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.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

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。     

吸入不同浓度七氟醚复合麻醉对青少年脊柱侧弯矫形术患者体感诱发电位的影响

目的 探讨吸入不同浓度七氟醚复合麻醉对青少年脊柱侧弯矫形术患者体感诱发电位(SEP)的影响.方法 择期全麻下行脊柱侧弯矫形手术的青少年患者45例,性别不限,年龄12～17岁,体重指数15 ～ 23 kg/m2,采用随机数字表法,将其随机分为3组(n=15):低、中、高浓度七氟醚组(S1组、S2组和S3组).静脉注射芬太尼4μg/kg、咪达唑仑0.03 mg/kg、异丙酚2.0 mg/kg和罗库溴铵0.6 mg/kg麻醉诱导,气管插管后进行机械通气.静脉输注异丙酚8 mg·kg-1·h-1、瑞芬太尼0.25mg· kg-1·min -1维持麻醉.3组手术开始后分别吸入1.8％、4.0％、6.0％七氟醚10 min,记录SEP显著抑制的发生情况;分别于吸入七氟醚前和吸入七氟醚10 min时记录胫后神经SEP的P40潜伏期、P40-N50波幅、P40波形改变时间和停止七氟醚吸入后P40波形恢复时间,计算P40潜伏期延长百分比和P40-N50波幅降低百分比.结果 S1组、S2组和S3组SEP显著抑制发生率分别为80％、100％和100％(P＞0.05).与S1组比较,S2组和S3组P40潜伏期延长百分比和P40-N50波幅降低百分比升高,P40波形改变时间缩短,P40波形恢复时间延长(P＜0.05);与S2组比较,S3组P40-N50波幅降低百分比升高,P40波形改变时间缩短,P40波形恢复时间延长(P＜0.05).结论 1.8％、4.0％、6.0％七氟醚复合麻醉均可抑制青少年脊柱侧弯矫形术患者SEP,不宜用于临床上需行SEP监测的手术.     

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.     

对青少年特发性脊柱侧弯患者的体感诱发电位检查

本体感觉神经传导异常被认为与青少年特发性脊柱侧弯有关。用体感诱发电位检查在青少年特发性脊柱侧弯患者中是否合并存在本体感觉传导通道的功能异常。研究包括147例青少年特发性脊柱侧弯患者及31位同年龄分布正常对照。对每一位受试者检查胜后神经体感皮质诱发电位，电信号缺失、传导时间延长或双侧传导时间不对称为本体感觉传导通道结构性异常诊断指标。在脊柱侧弯患者中有7人电信号单或双侧缺失，其余140例脊柱侧弯患者中10例传导时间延长，其中4例双侧延长，6例单侧延长。结果证实，部分青少年特发性脊柱侧弯患者同时有本体感觉传导异常，提示青少年特发性脊柱侧弯可进一步分为有本体感觉传导异常及无异常两组。     

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.     

经颅刺激运动诱发电位联合体感诱发电位监测在脊柱畸形手术中的应用

 目的分析联合应用经颅刺激运动诱发电位(transcranial electric stimulation motor evoked potential, TcMEP)+体感诱发电位(somatosensory-evoked potential, SEP)的多模式术中神经功能监测对预 测脊柱畸形矫形手术中医原性神经功能损害的意义。方法 在脊柱畸形矫形手术中, 同时应用 TcMEP 和(或)SEP进行神经功能监测。 MEP监测采用经颅刺激 ₃、C₄, 记录外周肌源性 MEP, SEP监测采用刺 激双侧胫后神经, 记录置于 C_z-FP_z。阳性诊断标准为, 与基线相比, MEP波幅下降 75%, SEP波幅下降 50%。结果 153例脊柱畸形患者中, 150例成功进行了术中 MEP监测, 83例进行了术中 SEP监测。联 合 MEP、SEP监测的检出率为 100%。MEP监测阳性共 12例, 所有患者中有 1例出现永久性神经功能障 碍, 4例出现一过性神经功能障碍。 MEP监测的敏感性为 90.9%, 特异性为 98.6%; SEP监测敏感性为 54.5%, 特异性为 94.3%;联合 MEP、SEP监测的敏感性达 92.3%, 特异性为 99.3%。结论 联合 MEP+ SEP的多模式术中神经功能监测可提高监测的敏感性及特异性, 可预测术中神经功能损伤事件的发生。 MEP是多模式监测的基础, 而 SEP是重要补充。     

青少年脊柱侧凸畸形患者超声心动图异常分析:特发性脊柱侧凸与先天性脊柱侧凸的比较

背景:脊柱畸形患者可合并有超声心动图(ultrasonic cardiography,UCG)结果异常,但文献中缺乏特发性脊柱侧凸(idiopathic scoliosis,IS)与先天性脊柱侧凸(congenital scoliosis,CS)患者UCG异常的比较.目的:比较青少年IS患者与CS患者UCG结果异常的发...     

经颅电刺激运动诱发电位和皮层体感诱发电位在脊柱侧凸手术中联合监护的观察研究

目的 探讨脊柱侧凸手术中经颅电刺激运动诱发电位(transcranial electrical stimulation motor evoked potential,TES-MEP)和皮层体感诱发电位(cortical somatosensory evoked potential,CSEP)联合监护的可行性和应用价值.方法 2006年7月至2008年4月,在脊柱侧凸手术中同时记录双侧胫前肌、足(足母)短屈肌TES-MEP和双侧胫后神经CSEP 76例.实施全静脉麻醉49例,七氟烷(吸入浓度＜1%)+异丙芬复合麻醉27例.对各麻醉组的TES-MEP检出结果 进行四格表χ2检验,并对术中两种电位的真、假阳性和真、假阴性结果 进行相关的指数统计分析.结果 TES-MEP和CSEP成功检出率均为96.1%,而两种麻醉组的TES-MEP检出率差异无统计学意义.术中诱发电位阳性11例,其中9例为真阳性,均与手术操作不当直接有关.CSEP、TES-MEP、联合监护的灵敏度分别为75.0%、87.5%和100%,特异度分别为98.5%、98.5%和97.0%,约登指数分别为0.74、0.86和0.97.结论 实施异丙芬静脉麻醉为主,辅以七氟烷吸入浓度＜1%的复合麻醉,也是联合监护切实町行的麻醉方案;联合监护对脊髓功能监测的敏感性和准确性明显高于单一的TES-MEP或CSEP监护.