特发性脊柱侧凸患者体感诱发电位研究

特发性脊柱侧凸存在多种解剖畸形,对心肺生理功能影响已有较多研究报告。为探讨脊柱侧凸对脊髓生理功能的影响,作者观察了Ｃｏｂｂ角６０°以上特发性脊柱侧凸患者体感诱发电位的变化。临床资料脊柱侧凸患者６８例,男３６例,女３２例,平均年龄１８６岁（１２～３６...     

皮层体感诱发电位（CSEP）在脊柱手术中的监护作用

作者总结了４８例脊柱手术的ＣＳＥＰ监护结果，介绍了术中ＣＳＥＰ的变化及脊髓损伤的指标。提示术中损伤脊髓的危险操作其大小依次是脊柱凹侧撑开，椎板下穿入Ｌｕｑｕｅ钢线，胸椎ＣＤ椎板钩放则驼背截骨较安全。除非已有胸椎椎管狭窄，否则，凿椎板时损伤脊髓机会较少，Ｈａｒｉｎｇｔｏｎ钩及腰段ＣＤ钩的放置及前路椎间盘切除最安全。     

127例脊柱侧凸术中皮层体感诱发电位特点的分析

目的: 回顾分析 127例脊柱侧凸矫形手术术中皮层体感诱发电位的特点。方法: 127例脊柱侧凸手术采用皮层体感诱发电位监测, 电刺激胫后神经, 颅顶正中脑皮质足区放置表面记录电极。以基准线为判断基础, 当波幅下降超过 50%以上为阳性。结果: 在 127例监测中, 皮层体感诱发电位阳性者且与临床相符 3例。结论: 皮层体感诱发电位 (CSEP) 是目前首选的监测方法, 再组合皮层下诱发电位监测, 可进一步提高监测质量。     

皮层下体感诱发电位监测脊柱侧凸手术的临床研究

目的：研究皮层下体感诱发电位对脊柱侧凸矫正手术监测的准确性,提高术中预防神经损伤的有效性。方法：对４１例脊柱侧凸患者于矫正术中采用皮层下体感诱发电位和皮层体感诱发电位监测脊髓功能。结果：皮层下体感诱发电位波形稳定可靠,很少受麻醉的影响;皮层体感诱发电位受麻醉影响较大,波幅几乎可消失。全组５例皮层下体感诱发电位出现异常,其中２例与临床相符,３例为假阳性;无假阴性发生。准确率为９２７％。结论：应用体感诱发电位术中监测脊髓功能,皮层下体感诱发电位是目前较理想的方法。     

皮层诱发电位(CSEP)在脊柱手术监护中的应用

目的：通过术中皮层诱发电位监护减少术中脊髓损伤。方法：用体感诱发电位仪对68例脊柱手术行CSEP监护。结果：68例中，56例术中即出现波形改善；11例术中监护及术后波形无改变；仅1例术中监护未见异常，而术后出现不全瘫，16h后恢复。结论：术中皮层诱发电位监护可有效降低脊柱手术后四肢瘫的发生并可预测患者术恢复程度。     

