青少年特发性脊柱侧凸患者体感诱发电位的特点及与Cobb角的关系

目的 分析不同Cobb角青少年特发性脊柱侧凸(AIS)体感诱发电位(SEP)的异常模式,探讨其在AIS发病机制中的作用.方法 回顾性分析2001年9月至2007年9月治疗的489例AIS患者(AIS组)的术前SEP的峰潜伏期及左、右侧峰潜伏期差值,并与45例年龄匹配的健康青少年(对照组)的SEP相比较.SEP波形消失、峰潜伏期延长及峰潜伏期不对称定义为SEP异常的标准.计算AIS组SEP异常发生率,并分析SEP异常与侧凸严重程度的相关性.结果 AIS组峰潜伏期(身高校正)较对照组略高,但无统计学意义.AIS组左右侧峰潜伏期差值显著高于对照组.489例AIS中SEP异常者共有166例,其中波形单侧或双侧消失17例(10.2%),单侧潜伏期延长50例(30.1%),两侧均延长38例(22.9%),两侧不对称120例(72.3%).根据不同侧凸严重程度分组分析,结果提示SEP异常与侧凸严重程度无关.结论 部分AIS患者存在体感传导通路异常,其可能为AIS的原发性因素,可能在AIS的发病机制中起着重要的作用.     

Cobb角大于40°的青少年特发性脊柱侧凸患者的小脑扁桃体位置分析

目的探讨小脑扁桃体位置在临床诊治大弯度青少年特发性脊柱侧凸(adolescent idio-pathic scoliosis,AIS)中的意义。方法AIS患者203例,男27例,女176例;年龄平均(14.6±1.6)岁;Cobb角平均55.3°±16.6°。对照组86例,男、女各43例,年龄平均(15.7±1.8)岁,均未患有大脑、中脑、小脑、脊髓病变及脊柱侧凸、后凸和脊柱发育异常等。在MRI图像上测量AIS患者和对照组青少年的小脑扁桃体位置,分析二组之间的差异,以及年龄和性别对小脑扁桃体位置的影响。在AIS组内分析不同侧凸角度和侧凸类型患者的小脑扁桃体位置的差异。结果AIS患者的小脑扁桃体平均位置明显低于对照组(分别为枕骨大孔上0.9mm和2.9mm)。AIS患者中小脑扁桃体异位的发生率(34.5%)明显高于正常对照组(5.8%)。年龄、性别和Cobb角对小脑扁桃体位置均无显著的影响。在不同的侧凸类型中,双胸弯AIS患者小脑扁桃体异位的发生率(62.5%)最高。腰部侧凸的患者中小脑扁桃体异位发生率显著低于胸和胸腰部侧凸的患者。结论大弯度AIS患者的小脑扁桃体位置明显低于正常对照组,小脑扁桃体异位的发生率明显高于正常对照组。小脑扁桃体异位低于枕骨大孔2mm为异常,而在中国大陆此比例极低。AIS患者小脑扁桃体异位的发生可能与侧凸类型存在一定的关联。     

青少年特发性脊柱侧凸患者的中枢神经异常

目的 :检查青少年特发性脊柱侧凸 (AIS)患者的后脑及脊髓的结构和功能异常 ,探讨两者间的相关性及与Cobb角的关系。方法 :用MRI探查AIS患者的后脑及脊髓的解剖结构 ,用体感诱发电位 (SEP)检查体感传导通路功能 ,并对两者结果作相关性检验。结果 :MRI见小脑扁桃体脱垂或脊髓空洞和SEP显示体感传导通路功能异常病例在Cobb角 >45°患者中依次占 31%和 2 7 6 % ,而 <45°患者中分别只占 3 7%和 11 9% ,结构异常和功能异常有显著相关性。结论 :对严重脊柱侧凸或合并SEP异常患者应常规行全脊髓MRI检查 ,以便及早发现后脑及脊髓病变     

