伴与不伴椎管内异常的重度先天性脊柱侧凸三柱截骨矫形术中神经电生理监测结果的对比研究

A comparative study of the intraoperative neurophysiological monitoring results during 3-column osteotomy surgery in severe congenital scoliosis with or without intraspinal anomalies

中文关键词:  先天性脊柱侧凸  椎管内异常  三柱截骨  术中神经电生理监测

英文关键词:Congenital scoliosis  Intraspinal anomalies  3-column osteotomy  Intraoperative neurophysiological monitoring

中文摘要:

  【摘要】 目的：比较伴与不伴椎管内异常的重度先天性脊柱侧凸（congenital scoliosis，CS）患者行三柱截骨矫形术中神经电生理监测（intraoperative neurophysiological monitoring，IONM）的差异，探究椎管内异常对CS患者术中IONM监测报警事件发生率及术后转归的影响。方法：回顾性分析2020年9月～2023年5月于我院行三柱截骨矫形手术治疗的重度CS患者临床资料，以是否合并椎管内异常分为两组，比较两组间基本信息、双下肢体感诱发电位（somatosensory evoked potentials，SSEPS）的潜伏期及波幅和双下肢经颅电刺激躯体运动诱发电位（transcranial electric motor evoked potentials，TCeMEPs）的波幅，比较两组患者术中使用多模式IONM监测的敏感性及特异性，分析两组患者术中IONM监测报警事件发生率及术后转归情况。结果：共37例符合标准的患者纳入研究，其中14例患者伴有椎管内异常，包括脊髓空洞8例，脊髓拴系2例，脊髓纵裂1例，脊髓纵裂合并脊髓拴系1例，脊髓空洞合并脊髓拴系2例。伴椎管内异常的CS患者凹侧下肢SSEPs-P37潜伏期（40.9±3.3ms）较不伴椎管内异常的CS患者（38.0±3.7ms）显著延长（P=0.03），除此以外，两组患者使用多模式IONM监测的敏感性及特异性相当，且在异常SSEPs发生率、术中IONM监测报警事件发生率及术后神经症状发生率上均无明显统计学差异（P＞0.05）。结论：多模式IONM监测可在重度CS患者行三柱截骨矫形术中提供良好的监测效果，伴椎管内异常的CS患者凹侧下肢SSEPs-P37潜伏期较不伴椎管内异常的CS患者显著延长，伴椎管内异常不会增加术中IONM监测报警事件发生率及术后出现神经并发症的比率。

英文摘要:

  【Abstract】 Objectives: To compare the intraoperative neurophysiological monitoring(IONM) results during 3-column osteotomy surgery in severe congenital scoliosis(CS) patients with or without intraspinal anomalies, and to explore the effect of intraspinal anomaly on the incidence of IONM alarm events and postoperative outcomes in CS patients. Methods: Clinical data of patients with severe CS who underwent 3-column osteotomy surgery in our hospital from September 2020 to May 2023 were retrospectively analyzed. The patients were divided into two groups according to whether combined with intraspinal anomalies. The basic information, the latency and amplitude of somatosensory evoked potentials(SSEPs) of both lower extremities, amplitude of transcranial electric motor evoked potentials(TCeMEPs), as well as the sensitivity and specificity of multimodal IONM were compared between the two groups. The incidence of IONM alarm events and postoperative outcomes were analyzed. Results: A total of 37 patients who met the criteria were included in the study, of which 14 patients combined with intraspinal anomalies, including 8 cases of syringomyelia, 2 case of tethered cord, 1 case of diastematomyelia, 1 case of diastematomyelia combined with tethered cord, and 2 cases of syringomyelia combined with tethered cord. The latency of SSEPs-P37 in the concave side lower extremity of CS patients with intraspinal anomalies was significantly longer than that of CS patients without intraspinal anomalies(40.9±3.3ms vs 38.0±3.7ms, P=0.03). In addition, the sensitivity and specificity of multimodal IONM were comparable between the two groups. There was no significant difference in the incidence of abnormal SSEPs, the incidence of IONM alarm events and the incidence of postoperative neurological symptoms between the two groups(P＞0.05). Conclusions: Multimodal IONM provides excellent monitoring effects in severe CS paitents undergoing 3-column osteotomy surgery. The latency of SSEPs-P37 in the concave side lower extremity of CS patients with intraspinal anomalies was significantly longer than that of CS patients without intraspinal anomalies. Intraspinal anomalies don′t increase the incidence of intraoperative IONM alarm events or the incidence of postoperative neurological complications.