脊柱侧弯矫形手术术中采用神经电生理功能监测838例效果分析

目的探讨脊柱侧弯矫形手术术中采用神经电生理功能监测的临床效果。方法使用十通道神经电生理功能监测系统,共对838例手术患者进行了术中神经电生理功能监测,分析838例脊柱侧弯矫形手术中应用体感诱发电位(SEP)监测脊髓和运动诱发电位的效果和体会。结果 838例患者中,19例患者术中神经电生理功能监测出现了SEP异常,波幅值下降50%或潜伏期延长超过10%。19例患者中术中SEP波幅恢复至基线的有8例,波幅好转11例。838例患者中有11个患者术中SEP没有变化,但是术后反而下肢有症状,假阳性率为1.4%。结论脊柱侧弯矫形手术术中联合应用SEP能够通过为术者实时监测脊髓功能,已达到了解神经系统功能状态的目的,最大限度地避免脊髓的损伤风险,为手术的安全性提供了一定的保障,降低了手术的致残率,应成为脊柱侧弯矫形手术的常规监测项目。

Analysis on the result of scoliosis orthopedic surgery in 838 cases by neural electrophysiological function monitoring

Objective To summarize the preliminary experience of scoliosis orthopaedic surgery, intraeperative application neural electrophysiological monitoring technology. Methods Using ten channels neural electrophysiological function monitoring system, a total of 838 cases of surgery for patients with intraoperative nerve electrephysiological monitoring function were included into this study. Somatosensory evoked potential （SEP） monitoring of the spinal cord and nerve root function effect and experience in 838 cases of scoliosis in orthopaedic surgery application were analyzed. Results In the 838 cases of patients, 19 cases showed intraoperative nerve electrophysiological function monitoring appeared abnormal SEP, incubation period amplitude value fell by 50% or extended by more than 10%. Of 19 cases, intraoperative SEP amplitude return to baseline in 8 cases. Amplitude is improved in 11 cases. And 11 cases evoked potential by monitoring patients postoperative lower limb myodynamia decline, false positive rate 1.4%. Conclusion Intraoperative scoliosis orthopaedic surgery combined application of somatosensory evoked potential （SEP） on spinal cord function in patients, which can provide reader with real -time monitoring, understand the function of the nervous system. In order to avoid risk of spinal cord injury, the physicians should provide guarantee for the security of operation, reduce the morbidity of the proce- dure, become the regular work of scoliosis orthopaedic surgery.