儿童脊柱侧凸矫正手术中神经电生理监测方案的选择及技术难点

儿童脊柱侧凸类型多样,症状轻重不一。手术矫正的目的是纠正脊柱冠状面及矢状面畸形,阻止畸形进展,改善外观和功能。医源性脊髓损伤一直是脊柱相关手术中最严重的并发症。术中神经电生理监测技术的应用,明显降低了脊柱手术后神经系统并发症的发生率。目前国内外公认在脊柱侧凸矫正过程中,只要涉及脊髓水平,不论成人或儿童,都需要进行神经电生理监测。术中神经电生理监测(intraoperative neurophysiological monitoring,IONM)是利用各种神经电生理技术,监测手术中处于危险状态的神经系统的功能完整情况。目前脊柱手术中主要应用以下几种方法:躯体感觉诱发电位(somatosensory evoked potentials,SSEPs)、运动诱发电位(motor evoked potentials,MEPs)、肌电图(electromyogram,EMG),EMG包括自由肌电图(free electromyogram,fEMG)和刺激肌电图(triggered EMG,tEMG)。本文介绍儿童脊柱侧凸的常见类型及矫正方法,同时对术中神经监测在小儿脊柱手术中的应用进行阐述。

Protocol selecting and technical dilemmas of intraoperative neurophysiological monitoring during corrective procedures for pediatric scoliosis

The clinical types and symptoms of pediatric scoliosis vary greatly.The objective of scoliosis correction is to correct the coronal and sagittal deformities of spine,prevent the deformity from progressing and improve the appearance and function.Iatrogenic spinal cord injury has always been the most severe complication during spine-related operations.The application of intraoperative neuroelectrophysiological monitoring(IONM)technology has significantly lowered the incidence of neurological complications.It is generally accepted that during scoliosis correction,as long as spinal cord is involved,both adults and children should be monitored by neuroelectrophysiology.IONM is performed for intraoperative tracking the integrity of nervous system function in critical state by various neurophysiological techniques.Currently somatosensory evoked potentials(SSEPs),motor evoked potentials(MEPs),electromyogram(EMG) are commonly employed during orthopedic operations.And EMG includes free electromyogram(fEMG) and triggered EMG(tEMG).Here common types and correction approaches of pediatric scoliosis are discussed and the application of intraoperative nerve monitoring is explored for pediatric spine operations.