术中体感诱发电位改善对颈椎病患者术后脊髓功能恢复的预测

背景体感诱发电位脊髓功能监护操作较为简单,结果较为可靠,是目前广为采用的术中脊髓监护方法.目的评估术中脊髓功能监护时体感诱发电位信号的改善对颈椎病患者术后脊髓功能的预测价值.设计以患者为观察对象,非随机化同期对照研究.单位协和医院骨科.对象在北京协和医院骨科2001-01/10接受手术治疗的颈椎病患者34例,前路减压植骨融合术24例,后路单开门手术3例,双开门手术7例.根据术中体感诱发电位的变化将患者分为体感诱发电位改善组12例,体感诱发电位无变化组22例.方法对所有患者的神经损伤情况,采用日本骨科学会评分系统(JOA)分别于术前,术后1,2,4周,3,6个月进行评分.每例患者在术中均接受体感诱发电位脊髓监护,并将体感诱发电位信号的变化分为改善(波幅增加50%以上或潜伏期减少10%以上),减弱(波幅降低50%以上或潜伏期延长10%以上)和无变化.主要观察指标①两组患者各时间点JOA评分.结果按意向处理分析,34例患者均进入结果分析.术后1,2周检查JOA评分体感诱发电位改善组较体感诱发电位无变化组明显提高[(14.08±1.44)分,(14.17±1.11)分,(12.73±1.42)分,(12.86±1.28)分,P＜0.05],术后4周及3个月和6个月随访检查,JOA评分体感诱发电位改善组与体感诱发电位无变化组基本相似[(14.00±1.04)分,(13.58±1.08)分,(13.68±1.61)分,(13.82±1.01)分,(13.41±1.22)分,(13.41±1.47)分,P＞0.05].结论颈椎病患者术中SEP监护信号的改善可以预示术后早期良好的临床效果.

Intraoperativeimprovements of somatosensory evoked potentials in predicting the clinical outcome of thesurgery for cervical spondylosis

BACKGROUND: Spinal somatosensory evoked potential(SEP) monitoring is widely used intraoperatively due to the easiness to operate and its reliability.OBJECTIVE: This study was designed to assess the significance of improving SEP signals in intraoperative spinal monitoring on predicting the post-operative spinal function.DESIGN: A non-randomized concurrent controlled study was conducted on selected patients.SETTING: This study was conducted at the Orthopedic Department of Peking Union Medical College Hospital.PARTICIPANTS: Totally 34 patients with cervical spondylosis underwent surgical treatment at the Orthopaedic Department of Peking Union Medical College Hospital were selected from January to October in 2001. Of all the patients, 24 underwent anterior decompression and fusion, 3 single door operation and 7 double door operation. According to the variance of intraoperative SEP, the patients were divided into the improvement group(12 cases)and the non-improvement group(22 cases).METHODS: All the patients' neurologic deficits were assessed according to the Japanese Orthopaedic Association scoring system(JOA score), prior to operation and postoperative week 1, 2, and 4 and month 3, 6. Each patient received the intraoperative spinal SEP monitoring. The variance of SEP signals in amplitude and latency were classified as improvement(an increase in amplitude of 50% or more, or a decrease in latency of 10% or more), decrease(a decrease in amplitude of 50% or more, or an increase in latency of 10% or more), and no improvement.MAIN OUTCOME MEASURES: JOA scores were calculated in two groups in the study at all time points.RESULTS: All the 34 patients entered the statistical analysis procedure. In postoperative week 1 and week 2, the improvement group showed a larger increase in JOA score than the non-improvement group did[improvement group:(14.08±1.44), (14.17±1.11) points; no improvement group:( 12.73 ± 1.42), ( 12.86 ± 1.28)points, P ＜ 0.05]. In postoperative week 4, month 3 and month 6, both groups showed an increase in JOA scores [improvement group: (14.00±1.04), (13.58±1.08), (13.68±1.61)points; no improvement group: (13.82 ± 1.01), (13.41 ± 1.22), (13.41± 1.47)points], but there was no significant difference( P ＞ 0.05).CONCLUSION: Improvement of intraoperative SEP can be used to predict the good early clinical outcomes in surgery for cervical spondylosis.