体感诱发电位联合运动诱发电位在Chiari畸形伴脊柱侧凸后路矫形手术中的应用价值

Use of somatosensory evoked potentials and transcranial electric motor evoked potentials in surgical correction of scoliosis secondary to Chiari malformation

中文关键词:  体感诱发电位  运动诱发电位  Chiari畸形  脊柱侧凸

英文关键词:Somatosensory evoked potentials  Motor evoked potentials  Chiarimalformation  Scoliosis

中文摘要:

  【摘要】 目的：评估体感诱发电位（somatosensory evoked potentials，SSEPs）联合经颅电刺激运动诱发电位（tran?鄄scranial electric motor evoked potentials，TCeMEPs）在Chiari畸形伴脊柱侧凸患者脊柱后路矫形手术中的应用价值。方法：选取2013年10月~2015年7月在鼓楼医院行脊柱后路矫形手术的63例Chiari畸形伴脊柱侧凸患者，均行术中SSEPs监测，其中50例患者行TCeMEPs监测。回顾性分析患者的术中SSEPs和TCeMEPs等神经电生理监测资料。分别计算单模式SSEPs、单模式TCeMEPs和联合应用SSEPs与TCeMEPs的成功率、报警率、真假阳性率、真假阴性率、阳性预测值、阴性预测值、监测的敏感性和特异性。采用卡方检验比较三种监测模式的监测结果。结果：单模式SSEPs监测成功率为95%，单模式TCeMEPs监测成功率为96%，联合应用SSEPs和TCeMEPs监测成功率为100%；单模式SSEPs监测敏感性为100%，特异性为95%；单模式TCeMEPs监测敏感性为100%，特异性为98%；联合应用SSEPs和TCeMEPs监测敏感性和特异性均为100%；三种监测模式的阴性预测值均为100%；三种模式之间比较均无统计学差异（P>0.05）。单模式SSEPs监测阳性预测值为25%，单模式TCeMEPs监测阳性预测值为50%，联合应用SSEPs和TCeMEPs监测阳性预测值为100%；三种模式之间比较存在统计学差异（P<0.05）。结论：SSEPs和TCeMEPs监测不同的神经传导通路，联合应用两种监测方法可提高Chiari畸形伴脊柱侧凸患者脊柱后路矫形手术中监护的预警价值，获得满意的监护成功率、敏感性及特异性。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical values of somatosensory evoked potentials(SSEPs) and transcranial electric motor evoked potentials(TCeMEPs) during surgical correction of scoliosis secondary to Chiari malformation. Methods: 63 patients with scoliosis secondary to Chiari malformation undergoing posterior spinal fusion from October 2013 to July 2015 were retrospectively reviewed, among them the intraoperative monitoring data including SSEPs and TCeMEPs were collected. SSEPs were attempted in 63 patients, and TCeMEPs were attempted in 50 patients. The successful rate, alert rate, positive predictive value, negative predictive value, sensitivity and specificity of SSEPs and TCeMEPs and combined use of SSEPs and TCeMEPs were calculated, respectively. Differences in test performances among groups were analyzed by using Chi-square test. Results: The sucessful rate of SSEPs and TCeMEPs was 95% and 96%, respectively. By combined using SSEPs and TCeMEPs, the successful rate increased to 100%. The sensitivity and specificity were 100% and 95% for SSEPs, 100% and 98% for TCeMEPs, respectively. The sensitivity and specificity were both 100% by combined using SSEPs and TCeMEPs. The negative predictive values for all were 100%. No differences were noted among three modalities(P>0.05). The positive predictive value of SSEPs and TCeMEPs and combined using SSEPs and TCeMEPs were 25%, 50%and 100%, respectively. There were significant differences among these groups(P<0.05). Conclusions: SSEPs and TCeMEPs are responsible for different neural pathways. Combined use of them can increase predicitive value and provide satisfactorily successful rate, sensitivity and specificity during surgical correction of scoliosis secondary to Chiari malformation