体感诱发电位对椎管内神经微创减压术效果的监测

目的为减少因显微内窥镜视野的局限所造成的椎管内神经减压不充分,利用节段性皮神经刺激体感诱发电位(SEP)技术对显微内窥镜下腰椎管内神经减压效果进行术中监测评定,探讨保证微创手术下受压神经彻底减压的有效方法。方法以术前麻醉后SEP值为基础,对60例采用常规直视下手术治疗的患者进行术中监测和术后随访检测。根据随访结果,回顾性研究,术后功能恢复优良者的术中SEP变化指标,确定提示术中神经组织充分减压的SEP标准。并以此标准进行微创术中监测研究。结果在神经减压术SEP监测电位指标中,潜伏期缩短10%～15%或波幅增加40%,提示神经减压充分,愈后良好。术中监测电位与术后功能恢复状态符合率为89%～91%。结论节段性皮神经刺激SEP术中监护是显微内窥镜下腰椎管内神经减压术效果评定的客观而有效的方法。

SEP moniters the effect of micro- injured decompression in nerve of vertebral canal

Aim To explore the effective method in completely depressing the pressed nerve in micro injure operation.Methods Based on SEP index of pre anaesthetization, the inspection of intra operation and long term follow up of post operation were observed among 60 patients with normal direct vision operation.As a result of the follow up, the changes of SEP of index of rehabilitees were retrospectively studied to definite the standard of the depression of nerve tissue during the operation and then study the monitoring of intra operation.Results The latency period was decreased 10-15 percent or the amplitudes were increased 40 percent, which showed that the depression was good enough and the prognosis was favorable. The correspondence rate was 86-91 percent between the monitoring potential of intra operation and the condition of functional recovery.Conclusion The SEP intraoperational guardianship of segmental dermo nerve stimulation is the objective and effective method in judging lumbar spinal tube operation under the micro endoscope.