对无脊髓发育畸形先天性脊柱侧凸患者体感诱发电位的检测及临床意义

The value of somatosensory evoked potentials in the pre-operative evaluation of congenital scoliosis complicated with no spinal cord malformation

中文关键词:  先天性脊柱侧凸  诱发电位  躯体感觉  术前评估

英文关键词:Congenital scoliosis  Evoked potentials  Somatosensory  Preoperative evaluation

中文摘要:

  【摘要】 目的：探讨体感诱发电位（SEPs）检查在先天性脊柱侧凸（CS）患者术前评估中的价值。方法：对152例不伴脊髓发育畸形的CS患者术前行SEPs检查，观察SEPs峰潜伏期及左、右侧峰潜伏期差值。SEPs波形消失、峰潜伏期延长及左右侧峰潜伏期不对称定义为SEPs异常。计算CS患者SEPs异常的发生率，分析SEPs异常与CS的类型、侧凸及后凸严重程度的相关性。结果：4例术前下肢不完全瘫的CS患者SEPs均表现为异常波形。术前临床体检无神经损害的患者60例（40.5%）存在SEPs异常。CS Ⅰ型和Ⅲ型患者的SEPs异常率分别为50.5%和47.1%，明显高于Ⅱ型患者的10.0% （P<0.05）。单纯侧凸的50例患者中，仅有1例伴椎体旋转半脱位（2%）患者表现为SEPs峰潜伏期延长、双侧潜伏期不对称；102例侧后凸患者中有63例（61.8%）SEPs异常。SEPs正常组平均侧凸Cobb角（66.8°±27.1°）与SEPs异常组（65.2°±26.7°）无明显差别（P>0.05），而SEPs异常组的后凸Cobb角（69.7°±21.7°）比SEPs正常组（50.9°±23.1°）明显偏大（P<0.05）。角状后凸畸形患者SEPs异常率（69%）明显高于平滑后凸畸形患者（45.2%）（P<0.05）。结论：CS患者术前神经功能损害的危险因素包括CS Ⅰ型或Ⅲ型、严重角状后凸畸形及椎体旋转半脱位。通过SEPs检查可以早期发现CS患者术前存在的神经功能损害，有利于临床评估及干预。

英文摘要:

  【Abstract】 Objective：To investigate the value of somatosensory evoked potentials（SEPs） in the pre-operative evaluation of congenital scoliosis complicated with no spinal cord malformation.Method：Posterior tibial nerve SEPs（PTN-SEPs） were performed on 152 CS patients treated surgically，and patients with myelodysplasia were excluded.Absence of SEPs waveforms，prolongation of peek latency or asymmetrical peek latency were defined as pathological abnormality.The incidence of pathological SEPs was determined in all CS patients.The association of abnormal SEPs and type of CS，severity of scoliosis and kyphosis were also assessed.Result：4 cases with lower limbs paresis showed abnormal waveforms.Abnormal SEPs were found in 60（40.5%） patients that were confirmed without neurological deficit.The incidence of abnormal SEPs for type Ⅰ，type Ⅱ and type Ⅲ was 50.5%，10.0% and 47.1% respectively（P<0.05）.Among 50 cases with single scoliosis，only 1（2%） patient with vertebra rotational subluxation showed prolongation of peek latency or asymmetrical latency.However，of 102 kyphoscoliosis patients，63 cases（61.8%） had pathological SEPs.The mean scoliosis Cobb angle showed no obvious difference between SEPs normal group（66.8°±27.1°） and abnormal group（65.2°±26.7°），while the mean kyphosis Cobb angle for SEPs abnormal group（69.7°±21.7°） was significantly larger than that in SEPs normal group（50.9°±23.1°）.The rate of abnormal SEPs was higher in anglular kyphosis（69%） than in round kyphosis（45.2%）.Conclusion：The risk factors of neurological damage secondary to congenital scoliosis include type Ⅰor Ⅲ CS，severe angular kyphosis and vertebra rotation subluxation.SEPs can detect early potential neurological damage in congenital patients，which contribute to clinical evaluation and intervention.