青少年特发性脊柱侧凸患者颅颈交界处的脑脊液动力学特征的MR比较研究

目的 本研究旨在明确青少年特发性脊柱侧凸(AIS)患者颅颈交界处是否亦存在脑脊液阻塞及其与小脑扁桃体位置、枕骨大孑L大小及体表皮层诱发电位异常的相关性.方法 对30例AIS和30例年龄、性别匹配的正常对照组进行常规和相位对比法核磁共振检查.在枕骨大孑L处蛛网膜下腹侧和背侧分别选择4个兴趣Ⅸ测量两组的脑脊液流动峰值速度.在正中矢状面上测量小脑扁桃体相对枕骨大孔连线的位置,枕骨大孔前后径、横径以及面积.将测量参数与体表皮层诱发电位进行相关性分析.结果 AIS患者枕骨大孔处脑脊液流动速度峰值与正常对照组差异无统计学意义.尽管AIS患者中有50％的小脑扁桃体低于枕骨大孔连线1 mm且位置明显低于正常对照组,其枕骨大孔的前后径及面积明显大于正常对照组,小脑扁桃体位置和枕骨大孔面积呈明显负相关.体表皮层诱发电位止常和异常的AIS患者脑脊液流速以及枕骨大孔形态均无明显差异.结论 尽管A1S患者存在低位小脑扁桃体,但其枕骨大孔处脑脊液流动并无明显阻塞,这可能是山于小脑扁桃体位置越低者其枕骨大孔越大而产生的中和代偿结果.AIS患者的体表皮层诱发电位异常亦与其枕骨大孔处的脑脊液流动无相关性.     

青少年特发性脊柱侧凸的全脊柱三维MRI特点及与侧凸严重度相关性研究

目的 研究青少年特发性脊柱侧凸(adolescent idiopathic seoliosis,AIS)的MRI特征性变化,探讨AIS的MRI特征性变化与侧凸严重度的相关性.方法 应用三维莺建MRI技术对90例青少年(49例AIS,41名健康青少年)进行全脊髓脊柱和后脑MR检查.测量颈椎和胸椎各节段的脊髓最大前后径(AP)、最大横向直径(TS)和凸凹侧脊髓旁间隙(LCS)、小脑扁桃体与枕骨大孔基线的距离、齿突与枕骨大孔基线的距离、颈髓中轴线与延髓中轴线夹角(α)、枕骨大孔基线与延髓中轴线夹角(β)、脊髓面积、椎管面积、脊髓椎管面积比,测量脊髓全长、脊柱全长、脊髓脊柱全长比.结果 与健康对照组相比,AIS患者的AP、TS、AP/TS 和LCS比值明显增加,小脑扁桃体位置相对枕骨大孔明显下移,脊髓圆锥位置相对上移,β角减小,脊髓椎管面积比增大(P＜0.01);AIS组与对照组相比,全脊髓或全脊柱长度差异无统计学意义,但脊髓脊柱全长比明显减小(P＜0.01),与Cobb角无明显相关性.AP、AP/TS和LCS比值与Cobb角明显正相关(P＜0.05).结论 AIS患者在脊髓和脊柱的横断面上存在显著性形态学异常,部分与Cobb角有明显正相关;脊髓和脊柱纵轴上存在明显的脊髓牵拉受限,提示可能存在神经系统和骨骼系统的生长不平衡,这些可能与AIS的发病机制有关.     

青少年特发性脊柱侧凸大弯度患者脊髓圆锥位置的MRI研究

目的探讨青少年特发性脊柱侧凸(AIS)患者的脊髓圆锥位置及其与患者年龄、性别、侧凸严重程度和侧凸模式之间的关系。方法对202名 Cobb 角40°以上的 AIS 患者和52名对照组青少年进行腰椎 MRI 扫描,在矢状面自旋回波 T1WI 序列图像上,观测脊髓圆锥末端的位置,并根据圆锥末端与相邻的椎体的上、中、下1/3和椎间盘的对应关系进行定位。结果 AIS 组和对照组青少年的圆锥位置范围分别为 T_(12)中1/3～L_(2/3)椎间盘和 T_(12)下1/3～L_2下1/3,平均位置则均为 L_1下1/3水平。两组间圆锥位置分布无统计学差异。这两组青少年的圆锥位置不受年龄和性别的影响。在AIS 组内,圆锥位置与侧凸的严重程度和侧凸模式无显著相关性。结论 AIS 患者的圆锥位置分布与对照组相当,圆锥位置不受年龄、性别、侧凸严重程度和侧凸模式等影响。这提示,圆锥位置的改变不能用于对 AIS 的发病及进展的研究。     

