手术治疗陈旧性寰枢椎脱位术中体感诱发电位监测的临床价值

Clinical applications of intraoperative cortex somatosensory evoked potential in the surgery of old at?鄄lantoaxial dislocation

中文关键词:  皮层躯体感觉诱发电位  术中监测  陈旧性寰枢椎脱位

英文关键词:Somatosensory cortical evoked potential  Intraoperative monitoring  Old atlantoaxial dislocation

中文摘要:

  【摘要】 目的：探讨手术治疗陈旧性寰枢椎脱位时皮层躯体感觉诱发电位（CSEP）术中监测评价脊髓功能状态的应用价值。方法：对42例陈旧性寰枢椎脱位行手术治疗患者，实施术中CSEP监测，观察并分析皮层体感觉诱发电位的潜伏期及波幅，把相对于基准值的潜伏期延长超过10％和（或）波幅峰值下降50％定为异常判断标准，对患者术前术后均行神经功能检查及JOA评分。结果：CSEP真阴性37例，手术操作完成后其中35例患者波幅升高和（或）潜伏期缩短，术后神经功能较术前有所改善，无新的神经功能受损，其余2例神经功能与术前无明显变化。CSEP真阳性2例，其中1例术者停止正在进行的寰椎后弓减压，麻醉医生给予甲强龙40mg，5min后潜伏期及波幅恢复至正常范围，术后神经功能较术前有所改善；1例出现波幅降低60%，停止螺钉置入操作后波形有所恢复，术后出现右上肢麻木。CSEP假阴性1例，此患者术中波形未见异常，术后出现右下肢肌力减弱，JOA评分较术前降低。CSEP假阳性2例，1例麻醉师给予升高血压后波形恢复正常；1例未查明原因，伤口关闭后波形恢复正常；术后神经功能未受损，JOA评分改善率平均为82％。结论：术中CSEP能较好地反映脊髓功能状态，对预防寰枢椎脱位手术术中脊髓发生不可逆损伤具有重要价值。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of the cortex somatosensory evoked potential(CSEP) on spinal cord function under C1-2 dislocation surgery. Methods: In this study, 42 cases with old atlantoaxial dislocation received intraoperative CSEP monitoring. Latency and amplitude of cortical potentials were observed with the value of the latency extension more than 10% and peak amplitude reduction more than 50% defined as abnormality. Preoperative and postoperative JOA score were used to evaluate the neurofunction. Results: True negative rate was 88.1%(37/42), increased amplitude and (or) latency were noted in 35 cases after operation, and neurological function improved. No new neurological deficit was noted, and the other 2 cases showed no change compared with preoperation. True positive was 4.8%(2/42), and decompression ceased in 1 case when suffering from abnormality, and the waveform returned to normal after administration of MEP 40mg, neurological function improved postoperatively. Wave amplitude decreasing 60% was noted in 1 case, and waveform returned to normal after ceasing screw placement, right upper limb was noted numbness after operation. False negative was 2.4%(1/42), this case showed no intraoperative wave abnormality, but postoperative right lower limb weakness was noted, and JOA score decreased compared with preoperation. False positive was 4.8%(2/42), 1 case had waveform returned to normal after performing hypertension; and the cause for the other one was unidentified, after closing the wound, waveform returned to normal; there was no damage of neurological function after operation, the improvement rate of JOA score was 82%. Conclusions: CSEP can reflect the functional state and integrity of the spinal cord so as to prevent irreversible damage to the spinal cord during the surgery of old atlantoaxial dislocation.