经颅刺激运动诱发电位联合体感诱发电位监测在特发性脊柱侧凸矫形手术中应用的研究

背景：特发性脊柱侧凸手术治疗中神经功能障碍是最应受到关注的并发症，术中神经功能监测可帮助早期发现可能的神经功能损伤。目的：分析联合应用经颅刺激运动诱发电位（TcMEP）和体感诱发电位（SEP）的多模式术中神经功能监测在特发性脊柱侧凸矫形手术中对预测医源性神经功能损害的作用。方法：在特发性脊柱侧凸矫形手术中，运用TcMEP和（或）SEP进行神经功能监测。MEP监测采用经颅刺激C3、C4，记录外周肌源性MEP，SEP监测采用刺激双侧胫后神经，记录电极采用Cz—CPz。阳性诊断标准：与基线相比，MEP波幅下降75％，SEP波幅下降50％。结果：112例特发性脊柱侧凸患者中，联合MEP、SEP监测的检出率为100％。MEP监测阳性6例，假阳性1例。1例出现一过性神经功能障碍。MEP的监测敏感性为100％，特异性为99％；SEP监测敏感性50％，特异性为100％；联合MEP、SEP监测的敏感性、特异性均为100％。结论：特发性脊柱侧凸矫形手术中MEP＋SEP的术中神经功能监测可提高监测敏感性及特异性，可预测术中神经功能损伤事件的发生。MEP是多模式监测的基础，SEP是重要补充。单独应用MEP监测在特发性脊柱侧凸患者手术中有应用前景。

Impact of combined transcranial electric stimulation motor evoked and somatosensory-evoked potential monitoring during surgery for idiopathic scoliosis

Background： Iatrogenic spinal cord injury remains the most feared complication of spinal corrective surgery of idiopathic scoliosis. The development of intraoperative monitoring （IOM） provides the opportunity to detect the impending neurologic injury during such procedure. Objective： To analyze the predictive value of transcranial electric stimulation motion evoked potential （MEP） and somatosensory evoked potential （SEP） for iatrogenic neurological impairment during surgical correction of idiopathic scoliosis. Methods： MEP and SEP monitoring was performed simultaneously during surgical correction of idiopathic seoliosis. C3 and C4 （International 10-20 system） were used for stimulation to elicit MEP and compound muscle action potentials （CMAPs） were recorded from distal limbs. The tibial nerves were stimulated to record SEP. Alterations with MEP wave amplitude decreasing more than 75% and SEP amplitude decreasing more than 50% were diagnosed as positive changes. Results： A total of 112 patients with idiopathic scoliosis were successfully monitored by combined method. Positive altera- tions presented in 6 patients. Transient neurological dysfunction oeeurrred in one patient. All the 6 eases were detected by MEP monitorings. There was extra one false positive for MEP monitoring. The sensitivity and specificity of MEP were 100% and 99%, respectively. Solo SEP was 50% and 100%. Combined MEP and SEP were 100% and 100%. Conclusions： Combined SEP/MEP monitoring provides higher sensitivity for intraoperative monitoring during idiopathic seoliosis correction and can predict events of neurological injury. Solo MEP monitoring has prospective future in intraoperative monitoring in such cases.