生长棒撑开术中经颅刺激运动诱发电位和体感诱发电位监测的应用价值

The analysis of necessity of transcranial electric stimulation motor evoked and somatosensory evoked potential monitoring during the growing rod lengthening surgery

中文关键词:  脊柱侧凸  生长棒技术  运动诱发电位  体感诱发电位

英文关键词:Scoliosis  Growing rod technique  Motion evoked potential  Somatosensory evoked potential

中文摘要:

  【摘要】 目的：分析生长棒撑开术中经颅刺激运动诱发电位（MEP）和体感诱发电位（SEP）神经功能监测的应用价值。方法：回顾性分析2010年10月～2015年1月我院进行的65例141次生长棒撑开手术，在生长棒撑开术中，运用MEP和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%或潜伏期延长10%。结果：141例次撑开手术中成功获得具有监护价值且重复性较好MEP 139例次，检出率98.6％，全程失败2例次（占1.4％）；SEP成功监测140例次，检出率99.3％，失败1例（占0.7％）。所有患者均能成功记录到一种以上的诱发电位。本组141例次手术中未出现MEP及SEP监测阳性。所有患儿术后神经系统检查均无异常发现，神经功能监测结果均为真阴性。结论：生长棒撑开术是简单安全的手术操作，但是，运用MEP和SEP进行术中神经功能监测可以为生长棒撑开术提供客观的安全评估指标。

英文摘要:

  【Abstract】 Objectives: To analyze the necessity of transcranial electric stimulation motion evoked potential (MEP) and somatosensory evoked potential(SEP) during the growing rod lengthening surgery. Methods: From October 2010 to January 2015, MEP and SEP monitoring were performed simultaneously during 141 growing rod lengthening surgeries. C3 and C4(international 10-20 system) were stimulated to elicit MEP and compound muscle action potentials were recorded from distal limbs. The bilateral tibial nerves were stimulated to record SEP. Alterations with MEP wave amplitude decreasing more than 75% and SEP amplitude decreasing more than 50% or latent period extending by 10% were diagnosed as positive changes. Results: Combined SEP and MEP monitoring was performed in all 141 growing rod lengthening surgeries. Success rate of MEP and SEP recording was 98.6% and 99.3%, respectively. There were two cases(1.4%) having failed SEP recording and one case in MEP(0.7%). All patients were successfully recorded by at least one kind of monitoring. There were no positive alterations and all recordings were true negative in both MEP and SEP. Conclusions: Growing rod lengthening surgery is a kind of simple and safe procedure, but MEP and SEP are used to monitor neurological function can provide the security evaluation index objective for the growing rod lengthening surgery.