体感诱发电位检查在先天性脊柱侧凸神经功能评估中的价值

目的 探讨体感诱发电位(SEP)检查在伴脊髓发育畸形的先天性脊柱侧凸(CS)中的诊断价值.方法 回顾性分析2001年9月到2007年9月诊治的187例CS患者临床资料,其中男性85例,女性102例;年龄3～22岁,平均13.8岁.所有患者均行全脊髓磁共振检查判断是否存在脊髓发育畸形.分析术前SEP的峰潜伏期及左、右侧峰潜伏期差值.SEP波形消失、峰潜伏期延长及峰潜伏期不对称定义为SEP异常.比较有无脊髓发育畸形患者的临床特征及SEP异常发生率的差异.结果 共有32例患者伴脊髓发育畸形.CSⅢ型(混合型)伴脊髓发育畸形比例(30.8%)高于Ⅰ型和Ⅱ型(P＜0.05).伴脊髓发育畸形组平均侧凸Cobb角大于无脊髓发育畸形组(P＜0.05),而两组平均后凸Cobb角差异无统计学意义(P＞0.05).伴脊髓发育畸形组SEP异常率与无脊髓发育畸形相比,差异有统计学意义(x2=4.70,P＜0.05).结论 SEP检查可以评估CS患者的神经功能状态,对CS伴脊髓发育畸形具有辅助诊断价值.     

青少年特发性脊柱侧凸患者颅颈交界区脑脊液动力学研究

目的探讨青少年特发性脊椎侧凸（adolescentidiopathicscoliosis,AIS）患者颅颈交界区脑脊液动力学异常与小脑扁桃体位置及枕骨大孔前后径的关系。方法用磁共振对比检测32例AIS患者及30例正常人,计算脑脊液头端流向尾端即向下（downflow,DF）时相持续时间,尾端流向头端即向上（upflow,UF）时相持续时间,二者在脑脊液循环时间内所占比率（DF比率及UF比率）,DF流动的起始时间（downflowstartpoint,DS）比率,静止期（stationary．phase,SP）比率,脑脊液向下流动最大流速（VDmax）,向上流动最大流速（VDmax）,绘制最大流速／时问曲线。测量小脑扁桃体相对枕骨大孔连线位置及枕骨大孔前后径。结果侧凸组与对照组相比,DS比率及SP比率明显增高,DF比率明显减低,枕骨大孔前后径明显增大,差异有统计学意义（P〈0．05）;UF比率、VDmax、及VDmax、差异无统计意义（P〉0．05）。侧凸组56．3％小脑扁桃体位置低于枕骨大孔连线。结论AIS患者存在颅颈交界区脑脊液动力学改变,考虑与脊柱脊髓生长不平衡导致脊髓牵拉,小脑扁桃体下移有关。枕骨大孔虽发生适应性增大,但仍不能完全代偿。     

对无脊髓发育畸形先天性脊柱侧凸患者体感诱发电位的检测及临床意义

目的:探讨体感诱发电位(SEPs)检查在先天性脊柱侧凸(CS)患者术前评估中的价值。方法:对152例不伴脊髓发育畸形的CS患者术前行SEPs检查,观察SEPs峰潜伏期及左、右侧峰潜伏期差值。SEPs波形消失、峰潜伏期延长及左右侧峰潜伏期不对称定义为SEPs异常。计算CS患者SEPs异常的发生率,分析SEPs异常与CS的类型、侧凸及后凸严重程度的相关性。结果:4例术前下肢不完全瘫的CS患者SEPs均表现为异常波形。术前临床体检无神经损害的患者60例(40.5%)存在SEPs异常。CSⅠ型和Ⅲ型患者的SEPs异常率分别为50.5%和47.1%,明显高于Ⅱ型患者的10.0%(P0.05)。单纯侧凸的50例患者中,仅有1例伴椎体旋转半脱位(2%)患者表现为SEPs峰潜伏期延长、双侧潜伏期不对称;102例侧后凸患者中有63例(61.8%)SEPs异常。SEPs正常组平均侧凸Cobb角(66.8°±27.1°)与SEPs异常组(65.2°±26.7°)无明显差别(P0.05),而SEPs异常组的后凸Cobb角(69.7°±21.7°)比SEPs正常组(50.9°±23.1°)明显偏大(P0.05)。角状后凸畸形患者SEPs异常率(69%)明显高于平滑后凸畸形患者(45.2%)(P0.05)。结论:CS患者术前神经功能损害的危险因素包括CSⅠ型或Ⅲ型、严重角状后凸畸形及椎体旋转半脱位。通过SEPs检查可以早期发现CS患者术前存在的神经功能损害,有利于临床评估及干预。     

