体感诱发电位联合运动诱发电位在严重脊柱侧后凸畸形患者矫形手术中的应用价值

Somatosensory evoked potentials combined with transcranial electric motor evoked potentials in posterior spinal correction and fusion for severe kyphoscoliosis

中文关键词:  体感诱发电位  运动诱发电位  严重脊柱侧后凸  术中监测

英文关键词:Somatosensory evoked potentials  Motor evoked potentials  Severe kyphoscoliosis  Intraoperative monitoring

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（transcranial electric motor evoked potentials，TCeMEPs）在严重脊柱侧后凸畸形患者矫形内固定术中的应用价值。方法：2015年8月~2017年10月在我院行脊柱后路矫形手术的69例严重僵硬性脊柱侧后凸畸形患者（侧凸或后凸Cobb角>90°）术中应用SSEPs和TCeMEPs监测，回顾性分析患者术中SSEPs和TCeMEPs的监测结果，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等。比较分析采用卡方检验。结果：58例患者SSEPs得到稳定的监测基线，其中5例监测改变达到报警标准，术后2例患者出现了神经损害，3例患者术中监测逐渐恢复，术后无明显神经损害。67例患者TCeMEPs得到稳定基线，术中预警3例，术后2例为真阳性，1例术后无神经损害。单模式SSEPs监测的成功率为84.1%（58/69），预警率为8.6%（5/58），真阳性率为3.4%（2/58），误检率为5.2%（3/58），真阴性率为91.4%（53/58），漏检率为0（0/58），阳性预测值为40%（2/5），阴性预测值为100%（53/53），敏感性为100%（53/53），特异性为94.6%（53/56）。TCeMEPs监测的成功率为97.1%（67/69），预警率为4.4%（3/67），真阳性率为3.0%（2/67），误检率为1.5%（1/67），真阴性率为95.5%（64/67），漏检率为0（0/67）、阳性预测值为66%（2/3），阴性预测值为100%（64/64），敏感性为100%（64/64），特异性为98.5%（64/65）。联合应用SSEPs和TCeMEPs监测的预警率为3.4%（2/58），真阳性率为3.4%（2/58），误检率为0（0/58），真阴性率为96.6%（56/58），漏检率为0（0/58），阳性预测值、阴性预测值、敏感性与特异性均为100%。三种模式的成功率、预警率、真阳性率、真阴性率、漏检率、阴性预测值、敏感性及特异性无统计学差异（P>0.05），误检率及阳性预测值有统计学差异（P<0.05）。结论：联合应用SSEPs和TCeMEPs两种监测方法可提高严重脊柱侧后凸畸形患者矫形手术中神经监测的预警价值，降低术中不可逆神经损伤风险。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical values of somatosensory evoked potentials(SSEPs) combined with transcranial electric motor evoked potentials(TCeMEPs) during posterior spinal correction and fusion for severe kyphoscoliosis. Methods: A total of 69 patients with severe kyphoscoliosis(coronal or sagittal Cobb angle more than 90°) undergoing posterior spinal fusion from August 2015 to October 2017 was reviewed, the intraoperative monitoring data including SSEPs and TCeMEPs were collected in all the patients. The followings were calculated: successful rate, alert rate, positive predictive value, negative predictive value, sensitivity and specificity of the intraoperative monitorings(SSEPs, TCeMEPs, SSEPs combined with TCeMEPs). Chi-square test was used to compare the data among the groups. Results: Stable monitoring baseline of SSEPs was obtained in 58 patients, of whom 5 cases met the alarm criteria. Postoperative neurological defect was found in 2 patients, while in the other 3 patients the SSEPs recovered generally during operation with no neurological defect postoperatively. Stable monitoring baseline of TCeMEPs was obtained in 67 patients. A total of 3 cases met the alarm criteria, of whom 2 cases were true positive and 1 case was with no significant neurological defect. The success rate, alert rate, true positive rate, false positive rate, true negative rate, false negative rate, positive predictive value, negative predictive value, sensitivity and specificity of single SSEPs were 84.1%(58/69), 8.6%(5/58), 3.4%(2/58)， 5.2%(3/58), 91.4%(53/58)， 0(0/58), 40%(2/5), 100%(53/53), 100%(53/53) and 94.6%(53/56), respectively. The values for single TCeMEPs were 97.1%(67/69), 4.4%(3/67), 3.0%(2/67), 1.5%(1/67), 95.5%(64/67), 0(0/67), 66%(2/3), 100%(64/64), 100%(64/64) and 98.5%(64/65), respectively. In addition, the alert rate, true positive rate, false positive rate, true negative rate, false negative rate, positive predictive value, negative predictive value, sensitivity and specificity of SSEPs combined with TCeMEPs were 3.4%(2/58), 3.4%(2/58), 0(0/58), 96.6%(56/58) and 0(0/58), 100%, 100%, 100% and 100%, respectively. No significant differences were found among 3 groups in success rate, alert rate, true positive rate, true negative rate, false negative rate, negative predictive value, sensitivity and specificity(P>0.05). Significant differences were observed in negative positive rate and positive predictive values among 3 groups(P<0.05). Conclusions: SSEPs combined with TCeMEPs can increase the predictive values during surgical correction of severe kyphoscoliosis and further reduce the risk of neurological complication.