颈脊髓损伤患者应用体感诱发电位监测的价值_《华西医学》

作者：

龙海波 ¹ , 康建平 ¹ ,  冯大雄 ¹ , 叶飞 ¹ , 张戈 ² , 雷飞 ¹ , 周云龙 ¹ , 周庆忠 ¹ , 杨剑 ¹

1泸州医学院附属医院脊柱外科（四川泸州，646000）;2泸州市人民医院骨科;

关键词：

脊髓损伤诱发电位, 躯体感觉监测, 手术中

DOI：

10.7507/1002-0179.20130115

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　探讨躯体感觉诱发电位（SEP）在颈脊髓损伤术前、术中监测的意义。方法　纳入2010年1月－2012年4月治疗的241例颈脊髓损伤患者，术前按美国脊柱脊髓损伤协会（ASIA）评分并分级，确定损伤平面。术前与术中SEP监测，分析不同损伤分级以及不同损伤平面术前的波幅及潜伏期的差异，术中SEP监测以波幅下降＞50%和或潜伏期延长＞10%为预警标准。结果　各损伤分级组术前SEP监测：A级组SEP波消失，呈一直线，而B、C、D、E级组均测出SEP波形，根据是否可测出SEP波形，可将A级与B、C、D、E及组区别。B、C、D级组之间波幅和潜伏期均无统计学意义（P＞0.05）。E级组较B、C、D级组波幅增高、潜伏期缩短，差异有统计学意义（P＜0.05）；不完全性颈脊髓损伤组内不同损伤平面组之间波幅和潜伏期差异均无统计学意义（P＞0.05）。术中SEP对脊髓功能损伤监测的灵敏度83.3%、特异度98.7%。其中术中：SEP阳性8例，真阳性5例，4例术者处理后波幅及潜伏期回复至正常范围，术后无新的神经功能损伤，另1例术者采取各种处理后波幅及潜伏期无恢复，术后神经功能损伤较术前加重；假阳性3例，1例麻醉师给予升高血压后波形恢复至正常，另2例经麻醉师调整麻醉深度后波形恢复正常，此3例术后无新的神经功能损伤。SEP阴性233例，真阴性232例，术后无新的神经功能损伤；假阴性1例，患者术中、术后波形未见异常，术后运动功能损伤程度较术前加重。结论　① SEP能准确评估完全性和不完性颈脊髓损伤，但对不完全性颈脊髓损伤的损伤程度不能作出准确评估、也不能区分颈脊髓损伤的损伤平面；② 术中SEP监测能较好地反映颈脊髓功能完整性，对减少颈脊髓损伤术中发生医源性颈脊髓损伤风险具有重要意义。

引用本文： 龙海波,康建平,冯大雄,叶飞,张戈,雷飞,周云龙,周庆忠,杨剑. 颈脊髓损伤患者应用体感诱发电位监测的价值. 华西医学, 2013, 28(3): 356-360. doi: 10.7507/1002-0179.20130115 复制

1.	周红俊, 汪家琮, 刘根林, 等. 脊髓损伤完全与否与体感诱发电位的关系[J]. 中华物理医学与康复杂志, 2002, 24(3): 160-161.
2.	Li F, Gorji R, Allott G, et al. The usefulness of intraoperative neurophysiological monitoring in cervical spine surgery: a retrospective analysis of 200 consecutive patients[J]. J Neurosurg Anesthesiol, 2012 , 24(3): 185-190.
3.	李建军, 周红俊, 孙迎春, 等译.脊髓损伤神经学分类国际标准（6版, 2006）[J].中国康复理论与实践, 2007, 13(1): 1-6.
4.	Nuwer MR, Aminoff M, Desmedt J, et al. IFCN recommended standards for short latency somatosensory evoked potentials. Report of an IFCN committee. International Federation of Clinical Neurophysiology[J]. Electroencephalogr Clin Neurophysiol, 1994, 91(1): 6-11.
5.	Nuwer M, Dawson E, C arlson L, et al. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery : results of a large multicenter survery. Electroencephalogr[J]. Clin Neurophysiol, 1995, 96(1): 6-11.
6.	Szalay E, Carollo J, Roach J, et al. Sensitivity of spinal cord monitoring to intraoperative events[J]. J Pediatr Orthop, 1986, 6(4): 437-441.
7.	Lim PA, Tow AM. Recovery and regeneration after spinal cord injury: a review and summary of recent literature[J]. Ann Acad Med Singapore, 2007, 36(1): 49-57.
8.	沈宁江, 王书成, 卢传新, 等. 皮层体感诱发电位在评价脊柱脊髓损伤中的意义[J]. 骨与关节损伤杂志, 1996, 11(2): 275-277.
9.	Shields CB, Ping Zhang Y, Shields LB, et al. Objective assessment of cervical spinal cord injury levels by transcranial magnetic motor-evoked potentials[J]. Surg Neurol, 2006, 66(5): 475-483.
10.	金大地, 王健, 瞿东滨. 颈椎前路手术早期并发症原因分析及对策[J]. 中华骨科杂志, 2005, 25(2): 102-106.
11.	Engler GL, Spielholz NJ, Bernhard WN, et al. Somatosensory evoked potentials during Harrington instrumentation for scoliosis[J]. J Bone Joint Surg Am, 1978, 60(4): 528-532.
12.	周琪琪, 张小峰. 神经监测技术在临床手术中的应用[M]. 北京：中国社会出版社, 2005: 5-19.
13.	龙厚清, 胡勇, 李广盛, 等. 皮层体感诱发电位监测轻度医源性脊髓冲击损伤的实验研究[J].中华创伤杂志, 2011, 27(3): 241-244.
14.	Epstein NE, Danto J, Nardi D.Evaluation of intraoperative somatosensory-evoked potential monitoring during 100 cervical operations[J]. Spine, 1993, 18(6): 737-747.
15.	Khan MH, Smith PN, Balzer JR, et al. Intraoperative somatosensory evoked potential monitoring during cervical spine corpectomy surgery: experience with 508 cases[J]. Spine, 2006, 31(4): 105-113.
16.	Ayoub C, Zreik T, Sawaya R, et al. Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery[J]. Neurol India, 2010, 58(3): 424-428.
17.	Taunt CJ Jr, Sidhu KS, Andrew SA. Somatosensory evoked potential monitoring during anterior cervical discectomy and fusion[J]. Spine, 2005, 30(17): 1970-1972.
18.	Jones SJ, Buonamassa S, Crockard HA. Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evoked potentials[J]. J Neurol Neurosurg Psychiatry, 2003, 74(2): 273-276.

