节段性皮神经体感诱发电位对腰椎间盘突出症的诊断意义

报告５０例正常人和３２例单侧型腰椎间盘突出者在刺激节段性（根性）皮神经（腓肠和腓浅）时的腰髓电位（ＬＰ）和皮层电位（ＣＰ），结果发现ＬＰ正确定位２６例（８３％），错定位２例，阴性４例；ＣＰ正确定位１６例（５１％），错定位４例，阴性１２例。     

胫后神经体感诱发电位对脊髓病变的定位诊断

研究胫后神经体感诱发电位对脊髓病变的定位诊断价值。方法：通过经皮恒流电刺激胫后神经，采用髂棘，脐部和头皮Ｆｐｚ作参考电极，分别于第４腰柱棘突，第１２胸椎棘突和头皮Ｃｚ’置记录是极，依次记录ＣＥ、Ｎ２４和Ｐ４０电位之峰潜伏期。共检测１５例健康成人和２９例经核磁共振证实的腰骶神经根或脊髓病变患者。结果：（１）ＣＥ、Ｎ２４和Ｐ４０电位均异常，见于腰骶神经根病变；（２）ＣＥ正常，Ｎ２４和Ｐ４０异常，见于腰     

皮节刺激节段性体感诱发电位对颈、腰、骶神经根病的诊断价值

目的：探讨皮节刺激节段性体感诱发电位（DSEP）对颈、腰、骶神经根病的诊断价值。方法：对60例椎间盘突出患者和30名健康人分别进行DSEP及颈、腰、骶椎体CT扫描检查,并将结果进行比较,结果：CT异常病人的DSEP异常率（91．8％）明显高于CT正常者（27．3％）,两者有显著差异（P＜0．01）。结论DSEP可作为MRI或CT等影像学检查的一种筛选而应用于临床。     

脊髓造影对诊断腰椎间盘突出症的价值（附30例分析）

我院自1991年5月至1993年5月共收治腰椎间盘突出症65例。其中30例做了脊髓造影和CT扫描，经手术证实两种检查的准确率，以探讨脊髓造影对诊断腰椎间盘突出症的价值．     

腰椎间盘突出症的治疗进展

腰椎间盘突出的治疗方法大致分为保守治疗和手术治疗二类。保守治疗有卧床休息、牵引、理疗、全身及局部药物治疗。手术治疗有传统的后路全椎板或半椎板切除腰椎间盘摘除术、椎板间开窗腰椎间盘摘除术及前路腰椎间盘摘除术。有借助穿刺针、显微镜、腹腔镜及椎间盘镜进行的腰椎间盘摘除术。腰椎间盘摘除后或行椎间融合或行人工椎间盘置换。本文就以上问题进行综述     

骶管囊肿伴腰椎间盘突出症的手术治疗

目的 探讨骶管囊肿伴腰椎间盘突出症的手术治疗方法及疗效。方法 回顾性分析2015年1月~2017年1月手术治疗的7例骶管囊肿伴腰椎间盘 突出症的临床资料。采取小切口开窗潜行减压髓核摘除及大部分切除、肌肉填塞交通孔处理骶管囊肿。结果 术后随访10~30个月,平均15个月。术前 囊肿压迫所致神经根症状和突出椎间盘压迫所致运动感觉症状觉缓慢恢复,1例性功能障碍术后部分恢复,2例排尿困难术后恢复。结论 手术摘除突 出的髓核及同期修补骶管囊肿交通孔是有效治疗骶管囊肿伴腰椎间盘突出症的方法。     

腰硬膜外封闭与牵引治疗腰椎间盘突出症96例

采用硬膜外封闭与牵引治疗腰椎间盘突出症96例,平均随访5个月,优良率85.4%,有效率94.7%;硬膜外封闭可以消除病变部位的炎症、粘连,骨盆牵引可促使突出的椎间盘还纳,解除神经根压迫。两种方法协同应用可提高腰椎间盘突出症的治疗效果。     

腰硬膜外封闭与牵引治疗腰椎间盘突出症96例

采用硬膜外封闭与牵引治疗腰椎间盘突出症９６例,平均随访５个月,优良率８５．４％,有效率９４．７％;硬膜外封闭可以消除病变部位的炎症、粘连,骨盆牵引可促使突出的椎间盘还纳,解除神经根压迫。两种方法协同应用可提高腰椎间盘突出症的治疗效果。     