体感诱发电位联合运动诱发电位在Chiari畸形伴脊柱侧凸后路矫形手术中的应用价值

目的:评估体感诱发电位(somatosensory evoked potentials,SSEPs)联合经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCe MEPs)在Chiari畸形伴脊柱侧凸患者脊柱后路矫形手术中的应用价值。方法:选取2013年10月~2015年7月在鼓楼医院行脊柱后路矫形手术的63例Chiari畸形伴脊柱侧凸患者,均行术中SSEPs监测,其中50例患者行TCe MEPs监测。回顾性分析患者的术中SSEPs和TCe MEPs等神经电生理监测资料。分别计算单模式SSEPs、单模式TCe MEPs和联合应用SSEPs与TCe MEPs的成功率、报警率、真假阳性率、真假阴性率、阳性预测值、阴性预测值、监测的敏感性和特异性。采用卡方检验比较三种监测模式的监测结果。结果:单模式SSEPs监测成功率为95%,单模式TCe MEPs监测成功率为96%,联合应用SSEPs和TCe MEPs监测成功率为100%;单模式SSEPs监测敏感性为100%,特异性为95%;单模式TCe MEPs监测敏感性为100%,特异性为98%;联合应用SSEPs和TCe MEPs监测敏感性和特异性均为100%;三种监测模式的阴性预测值均为100%;三种模式之间比较均无统计学差异(P0.05)。单模式SSEPs监测阳性预测值为25%,单模式TCe MEPs监测阳性预测值为50%,联合应用SSEPs和TCe MEPs监测阳性预测值为100%;三种模式之间比较存在统计学差异(P0.05)。结论:SSEPs和TCe MEPs监测不同的神经传导通路,联合应用两种监测方法可提高Chiari畸形伴脊柱侧凸患者脊柱后路矫形手术中监护的预警价值,获得满意的监护成功率、敏感性及特异性。     

脊柱侧凸患者的体感诱发电位研究

[摘要]目的：探讨对脊柱侧凸患者进行脊髓功能神经电生理评定时,皮节体感诱发电位（DSEP）与皮层体感诱发电位（CSEP）的阳性率。方法：对58例脊柱侧凸患者行术前DSEP与CSEP检查,观察两者峰潜伏期、左右侧峰潜伏期差值以及波幅差值。     

脊柱外科术中皮层体感诱发电位监护与临床研究

脊柱外科术中脊髓功能的监测方法有：①术中唤醒试验；②皮层体感诱发电位（cortical somatosensory evoked potential，CSEP）监护；③运动诱发电位监测。（moter evoded potedntial，MEP）监护。CSEP监测．近几年在脊柱手术中应用逐渐增多．尽管有许多局限性．但由于操作简单，容易记录、重要性好。不影响手术视野．不需禁用肌松药等优点．在脊柱手术中有一定的实用价值。本院自2004年7月至2005年11月．有选择性对部分重大疑难脊柱手术行术中CSEP监护．大大减少了脊柱外科手术中脊髓损伤的机会．增加手术安全性．并具有法医学上的潜在价值。     

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.     

皮层体感诱发电位监护在胸椎管狭窄症手术中的应用

目的：探讨皮层体感诱发电位（CSEP）监护在胸椎管狭窄症手术中的应用价值。方法：自2000年4月～2003年11月共有32例胸椎管狭窄症患者接受术中体感诱发电位监护，男21例，女11例，年龄38～75岁；其中单纯胸椎黄韧带骨化症13例，胸椎间盘突出症合并胸椎黄韧带骨化症10例，胸椎间盘突出症合并胸椎孤立后纵韧带骨化9例。单纯胸椎后路全椎板切除术4例，单纯后路全椎板截骨原位再植、椎管扩大减压术9例，全椎板截骨原位再植、环脊髓减压、椎管扩大减压成形术19例。术中均应用丹迪Key—Poim脊髓监护系统进行皮层体感诱发电位监护。结果：23例术中监护无异常，术后未出现神经系统并发症。其中12例患者术中即可见波形改善。4例术中出现波形异常，其中2例术后发生神经功能障碍。4例术中监护未见异常。术后症状加重，假阴性率12．5％。1例术中波形异常，但术后无脊髓损伤表现，假阳性率3.1％。结论：皮层体感诱发电位（CSEP）监护可及时发现术中危及脊髓的因素，但存在一定的假阳性或假阴性率。与其它监测方法合用可提高手术安全性。     

Variability of somatosensory evoked potential monitoring during scoliosis surgery