伴神经损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化

目的:观察伴神经功能损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化和功能转归。方法:2005年1月~2014年1月在我院接受脊髓内移、脊柱后路矫形内固定术治疗伴神经损害的脊柱侧后凸畸形患者14例,女6例,男8例;年龄22.0±14.5岁(6~53岁)。术前均表现为双下肢麻木,其中7例伴行走不稳;双下肢病理征均为阳性。神经功能Frankel分级:C级5例,D级9例。胸弯11例,胸腰弯3例,后凸顶椎均位于侧凸顶椎区内。术前冠状面主弯Cobb角为76.9°±33.2°(65°~100°),后凸Cobb角为71.5°±31.8°(41°~125°)。采用加拿大XLTEK肌电诱发电位仪分别于术前和术后1周检测14例患者的体感诱发电位(SEP),术中行SEP和运动诱发电位(MEP)监测。在MRI上测量顶椎区凸侧脊髓外缘至椎管内缘距离,计算脊髓内移距离。结果:术前胫后神经SEP P40的波幅与峰潜伏期为1.67±0.38μV和38.96±2.51ms,术中为1.69±0.36μV和38.15±2.14ms,术中与术前比较波幅与峰潜伏期均无显著性变化(P0.05)。术后冠状面主弯Cobb角矫正率为(50.3±20.6)%(14.5%~85%),后凸Cobb角矫正率为(39.0±17.7)%(20.8%~57.9%);顶椎区脊髓位置平均内移2.3±1.6mm(0.6~4.4mm)。术后1周时胫后神经SEP P40波幅与潜伏期为2.10±0.35μV和35.54±2.12ms,与术前比较明显改善(P0.05)。神经功能均有明显改善。结论:脊髓内移后路矫形内固定治疗伴神经损害的脊柱侧后凸畸形术后患者神经电生理指标和神经功能均明显改善。     

Comparison of somatosensory evoked potentials between adolescent idiopathic scoliosis and congenital scoliosis without neural axis abnormalities

Background contextAbnormal somatosensory evoked potentials (SEPs) have been documented in patients with adolescent idiopathic scoliosis (AIS) with different cure severity. However, few studies investigated whether abnormal SEPs were the cause or effect of idiopathic scoliosis.PurposeThe purpose of this study was to investigate the significance of abnormal SEPs in patients with AIS, and to explore its effect on the etiopathogenesis of AIS.Study design/SettingThis study evaluated SEPs in patients with AIS and congenital scoliosis (CS) with similar curve pattern and severity both in coronal and sagittal planes.Patient sampleFemale patients with AIS and CS in our spine surgery center from 2000 to 2009 were recruited for this study.Outcome measuresRate of abnormal SEPs.MethodsPosterior tibial nerve SEPs (PTN-SEPs) were performed on female patients with AIS and CS. The inclusion criteria were patients with AIS with a Lenke type 1 curve and patients with CS with right thoracic curve (apex between T5 and T12) and normal sagittal profile (kyphosis less than 50° measured from T2 to T12). All patients were evaluated with total spine magnetic resonance imaging, and those with neural axis abnormalities were excluded. The patients with neurological deficits on detailed physical examination were also excluded. Absence of SEPs waveforms or prolongation of peak latency or asymmetrical peak latency were defined as pathological change. The incidence of pathological SEPs and clinical characteristics were compared between patients with AIS and patients with CS.ResultsForty-six patients with AIS and 33 patients with CS were included in this study. There was no significant difference in coronal and sagittal Cobb angle between the two groups. The rate of abnormal SEPs was 32.6% (15/46) and 12.1% (4/33) in AIS and CS groups, respectively, and the difference was statistically significant (p<.05).ConclusionSomatosensory pathway dysfunction could be found in both AIS and CS without neural axis abnormalities, and the patients with AIS tended to have higher rates of somatosensory disorders than patients with CS with similar scoliosis curve, which indicates that both scoliosis curve and primary etiopathogenic factor contribute to the sensory deficit in patients with AIS.     