正中神经体感诱发电位在帕金森病中的诊断价值

正中神经体感诱发电位(SLSEP)顶部记录为N_(20)-P_(25)复合波,中央前记录为P_(22)-N_(30)复合波。已有的研究表明,中央前成份由运动区起源,并同运动及运动机制有关。帕金森病是由黑质-纹状体病变引起的锥体外系综合征。对该病的体感诱发电位研究国内仍未见类似报道。本文拟研究早期帕金森病的SLSEP顶、中央前成份的异常特征、病理机制及可能的诊断。     

可视化环锯辅助下椎间孔镜技术治疗脱出游离型腰椎间盘突出症

目的 探讨可视化环锯辅助下椎间孔镜技术（VPTED）治疗脱出游离型腰椎间盘突出症（LDH）的疗效。方法 回顾性分析2017年6月至2019年4月VPTED治疗的37例脱出游离型LDH的临床资料。手术前后采用视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）及日本骨科协会（JOA）评分评估手术疗效,末次随访改良MacNab标准评定疗效。结果 1例因高髂嵴及腰5横突肥大,置管困难,最终选择实施椎板间入路椎间孔镜手术;其余36例均顺利完成手术。术后随访12~24个月,平均为（18.25±6.44）个月;1例术后8个月出现同节段复发,予以内固定融合手术治疗;37例术后VAS 评分、ODI 及 JOA 评分较术前均明显改善（P<0.05）。末次随访改良MacNab标准评价临床疗效:优26例,良8例,可2例,差 1例;优良率为91.89（34/37）。结论 VPTED治疗脱出游离型LDH疗效确切,手术并发症少,操作简便、安全     

Dermatomal somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies

The diagnostic sensitivity of dermatomal somatosensory evoked potentials (DSEPs) was evaluated in a homogeneous group of fifteen patients with low back pain due to isolated lumbosacral radiculopathy. The normative values from L3 to S1 were defined, as were the parameters of abnormality. In seven patients with pseudoradicular or referred leg pain, a negative neurological examination and images indicative of protrusion or paramedian disc hernia, the DSEPs were normal in six cases and slightly altered in one. In eight patients with deafferentiation leg pain, clinical signs of root damage and images indicative of an intraforaminal hernia, the DSEPs showed varying degrees of alteration which could generally be correlated to the severity of the clinical picture.This method can therefore be useful in differentiating pain due to stimulation of the receptors of the osteoarticular structures or the root sheath, in which the DSEPs are normal, from pain due to direct root damage, in which the DSEPs are altered. This functional evaluation of anatomical damage provides further information which may help to achieve a better therapeutic approach.

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Sommario La sensibilità diagnostica dei Potenziali Evocati Sensitivi Dermatomerici (DSEP) è stata valutata in una casistica omogenea di 15 pazienti con lombosciatalgia da monoradicolopatia lombo-sacrale. Sono stati definiti i valori normativi da L3 a S1 e i parametri di anormalità. In 7 pazienti con pseudoradicular or referred leg pain, obiettività neurologica negativa e imaging indicativa di protrusione o ernia discale paramediana, i DSEP sono risultati normaliin 6 casi e modestamente alterati in 1 caso. In 8 pazienti con de-afferentation leg pain, segni clinici di danno radicolare e imaging indicativa di ernia intraforaminale i DSEP presentavano vari gradi di alterazione, in genere correlabili alla severità del quadro clinico.Il metodopuò pertanto essere utile nel differenziare il dolore dovuto alla stimolazione dei recettori delle strutture osteo-articolari o delle guaine radicolari in cui i DSEP risultano normali, dal dolore dovuto a danno radicolare diretto in cui i DSEP risultano alterati. Questa valutazione del danno anatomico fornisce ulteriori informazioni che possono meglio indirizzare il comportamento terapeutico.

