumor may predict the improvement of postoperative neurological status and subjective symptoms,and it has high application value.