体感诱发电位皮层成份在监测脊柱手术中的作用

目的：评价监测体感染诱发电位（ＳＥＰ）Ｎ２０、Ｐ４０波在脊柱手术时的方法及意义。方法：对２２例脊柱手术病人进行上肢或下肢ＳＥＰ监测并进行术后随访。结果：１０例病人的Ｎ２０、Ｐ４０波潜延长大于１ｍｓ,波幅降低大于５０％,３例波形完全消失,但只有１例术后神经症状加重。结论：脊柱手术时仅则上肢或下肢ＳＥＰ皮层成份意义较小,需做多形式监测;判断时除既往异常标准外,需注意ＳＥＰ异常持续的时间及潜伏期无明显变     

正中神经体感诱发电位在脊髓型颈椎病手术预后评估中的作用

目的回顾性分析正中神经体感诱发电位（somatosensory evoked potential,SEP,）的检测结果和分型在脊髓型颈椎病（cervical spondylotic myelopathy,CSM）手术预后评估中的作用。方法随访76例接受手术治疗的CSM患者,男49例,女27例;年龄55—74岁,平均62．4岁。将术前检测SEP的波形分为5型：Ⅰ型为正常SEP,Ⅱa型为单独幅值异常,Ⅱb型为单独潜伏期异常,Ⅲ型为幅值和潜伏期同时异常,Ⅳ型为SEP消失。根据术前和术后随访的JOA评分评估临床症状和计算康复率,统计分析SEP与临床数据之间的相关性。结果SEPⅠ型18例,Ⅱa型16例,Ⅱb型17例,Ⅲ型14例,Ⅳ型11例。SEP与术前JOA评分有显著相关性（X^2=53．9,P〈0．05）。比较术后2年随访时的康复率发现Ⅰ型和Ⅱa型、Ⅱb型和Ⅲ型之间无显著性差异,而Ⅰ型和Ⅱa型、Ⅱb型和Ⅲ型、Ⅱb型和Ⅳ型之间有显著性差异（独立样本检验,P〈0．05）。结论SEP分型为临床提供客观、有价值的信息,有助于准确了解脊髓的受损程度和评估手术预后。     

Somatosensory evoked potentials and spinal cord perfusion pressure are significant predictors of postoperative neurologic dysfunction

Paraplegia after thoracoabdominal aneurysm repair can occur in 3% to 40% of patients. This study investigated the efficacy of cerebrospinal fluid (CSF) drainage to protect the spinal cord during aortic cross-clamping (AXC) and the interrelationship between drainage, spinal cord perfusion pressure (SCPP), and changes in somatosensory evoked potentials (SEP) in a canine model of spinal cord ischemia. SCPP was defined as the mean distal aortic pressure minus the CSF pressure. In the experimental group, CSF was drained before AXC. SEP changes were quantitated as time to latency increase of 10% (L-10) and time to complete SEP loss. Drainage of CSF had no significant effect on the distal aortic pressure but significantly increased SCPP from 9.4 to 21.8 mm Hg and decreased the incidence of postoperative neurologic injury. Ischemic SEP changes were highly significant predictors of postoperative neurologic injury, occurring more than two times earlier in the paralyzed and paraparetic animals. Dogs without neurologic injury had significantly higher SCPP, delayed L-10 time, and delayed SEP loss.     