OBJECTIVE: Somatosensory evoked potentials (SEPs) of 65 patients undergoing scoliosis surgery were monitored by stimulation of posterior tibial nerve to observe variations in latencies and amplitudes. METHODS: Monitoring was divided into five stages: pre incision, spine exposure, instrumentation loading, deformity correction, and wound closure (stages 1-5, respectively). RESULTS: We found the latency showed significant increase and the amplitude significant reduction from stages 1 to 2. There was no significant variability from stages 2, 3, and 4, but both latency and amplitude recovered significantly from stage 4 to 5. This variability correlated with the changes in mean arterial pressure and end-tidal concentrations of isoflurane and was not dependent on the type of surgical procedure. If either 50% amplitude reduction or 10% latency prolongation of SEP compared with baseline recordings at stage 1 (pre incision) was used as warning criterion, the overall false-positive rate was 23.1%. It was significantly reduced to 7.7% if stage 2 (spine exposure) recordings were used as the baseline (P < 0.05). The false-positive rate decreased to 0% if a combined 50% amplitude reduction and 10% latency prolongation of SEP compared with the stage 2 baseline were used (P < 0.001). CONCLUSION: Based on these findings, we concluded that the time to obtain SEP baseline data should be adjusted to be post incision instead of pre incision.     

Intraoperative somatosensory evoked potential monitoring in scoliosis

During surgical correction of scoliosis, 63 patients had somatosensory evoked potential (SEP) monitoring of the spinal cord. Tibial nerves were unilaterally stimulated, and the potentials were recorded from the midcervical spine with surface and epidural needle electrodes. Over 85% had no significant change in their SEP and no postoperative neurologic deficits. Eleven percent had a significant change in their potential (amplitude decrease of greater than 60% and/or latency increase of greater than 2.5 msec) with no neurologic complications. One patient had a significant potential change and temporary postoperative sensory deficits did occur. One additional patient experienced postoperative neurologic complications but had no SEP change. This single false negative case, however, was clinically significant only for motor dysfunction, which is not monitored by the SEP. When changes in patient core temperature were compared to changes in SEP amplitude and latency, an intraoperative decrease in core temperature increased SEP latency and decreased amplitude, which may explain in part the false positive rate of the procedure.     

Intra-operative spinal cord monitoring during surgery for scoliosis using somatosensory evoked potentials

The method of intra-operative monitoring of spinal cord function by spinal somatosensory evoked potentials (SEP), as used at the Royal Alexandra Hospital for Children during surgery for scoliosis is described. Using a non-polarisable platinum spinal epidural electrode, SEP elicited by tibial and peroneal nerve stimulation in the popliteal fossa are recorded proximal to the level of spinal correction. The large amplitude and discrete waveform of the SEP enable rapid signal acquisition and easy interpretation. The spinal SEP is stable under both therapeutic hypotension and general anaesthesia. Electrophysiological monitoring has now superceded the 'wake-up' test as an index of spinal cord function during corrective surgery for scoliosis.     

颈椎病前路手术中体感诱发电位监护临床研究

目的探讨体感诱发电位监护(SSEP)在颈椎病前路手术中的应用价值。方法收治颈椎病前路手术患者142例,年龄37~75岁,男96例,女46例。神经根型颈椎病35例,脊髓型颈椎病107例。对照组83例无SSEP监护,监护组59例。在麻醉诱导后和摆放体位前确立SSEP基线,波幅降低50%或潜伏期延长10%为报警标准。记录SSEP报警因素及改善措施,术后明确有无医源性神经损伤。结果对照组无医源性神经损伤。监护组:真阳性2例出现报警,采取措施后解除报警;假阳性0例;真阴性56例SSEP无报警,无医源性神经损伤;假阴性1例SSEP无报警,术后右侧三角肌麻痹;SSEP监护医源性神经损伤的敏感性和特异性分别为66.7%和100%。结论 SSEP在颈椎病前路手术中监护脊髓损伤方面较敏感,对神经根损伤不敏感。     

Variability of somatosensory cortical evoked potential monitoring during spinal surgery