     

术中体感诱发电位在切除中央沟附近癫痫病灶中的应用

目的 探讨术中皮层体感诱发电位(conical somatosensory evoked potential,CSEP)在切除脑中央沟附近致痫灶中的应用意义.方法 28例难治性癫痫患者,术中采用肌电/诱发电位仪,刺激癫痫灶所在运动区所支配对侧上肢的正中神经,使用条状皮层电极于该侧拟确定的中央沟前后的皮层进行CSEP记录.依据中央沟前后的皮层所记录到的上肢CSEP具有极性倒转的特性,进行中央沟定位.在皮层脑电图监测下进行致痫灶切除,术后常规应用抗癫痫药物.结果 术后疗效评价,按照Engel分级评价为:Ⅰ级19例,Ⅱ级4例,Ⅲ级3例,Ⅳ级2例;总有效者26例,有效率达92.9%.结论 术中CSEP是一种简单可靠的准确定位中央沟方法,有助于提高手术治疗的安全性,在癫痫外科治疗中具有一定的应用价值.     

Changes of somatosensory evoked potential accompanying ischaemia and hypoxia in cats

Changes of evoked potential accompanying haemorrhagic hypotension and hypoxia were investigated on cats to evaluate the usefulness of SEP as a monitor in an intensive care unit (ICU), and the following results were obtained. (1) Positive-negative diphasic potential was elicited at posterior sigmoid gyrus (PSG) by contralateral superficial radial nerve stimulation.

This potential was recorded at the restricted area of the posterior border of PSG and regarded as primary somatosensory evoked potential. (2) In the initial stage of haemorrhagic hypotension, both positive and negative components of SEP occasionally increased in amplitude. In profound hypotension in which CBF fell to less than the critical level of 30 ml 100 g^–1 min^–1, the latency was retarded and the amplitude was decreased. At CBF less than 10 ml 100 g^–1 min^–1, SEP disappeared. Within the range of CBF between 10 and 30 ml 100 g^–1 min^–1, a close correlation was noted between CBF and SEP amplitude. Transient increase of SEP amplitude was also observed during hypoxia induced by inhalation of nitrogen gas. (3) In normal state SEP was decreased in amplitude by conditioning stimulation of the nucleus lateralis posterior (LP nucleus) of the thalamus. This might be explained by the fact that intracortical inhibitory interneurons were activated by stimulation of LP nucleus, After haemorrhagic hypotension and hypoxia, however, the inhibitory effect on SEP elicited by LP nucleus stimulation attenuated or disappeared. Because of the initial impairment of the inhibitory interneurons by ischaemia and hypoxia, the amplitude of SEP might increase transiently.

In conclusion, the authors thought that SEP might be less useful than EEC in ICU, because of its insensible change to hypoxia and ischaemia.     

Diagnostic accuracy of somatosensory evoked potential monitoring during scoliosis fusion

The goal of this review was to ascertain the diagnostic accuracy of intraoperative somatosensory evoked potential (SSEP) changes to predict perioperative neurological outcome in patients undergoing spinal deformity surgery to correct adolescent idiopathic scoliosis (AIS). The authors searched PubMed/MEDLINE and World Science databases to retrieve reports and/or experiments from January 1950 through January 2014 for studies on SSEP use during AIS surgery. All motor and sensory deficits were noted in the neurological examination administered after the procedure which was used to determine the effectiveness of SSEP as an intraoperative monitoring technique. Fifteen studies identified a total of 4763 procedures on idiopathic patients. The observed incidence of neurological deficits was 1.11% (53/4763) of the sample population. Of the patients with new postoperative neurological deficits 75.5% (40/53) showed significant SSEP changes, and 24.5% (13/53) did not show significant change. Pooled analysis using the bivariate model showed SSEP change with pooled sensitivity (average 84%, 95% confidence interval 59–95%) and specificity (average 98%, 95% confidence interval 97–99%). The diagnostic odds ratio of a patient who had a new neurological deficit with SSEP changes was a diagnostic odds ratio of 340 (95% confidence interval 125–926). Overall, detection of SSEP changes had excellent discriminant ability with an area under the curve of 0.99. Our meta-analysis covering 4763 operations on idiopathic patients showed that it is a highly sensitive and specific test and that iatrogenic spinal cord injury resulting in new neurological deficits was 340 times more likely to have changes in SSEP compared to those without any new deficits.     