Diagnostic validity of somatosensory evoked potentials in subgroups of patients with sciatica

The diagnostic utility of scalp-recorded somatosensory evoked potentials (SEP) in patients with sciatica has generally been regarded as low. The purpose of the present study was to determine the validity of sensory nerve SEP in different subgroups of sciatic patients. A total of 65 consecutive patients with sciatica showing disc pathology and/or facet joint hypertrophy on lumbar computed tomography (CT) and/or myelography were studied. Symptomatic myelographically compressed nerve roots were defined as truly compromised roots. Asymptomatic myelographically normal nerve roots were defined as truly normal roots. Bilateral sensory nerve SEP representing nerve roots L4, L5, and S1 were performed in all patients. Evaluation of SEP included the use of P1 latency inter-root comparison. The false-positive rate of SEP was low. Pathological L4, L5, and S1 SEP therefore strongly indicate true compromise of the corresponding nerve roots. The true-positive rate was higher in patients with facet joint hypertrophy with or without additional disc disease than in patients with disc pathology only, and highest if the sciatic sensory symptoms were present during the SEP registration. Diagnostic validity was not influenced by previous episodes of sciatica, the duration of the present episode, or the number of spinal levels with ipsilateral myelographically compressed nerve roots. Pathological SEP strongly indicate sensory radiculopathy in patients with sciatica. Diagnostic efficacy is higher in patients with facet joint hypertrophy than in patients with disc pathology only and highest when the sciatic symptoms are present during registration.     

Continuous monitoring of short-latency somatosensory evoked potentials during cardiac and aortic surgery

The effectiveness of monitoring somatosensory evoked potentials (SEPs) intraoperatively to detect brain damage early remains controversial. To assess the diagnostic accuracy of this modality, a study was conducted between 1991 and 1994, recording SEPs in 287 consecutive patients undergoing cardiac and aortic surgery using cardiopulmonary bypass (CPB) with moderate hypothermia or deep hypothermic circulatory arrest. From P1 to N2 of the SEPs occurring within 50 ms latency in response to electrical stimulation of the median nerve were recorded over the contralateral postcentral cortex at 5-min intervals using a Neuropack-2 (Nihon Koden, Tokyo, Japan). Normal SEPs were recovered in 247 patients postoperatively; however, 2 of these patients had suffered a cerebral infarction and 1, a transient stroke intraoperatively, demonstrating a false-negative incidence of 1.2%. On the other hand, three different types of abnormal SEPs were recorded postoperatively. P1 and N1 absence, probably caused by a subcortical lesion, was observed in 4 patients; P2 and N2 absence, probably caused by a cortical lesion, was observed in 8 patients; and a flat SEP, representing diffuse damage, was observed in 2 patients. Among these 14 patients with abnormal SEPs, 7 showed no neurologic disturbance at all, demonstrating a false-positive incidence of 50%. Thus, we concluded that when normal SEPs are recovered during weaning from CPB, the incidence of brain damage could be predicted at below 5%. Conversely, when abnormal SEPs are demonstrated, the incidence of brain dysfunction impeding a return to active life is estimated to be about 70%.     

体感诱发电位在腰椎间盘突出症患者功能评定中的应用简

目的探讨体感诱发电位技术在腰椎间盘突出症患者下肢感觉功能评定中的临床应用。方法腰椎间盘突出症患者64例,按照下肢感觉神经功能是否合并下肢麻木,分为疼痛组（A组）和麻木组（B组）。分别采集两组患者的体感诱发电位,分析P40峰潜伏期变化。结果主要表现为P40峰值潜伏期延长,两组患者体感诱发电位检测阳性率分别达91．7％、92．8％,A、B两组患者患侧P40峰潜伏期较健侧均降低（P〈0．05）,组间比较：两组患者健侧P40峰潜伏期比较差异无统计学意义（P〉0．05）,B组较A组患者患侧P40峰潜伏期及两侧间差异值均降低（P〈0．05）。结论体感诱发电位检测可以作为一种无创检测腰椎间盘突出症及评定下肢感觉神经功能状态的工具。     

体感诱发电位在椎体后凸成形术中的脊髓监测

目的探讨体感诱发电位（SEP）在椎体后凸成形术（PKP）中的脊髓监测作用。方法33例46个椎体行PKP,术中均予SEP监护。结果46个椎体疼痛均好转,椎体复位良好,2例出现波幅降低,1例出现潜伏期延长,无重大并发症。结论SEP在PKP中对脊髓有良好的监测作用。