The intraoperative variability of somatosensory cortical evoked potentials (SCEPs) has been measured for 320 consecutive spinal surgeries and found to be a function of patient diagnosis, neuromuscular status, age, and procedural factors. In many cases, it is likely that this variability severely limits the reliability and usefulness of spinal cord monitoring in detecting early cord compromise. Patients with idiopathic scoliosis, spondylolisthesis, and pseudarthrosis have the smallest spontaneous variability and strongest amplitudes, while those with congenital, paralytic scoliosis, stenosis, or tumor have very variable, weak SCEPs. Patients with neurologic disorders, particularly cerebral palsy, myelomeningocele, Friedreich's ataxia, and peripheral deficits, also have high variability and weak amplitudes. A monitoring quality scoring system is proposed that may be useful during surgery in judging how well the SCEPs can discern surgically related changes in cord function from background variations.     

Transcranial Doppler sonography and somatosensory evoked potential monitoring in carotid surgery

Ninety-seven patients undergoing 103 carotid operations were studied intraoperatively using somatosensory evoked potentials after median nerve stimulation (SEP) and transcranial Doppler sonography (TCD). SEP were recorded from the scalp (C3'-Fz or C4'-Fz) and from the second cervical vertebra. The amplitude of the primary cortical response (N20P25) was measured peak-to-peak. Central conduction time (CCT) resulted from the difference between the first negative cortical (N20) and cervical (N14) response. TCD was performed using a pulsed 2-MHz-Doppler device to record the mean blood flow velocity of the middle cerebral artery (Vm-MCA) transtemporally. TCD and SEP variables were registered prior to and after carotid clamping, at short intervals during the clamping period, and after declamping. Critical SEP alterations (N20P25 less than 50% and/or CCT greater than 20% compared to the preceding values) were regarded as significant indicators of cerebral ischaemia, and selective intraluminal shunting was generally based on SEP criteria. The incidence of critical SEP changes was compared to Vm-MCA reductions greater than 60% using the Chi2-test. With SEP always recordable, additional TCD monitoring was possible in only 78 patients in our series for technical or anatomical reasons. Vm-MCA reductions greater than 60% were associated with critical SEP alterations in six cases. In five patients, Vm-MCA was reduced greater than 60% without relevant SEP changes, whereas one patient with critical SEP findings had only a minor Vm-MCA reduction (33%). In the remaining 66 cases, carotid clamping was tolerated without critical SEP changes associated with Vm-MCA reductions not exceeding 60%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intraoperative spinal somatosensory evoked potential monitoring

The relationship of intraoperative monitoring of spinal cord somatosensory evoked potentials and postoperative deficit in 220 cases (121 with scoliosis, 41 with neoplasms, and 58 others) is reported. Bilateral posterior tibial nerve stimulation was used in 181 cases and unilateral median nerve stimulation in 39. Spinal cord (interspinous ligament needles), subcortical (neck surface), and cortical (scalp surface) SEP's were monitored. Seven patients had worsening of neurological function after surgery, three of whom demonstrated significant changes in SEP's monitored. In an additional four cases, there was more than a 50% decrease in amplitude of subcortical/cortical SEP's during monitoring, but no change in neurological status postoperatively. Combined monitoring of spinal cord, subcortical, and cortical SEP's enhanced the certainty of detecting spinal cord dysfunction even though there was a significant number of false-negative and false-positive results. A marked change in the SEP's indicated a high chance of developing a neurological deficit (three or 43% of seven cases), and if there was no change the chance of any neurological postoperative deficit was extremely low (four or 1.87% of 213 cases). These data justify the use of intraoperative SEP monitoring.     

Intraoperative somatosensory evoked potential monitoring in achondroplasia

Surgical airway intervention in children with achondroplastic dwarfism poses potential neurological risk secondary to the neck manipulation required for tracheal intubation and operative head positioning. This is particularly true of achondroplastic dwarfs with radiographically documented foramen magnum and spinal canal stenosis. In these children, upper extremity somatosensory evoked potential monitoring establishes the integrity of sensory conduction from peripheral nerve to cortex, providing intraoperative notification of neurologically significant cervicomedullary compression during laryngoscopy and surgical positioning.