经颅电刺激运动诱发电位和体感诱发电位在脊柱侧弯矫形术中监测脊髓损伤的价值

Value of transcranial electrical motor evoked potential and somatosensory evoked potential in monitoring spinal injury during scoliosis orthopedics

目的:探讨经颅电刺激运动诱发电位(MEP)及体感诱发电位(SSEP)在脊柱侧弯矫形术中监测脊髓损伤的价值。方法:选取2020年1月1日至2020年12月31日于河南省人民医院接受脊柱侧弯矫形术的69例患者,分析其术中MEP、SSEP出波情况及报警情况(MEP报警标准为波形消失;SSEP报警标准为相比基线,潜伏期延长大于10%或波幅下降大于50%)。结果:股外侧肌、胫前肌、踇展肌的MEP出波率差异有统计学意义(P<0.05),其中酶展肌出波率最高。术中所有病例均成功获取SSEP波形。股外侧肌、胫前肌、踇展肌MEP报警的敏感度分别为100.00%、100.00%、60.00%,特异度分别为97.96%、95.58%、97.67%,假阳性率分别为2.04%、4.42%、2.33%;将单侧下肢视为整体,整体MEP报警的敏感度、特异度及假阳性率分别为100.00%、92.48%及7.52%;SSEP波幅下降大于50%的敏感度、特异度及假阳性率分别为100.00%、86.47%及13.53%;SSEP联合MEP报警的敏感度、特异度及假阳性率分别为100.00%、98.50%及1.50%。结论:MEP、SSEP监测对于脊柱侧弯矫形术中脊髓损伤均有较高的敏感度和特异度,两者联合不仅能提高监测的敏感度和特异度,还能够降低监测的假阳性率。

Aim:To explore the value of transcranial electrical motor evoked potential(MEP)and somatosensory evoked potential(SSEP)in monitoring spinal injury during scoliosis orthopedics.Methods:A total of 69 patients who received scoliosis orthopedics in Henan Provincial People′s Hospital from January 1,2020 to December 31,2020 were selected.The waveform acquisition ratio and alarm of MEP and SSEP were analyzed(MEP alarm standard was waveform disappearance,SSEP alarm standard was the latency extended more than 10%or wave amplitude decreased more than 50%compared with baseline).Results:The waveform acquisition ratio of vastus lateralis muscle,tibialis anterior muscle and hallus flexus muscle had significant difference(P<0.05),and that of hallus flexus muscle was the highest.SSEP waveform was successfully obtained in all cases.The sensitivity of MEP alarm for vastus lateralis muscle,tibialis anterior muscle and hallus flexus muscle was 100.00%,100.00%and 60.00%,the specificity was 97.96%,95.58%and 97.67%,and the false positive rate was 2.04%,4.42%and 2.33%,respectively.When unilateral lower limb was considered as a whole,the sensitivity,specificity and false positive rate of overall MEP alarm were 100.00%,92.48%and 7.52%,respectively.The sensitivity,specificity and false positive rate of SSEP amplitude reduction greater than 50%were 100.00%,86.47%and 13.53%,respectively.The sensitivity,specificity and false positive rate of SSEP combined with MEP were 100.00%,98.50%and 1.50%,respectively.Conclusion:In scoliosis orthopedics,MEP and SSEP monitoring have high sensitivity and specificity for spinal cord injury.Combination of MEP and SSEP can not only improve the sensitivity and specificity of monitoring,but also significantly reduce the false positive rate of monitoring.