[1]华德河　郝其全　孙中政　高孟亮　王永才　孙海燕.多模式神经电生理监测技术在颈前路手术摆体位过程中的作用[J].中国临床神经外科杂志,2019,(05):281-285.[doi:10.13798/j.issn.1009-153X.2019.05.008]
　HUA De-he,HAO Qi-quan,SUN Zhong-zheng,et al.Role of multimodal intraoperative neurophysiological monitoring during positioning of anterior cervical spine surgery[J].,2019,(05):281-285.[doi:10.13798/j.issn.1009-153X.2019.05.008]
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多模式神经电生理监测技术在颈前路手术摆体位过程中的作用()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2019年05期
页码:
281-285
栏目:
论著
出版日期:
2019-05-27

文章信息/Info

Title:
Role of multimodal intraoperative neurophysiological monitoring during positioning of anterior cervical spine surgery
文章编号:
1009-153X（2019）05-0281-05
作者:
华德河　郝其全　孙中政　高孟亮　王永才　孙海燕
255400 山东淄博，北大医疗鲁中医院脊柱外科（华德河、郝其全、孙中政、高孟亮、王永才、孙海燕）华德河、郝其全、孙中政为共同第一作者
Author(s):
HUA De-he;  HAO Qi-quan;  SUN Zhong-zheng;  GAO Meng-liang;  WANG Yong-cai;  SUN Hai-yan
Department of Spinal Surgery, Luzhong Hospital, PKU Health Care, Zibo 255400, China
关键词:
颈椎疾病; 神经电生理监测; 颈前路手术; 体位摆放
Keywords:
Cervical spine surgery;  Multimodal intraoperative neuroelectrophysiological monitoring;  Position
分类号:
R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2019.05.008
文献标志码:
A
摘要:
目的 探讨多模式神经电生理监测（MIOM）技术在颈前路手术摆体位过程中的作用。方法 回顾性分析2016年9月至2018年7月在MIOM辅助下颈前路手术治疗的55例病人的临床资料。采用日本骨科协会（JOA）评分评估疗效。观察颈椎体位摆放过程中，经颅运动诱发电位（TcMEP）、体感诱发电位（SSEP）变化。结果 在体位摆放过程中，6例TcMEP部分消失、SSEP未见明显变化，其中5例在颈部重新摆放体位后，TcMEP完全恢复、SSEP未见明显变化；1例在颈部复位后，TcMEP并没有立即完全恢复，而是在减压后完全恢复，SSEP未见明显变化。术毕TcMEP波幅较术前均有提高，而TcMEP潜伏期及SSEP均未见明显变化。所有病人术后均未出现新的神经功能障碍。55例术后7 d JOA评分[（13.53±1.93）分]较术前[（10.25±2.80）分]显著提高（P<0.05）。结论 MIOM技术是预防颈前路手术体位摆放过程中颈髓、神经根损伤的有效方法，其中TcMEP对颈部体位摆放相关颈髓及神经根损伤的敏感性较高，颈部复位可纠正不当体位，避免或加重颈髓或神经的损伤。
Abstract:
ObjectiveToexploretheroleofmultimodalintraoperativeneuroelectrophysiologicalmonitoring(MINM)duringthepositioningofanteriorcervicalspinesurgery(ACSS).MethodsTheclinicaldataof55patientsundergoingACSSunderMINMinourdepartmentfromSeptember,2016toJuly,2018wereanalyzedretrospectively,includingMINMdataof55patientsfromthebeginningofpositioningtotheendofthesurgicalprocedure,demographic,imagesandpreoperativeandpostoperativeelectrophysiologicaldataandJapaneseOrthpaedicAssociation(JOA)score.ResultsMINMwarningsappearedin6patientsduringthepositioning.Thetranscrainialmotorevokedpatential(TcMEP)disappearedandthesomatosensoryevokedpotentials(SSEP)didnotchangesignificantlyin6patients,ofwhom,5hadcompleterecoveryofTcMEPand1whodidnothadcompleterecoveryofTcMEPafterneckrepositioning.TheamplitudesofTcMEPwereimprovedsignificantlyaftertheoperationinallthepatients,inwhomnewneurologicaldysfunctionwasnotfoundaftertheoperation.TheJOAscoreswereimprovedsignificantly7daysafterthesurgerycomparedwiththosebeforethesurgeryinallthepatients(P<0.05).ConclusionsMINMisanefficientmethodtopreventtheinjuryofcervicalspinalcordandnerverootduringthepositioningduringACSS.TcMEPshowshighersensitivitytocervicalspineinjuryrelatedtothepositioning.Neckrepositionisveryhelpfultorestoringtheelectrophysiologicalsignalsbycorrecingtheimproperpositionoftheneckandthesequelaeareeffectivelyprevented.

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备注/Memo

备注/Memo:

通讯作者：孙海燕，E-mail：hhysun1269@163.com
更新日期/Last Update: 2019-05-27