1. 　周红俊, 汪家琮, 刘根林, 等. 脊髓损伤完全与否与体感诱发电位的关系[J]. 中华物理医学与康复杂志, 2002, 24(3): 160-161.
2. 　Li F, Gorji R, Allott G, et al. The usefulness of intraoperative neurophysiological monitoring in cervical spine surgery: a retrospective analysis of 200 consecutive patients[J]. J Neurosurg Anesthesiol, 2012 , 24(3): 185-190.
3. 　李建军, 周红俊, 孙迎春, 等译.脊髓损伤神经学分类国际标准（6版, 2006）[J].中国康复理论与实践, 2007, 13(1): 1-6.
4. 　Nuwer MR, Aminoff M, Desmedt J, et al. IFCN recommended standards for short latency somatosensory evoked potentials. Report of an IFCN committee. International Federation of Clinical Neurophysiology[J]. Electroencephalogr Clin Neurophysiol, 1994, 91(1): 6-11.
5. 　Nuwer M, Dawson E, C arlson L, et al. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery : results of a large multicenter survery. Electroencephalogr[J]. Clin Neurophysiol, 1995, 96(1): 6-11.
6. 　Szalay E, Carollo J, Roach J, et al. Sensitivity of spinal cord monitoring to intraoperative events[J]. J Pediatr Orthop, 1986, 6(4): 437-441.
7. 　Lim PA, Tow AM. Recovery and regeneration after spinal cord injury: a review and summary of recent literature[J]. Ann Acad Med Singapore, 2007, 36(1): 49-57.
8. 　沈宁江, 王书成, 卢传新, 等. 皮层体感诱发电位在评价脊柱脊髓损伤中的意义[J]. 骨与关节损伤杂志, 1996, 11(2): 275-277.
9. 　Shields CB, Ping Zhang Y, Shields LB, et al. Objective assessment of cervical spinal cord injury levels by transcranial magnetic motor-evoked potentials[J]. Surg Neurol, 2006, 66(5): 475-483.
10. 　金大地, 王健, 瞿东滨. 颈椎前路手术早期并发症原因分析及对策[J]. 中华骨科杂志, 2005, 25(2): 102-106.
11. 　Engler GL, Spielholz NJ, Bernhard WN, et al. Somatosensory evoked potentials during Harrington instrumentation for scoliosis[J]. J Bone Joint Surg Am, 1978, 60(4): 528-532.
12. 　周琪琪, 张小峰. 神经监测技术在临床手术中的应用[M]. 北京：中国社会出版社, 2005: 5-19.
13. 　龙厚清, 胡勇, 李广盛, 等. 皮层体感诱发电位监测轻度医源性脊髓冲击损伤的实验研究[J].中华创伤杂志, 2011, 27(3): 241-244.
14. 　Epstein NE, Danto J, Nardi D.Evaluation of intraoperative somatosensory-evoked potential monitoring during 100 cervical operations[J]. Spine, 1993, 18(6): 737-747.
15. 　Khan MH, Smith PN, Balzer JR, et al. Intraoperative somatosensory evoked potential monitoring during cervical spine corpectomy surgery: experience with 508 cases[J]. Spine, 2006, 31(4): 105-113.
16. 　Ayoub C, Zreik T, Sawaya R, et al. Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery[J]. Neurol India, 2010, 58(3): 424-428.
17. 　Taunt CJ Jr, Sidhu KS, Andrew SA. Somatosensory evoked potential monitoring during anterior cervical discectomy and fusion[J]. Spine, 2005, 30(17): 1970-1972.
18. 　Jones SJ, Buonamassa S, Crockard HA. Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evoked potentials[J]. J Neurol Neurosurg Psychiatry, 2003, 74(2): 273-276.

《华西医学》

颈脊髓损伤患者应用体感诱发电位监测的价值

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《华西医学》

颈脊髓损伤患者应用体感诱发电位监测的价值

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料