早发性脊柱侧凸手术中神经功能监测的应用及意义探讨

目的探讨术中经颅电刺激运动诱发电位(transcranial electric Motor Evoked Potential,TceMEP)和体感诱发电位(somatosensory evoked potentials,SSEP)监测在早发性脊柱侧凸(early-onset scoliosis,EOS)脊柱截骨矫形手术中的应用价值,并分析此类手术中的神经电生理监测特点。方法收集2015年9月至2016年12月由北京协和医院骨科收治的20例EOS和120例特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者进行回顾性研究,其中20例EOS患者平均年龄(2.65±0.11)岁,120例AIS患者平均年龄(13.9±0.51)岁。TceMEP、SSEP、自由运动肌电图(free-run EMG)和标准化的麻醉方案用于术中神经功能监测的研究。结果 EOS患儿采用后路半椎体或者全脊椎切除、短节段固定融合的手术方式。其中95.0%(19/20)的患儿获得术中稳定可靠的SSEP和TceMEP监测基线。1例(2岁,9 kg)直至手术截骨时未获得有效的TceMEP基线。本研究EOS患儿平均TceMEP基线波幅为(88.7±21.9)μV(范围:27~278μV),显著低于AIS患者的(346.7±24.2)μV,差异有统计学意义(t=2.162,P<0.01)。AIS患者均采用后路内固定,脊柱侧弯矫形植骨融合的手术方式。结论 TceMEP,SSEP和free-run EMG监测方法针对EOS患儿是准确可行的。监测结果可以为手术团队提供准确的神经功能信息,防止术后神经系统并发症的发生。

Effectiveness analysis of intraoperative electrophysiological monitoring for early-onset scoliosis

Objective To explore the feasibility of combining intraoperative transcranial electric-stimulation motor evoked potential(TceMEP) and somatosensory evoked potentials(SSEP) monitoring during spinal osteotomy of early-onset scoliosis(EOS) and analyze the characteristics of intraoperative electrophysiological monitoring.ethods From September 2015 to December 2016,a total of 20 EOS children with a mean age of(2.65±0.11) years and 120 children of adolescent idiopathic scoliosis(AIS) with a mean age of(13.9±0.51) years were retrospectively reviewed.Transcranial motor evoked potentials(TceMEPs),somatosensory evoked potentials(SSEPs),free-run intra-operative electromyography(free-run EMG) and a standardized anesthesia protocol were applied for intraoperative electrophysiological monitoring.Results The procedures included posterior hemivertebra or vertebra column resection,instrumentation and short fusion surgery.And 95.0%(19/20) cases had stable and reliable intra-operative baseline levels of SSEP and TceMEP.One 2-year-old child with a body weight of 9 kg failed to achieve a baseline TceMEP until osteotomy.And AIS children underwent posterior instrumentation deformity correction and bone graft fusion.The average baseline amplitude of TceMEP was markedly lower than that of EOS[(88.7±21.9)(27-278) vs(346.7±24.2) μV](t=2.162,P <0.01).The differences were statistically significant.Conclusion Combining TceMEP,SSEP and free-run EMG monitoring is both feasible and effective.It provides accurate information for surgical teams to prevent the postoperative occurrences of neurological deficits.