听觉诱发电位及体感诱发电位在颅脑外伤致昏迷患者的应用

严重颅脑损伤昏迷患者脑功能的监测是判断预后和指导治疗的重要手段。听觉诱发电位(BAEP)及体感诱发电位(SSEP)因其方便、无创并能连续实时监测昏迷患者相关神经传导通路电生理的变化,间接反映脑干上行激活系统、大脑皮层结构与功能的完整性,越来越成为临床对严重颅脑损伤昏迷患者预测预后和指导治疗的重要手段。本文就近年来相关研究进行综述,旨在指导临床实践。     

Somatosensory evoked potentials in patients with thalamic lesions

Summary Somatosensory evoked potentials (SEPs) were recorded in 20 patients with thalamic lesions confirmed by CT (10 with infarction, 10 with haemorrhage). The changes in SEP configuration are discussed in their relationship to clinical symptoms. Four types of SEP abnormality produced by thalamic lesion are distinguished: (1) FF type, (2) N20/P23 dissociation type, (3) N18/N20 false shift type, and (4) reduced early component type. It was shown that clinically similar lesions might produce different SEP patterns.     

Intraoperative subdural low-noise EEG recording of the high frequency oscillation in the somatosensory evoked potential

Objective

The detectability of high frequency oscillations (HFO, >200 Hz) in the intraoperative ECoG is restricted by their low signal-to-noise ratio (SNR). Using the somatosensory evoked HFO, we quantify how HFO detectability can benefit from a custom-made low-noise amplifier (LNA).

Cortical myoclonus in huntington's disease associated with an enlarged somatosensory evoked potential

We report the electrophysiologic findings of myoclonus in a patient with Huntington's disease (HD). This patient was studied postoperatively after a bilateral fetal cell transplant in his striatum. Incomplete transient improvement was seen in the myoclonus, followed by gradual deterioration. The myoclonus itself had a cortical correlate and was associated with an enlarged somatosensory evoked potential (SEP), consistent with the presence of cortical reflex myoclonus. An enlarged SEP has not been previously reported in myoclonus associated with HD. The postulated mechanisms for myoclonus, when it occurs in HD, have differed in the literature. The reason for the transient improvement of the myoclonus following transplantation is unclear, but this case raises the possibility that basal ganglia circuits may modulate cortical myoclonic activity.     

脊髓手术中体感诱发电位监测的临床研究

报告３０例脊髓手术中体感诱发电位（ＳＥＰ）连续监测的临床研究结果。ＳＥＰ记录包括脊髓ＳＥＰ（ＳＳＥＰ）和皮层ＳＥＰ（ＳＣＥＰ）。麻醉药物对ＳＥＰ有一定程度影响，ＳＣＥＰ相对较大。认为，至少术中ＳＥＰ潜伏期延长不超过８％和波幅降低不超过５０％，不会引起术后并发症，超过该范围由于病例较少，尚不能肯定与预后的关系，需进一步探讨。     

The clinical significance of the P15 wave of the somatosensory evoked potential in tentorial herniation

Somatosensory evoked potentials (SEPs) to median nerve stimulation and auditory brainstem evoked potentials (BAEPs) were recorded in 16 comatose patients who had suffered transtentorial herniation (TH) due to intracranial haematoma, hydrocephalus or tumour. An attempt was made to correlate the changes in the N14-P15 component of the central conduction time (CCT) and the I-V interpeak latencies (IPLs) of the BAEP with the clinical severity of TH. The N14-P15 component was not affected in seven patients at the diencephalic or early third-nerve stage, and six of these seven showed normal I-V IPLs. All six patients at the late third-nervel midbrain stage or worse, however, showed abnormalities in the N14-P15 components. Interestingly, five patients showed dissociation of SEP and BAEP abnormalities suggesting a differential sensitivity of the medial and lateral lemnisci in the brainstem to ischaemia and/or compression. All five patients in whom the P15 potential was absent on either side had a poor outcome and there was a correlation between the electrical failure in the N14-P15 component and the degree of brainstem damage caused by TH as assessed clinically. Reversible loss of the P15 potential by brainstem retraction has been shown in intraoperative SEP monitoring during aneurysm surgery. Prolonged compression of the upper brainstem seems to cause irreversible loss of the P15 which should be regarded as being due to irrecoverable brainstem dysfunction.