先天性脊柱侧凸与青少年特发性脊柱侧凸矫形术中神经电生理监测对比分析

Comparison of intraoperative neurophysiological monitoring during spinal correction surgery between patients with congenital scoliosis and adolescent idiopathic scoliosis

中文关键词:  先天性脊柱侧凸  特发性脊柱侧凸  体感诱发电位  运动诱发电位  椎管内异常

英文关键词:Congenital scoliosis  Adolescence idiopathic scoliosis  Somatosensory evoked potentials  Motor evoked potentials  Intraspinal anomalies

中文摘要:

  【摘要】 目的：对比分析先天性脊柱侧凸（congenital scoliosis，CS）和青少年特发性脊柱侧凸（adolescence idiopathic scoliosis，AIS）患者脊柱后路矫形术中神经电生理监测（intraoperative neurophysiological monitoring，IONM）的结果，并评估术前合并椎管内异常对CS患者矫形术中IONM异常的影响。方法：回顾性分析2017年6月～2019年10月于我院行脊柱矫形手术的67例CS患者的临床资料，对照组为同时期内于我院行脊柱矫形手术的134例AIS患者，两组患者年龄（P=0.065）及术前侧凸Cobb角（P=0.077）均无统计学差异。比较两组凹凸侧体感诱发电位（somatosensory evoked potentials，SSEPs）的潜伏期和波幅、经颅电刺激运动诱发电位（transcranial electric motor evoked potentials，TCeMEPs）的波幅及异常SSEPs的发生率。将CS患者按术前是否合并椎管内异常分为两组，比较两组间出现异常SSEPs的发生率。结果：CS患者中67例（100%）术中均成功获得SSEPs监测结果，66例（98.5%）成功获得TCeMEPs监测结果；AIS患者均成功获得SSEPs基线及TCeMEPs基线。术后CS组3例、AIS组1例出现神经功能损害，两组SSEP和TCeMEPs监测的敏感度和特异度均无显著性差异（P>0.05）。两组患者凹凸侧SSEPs－P37的潜伏期、N45的潜伏期和波幅、TCeMEPs波幅均无统计学差异（P>0.05），两组异常SSEPs的发生率亦无显著性差异（55.2% vs 42.5%, P=0.094）。伴椎管内异常的CS患者凸侧SSEPs-N45的潜伏期与无椎管无异常的CS患者比较显著性延长（47.1±5.8ms vs 44.5±3.0ms，P=0.018），且异常SSEPs发生率明显升高（80.0% vs 44.7%，P=0.017）。结论：术前无明显神经损害的CS患者与AIS患者IONM的监测效果基本一致，但术前合并椎管内异常的CS患者凸侧SSEPs-N45的潜伏期明显延长，异常SSEPs的发生率明显升高。

英文摘要:

  【Abstract】 Objectives: To compare the intraoperative neurophysiological monitoring(IONM) results of posterior spinal correction surgery between congenital scoliosis(CS) and adolescent idiopathic scoliosis(AIS) patients and to investigate whether intraspinal anomalies are the risk factors of abnormal IONM data. Methods: A total of 67 CS patients receiving operation from June 2017 to October 2019 were retrospectively reviewed and 134 AIS patients at the same period were selected as control group. There was no significant difference in age (P=0.065) or Cobb angle of main curve(P=0.077) between the teo groups. The absolute values of latency and amplitude for somatosensory evoked potentials(SSEPs) and transcranial electric motor evoked potentials(TCeMEPs) in concave and convex sides, as well as the incidences of abnormal SSEPs were compared between CS and AIS patients. According to with or without intraspinal anomalies, CS patients were divided into two groups and between which the incidences of abnormal SSEPs were compared. Results: The SSEPs were all successfully obtained in 67(100%) CS patients, while TCeMEPs were successfully obtained in 66(98.5%), respectively; All SSEPs and TCeMEPs were successfully obtained in AIS patients. New neurologic deficits occurred in 3 CS patients and 1 AIS patients in the immediate postoperative period, and the sensitivity and specificity of IONM were not significantly different between the two groups. There was no significant difference in latencies of SSEPs-P37, SSEPs-N45 and amplitude of SSEPs and TCeMEPs between CS and AIS patients both in concave and convex sides(P>0.05). The incidences of abnormal SSEPs were not statistically different between CS and AIS groups(55.2% vs 42.5%, P=0.094). However, CS patients with intraspinal anomalies had significantly higher SSEPs-N45 latency in convex side(47.1±5.8ms vs 44.5±3.0ms, P=0.018) and higher incidence of abnormal SSEPs(80.0% vs 44.7%, P=0.017) than those of CS patients with no intraspinal anomalies. Conclusions: Similar IONM performance could be expected in CS patients without preoperative neurologic deficits compared with AIS patients. CS patients with intraspinal anomalies showed significantly higher SSEPs-N45 latency and higher risk of abnormal SSEPs than those without intraspinal anomalies.