神经电生理监测在腰椎滑脱矫正手术中的应用

Application of neuroelectrophysiological monitoring in lumbaRspondylolisthesis correction surgery

目的分析神经电生理监测在腰椎滑脱矫正手术中的应用价值。方法采用腰椎滑脱矫正手术治疗20例腰椎滑脱患者,术中均采用神经电生理监测,包括躯体感觉诱发电位监测(SEP监测)、运动诱发电位监测(MEP监测)、肌电图监测(EMG监测)和肌松监测(TOF监测)。监测术中报警次数,记录手术时间、手术并发症发生情况,采用邹德威的综合评价标准评估临床疗效。结果手术时间125~168(136.38±16.56)min。13例术中出现报警,报警发生率为65%,其中术中报警率SEP监测为9/20(45%),MEP监测为4/20(20%),EMG监测为7/20(35%),TOF监测波消失后有3例诱发出现MEP的异常。患者均获得1年随访。术后1年采用邹德威的综合评价标准评价临床疗效:优12例,良3例,中4例,差1例,总有效率为19/20。术中未出现死亡、截瘫、神经根严重损伤等并发症,术后1例发生切口感染,3例发生一过性神经根牵拉导致患肢麻木症状,并发症发生率为4/20。结论神经电生理监测用于腰椎滑脱矫正手术中并不延长手术时间,而且能够提高手术安全性,对术中指导减压范围及经皮内固定物置入安全性方面有指导意义。

Objective To analyze the application value of neuroelectrophysiological monitoring in lumbaRspondylolisthesis surgery.Methods Twenty patients with lumbaRspondylolisthesis were treated by corrective operation.Neuroelectrophysiological monitoring was used during operation,including somatosensory evoked potential monitoring(SEP monitoring),motoRevoked potential monitoring(MEP monitoring),electromyography monitoring(EMG monitoring)and muscle relaxation monitoring(train of fouRstimulation,TOF monitoring).The numbeRof intraoperative alarms were monitored,and the operation time and the incidence of surgical complications were recorded,the comprehensive evaluation criteria of ZOU De-wei was used to evaluate the clinical efficacy.Results The operation time was 125~168(136.38±16.56)min.The 13 cases had intraoperative alarm,and the incidence rate of alarm was 65%,including 9/20(45%)of SEP monitoring,4/20(20%)of MEP monitoring and 7/20(35%)of EMG monitoring.AfteRthe disappearance of TOF monitoring wave,MEP was induced in 3 cases.All patients were followed up foR1 year.At 1 yeaRafteRoperation,ZOU De-wei comprehensive evaluation criteria was used to evaluate the clinical efficacy:excellent in 12 cases,good in 3 cases,faiR4 cases and pooR1 case,the total effective rate was 19/20.No complications such as death,paraplegia oRsevere nerve root injury occurred during the operation.Postoperative incision infection occurred in 1 case,and transient nerve root pulling caused limb numbness in 3 cases,with a complication incidence rate of 4/20.Conclusions Neuroelectrophysiological monitoring can improve the safety of lumbaRspondylolisthesis without prolonging the operation time,and which has guiding significance foRintraoperative decompression range and the safety of percutaneous internal fixation placement.