张乐乐;吴继功;马华松;邵水霖;高博;王加旭;李海侠;陈牡;

• 1:解放军第306医院骨科全军脊柱外科中心

摘要(Abstract)：

[目的]评估联合体感诱发电位(somatosensory evoked potential,SSEP)和经颅运动诱发电位(transcranial motor evoked potential,TcMEP)监测在重度脊柱畸形翻修截骨矫形手术中的应用价值,探讨术中出现神经监测变化的危险因素。[方法]回顾性分析2015年1月~2017年1月于本科全麻下进行重度脊柱畸形翻修截骨矫形手术54例患者,男19例,女35例。术中均应用SSEP和TcMEP联合监测。统计比较单模式SSEP、单模式TcMEP及双模式联合监测的阳性预测值和阴性预测值、敏感性及特异性。分析术中出现真阳性电生理监测变化的原因和危险因素,并提出相应的管理措施。[结果]联合SSEP及TcMEP监测成功率、阳性预测值、阴性预测值、敏感性及特异性均为最高。54例患者中共有14例(25.93%)出现阳性电生理监测变化。经术中干预后,随访时最终2例(3.70%)未恢复至术前神经功能状态。术前合并胸椎管狭窄、主弯Cobb角>130°为出现真阳性电生理变化的危险因素。[结论]在重度脊柱畸形翻修截骨矫形手术中,联合SSEP及TcMEP监测能有效地检测早期脊髓损伤,有更好地进行预警的价值。积极进行干预能扭转电生理变化并可以避免严重脊髓损伤并发症发生。翻修术中截骨矫形过程出现电生理变化概率较高。术前合并胸椎管狭窄以及主弯Cobb角>130°的患者更易导致真阳性监测变化发生。

关键词(KeyWords)： 术中电生理监测;脊柱畸形;截骨术;翻修术;危险因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张乐乐;吴继功;马华松;邵水霖;高博;王加旭;李海侠;陈牡;

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参考文献(References)：

• [1]Yang JH,Suh SW,Cho WT,et al.Effect of posterior multilevel vertebral osteotomies on coronal and sagittal balance in fused scoliosis deformity caused by previous surgery:preliminary results[J].Spine,2014,39(22):1840-1849.
• [2]Saifi C,Laratta JL,Petridis P,et al.Vertebral column resection for rigid spinal deformity[J].Global Spine J,2017,7(3):280-290.
• [3]Vitale MG,Moore DW,Matsumoto H,et al.Risk factors for spinal cord injury during surgery for spinal deformity[J].J Bone Joint Surg Am,2010,92(1):64-71.
• [4]Bhagat S,Durst A,Grover H,et al.An evaluation of multimodal spinal cord monitoring in scoliosis surgery:a single centre experience of 354 operations[J].Eur Spine J,2015,24(7):1399-1407.
• [5]Schwartz D,Auerbach J,Dormans J,et al.Neurophysiological detection of impending spinal cord injury during scoliosis surgery[J].J Bone Joint Surg Am,2007,89(11):2440-2449.
• [6]Hilibrand AS,Schwartz DM,Sethuraman V,et al.Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery[J].J Bone Joint Surg Am,2004,86-A(6):1248-1253.
• [7]Ji X,Chen H,Zhang Y,Zhang L,Zhang W,Berven S,et al.Threecolumn osteotomy surgery versus standard surgical management for the correction of adult spinal deformity:a cohort study[J].JOrthop Surg Res,2015,10(1):23.
• [8]Sacramento-Dominguez C,Yagi M,Ayamga J,et al.Apex of deformity for three-column osteotomy.Does it matter in the occurrence of complications[J].Spine J,2015,15(11):2351-2359.
• [9]Lenke LG,Newton PO,Sucato DJ,et al.Complications after 147consecutive vertebral column resections for severe pediatric spinal deformity:a multicenter analysis[J].Spine,2013,38(2):119-132.
• [10]Henderson L,Tsirikos AI.Intraoperative neurophysiological monitoring in spinal deformity surgery[J].Orthop Trauma,2017,31(6):425-432.
• [11]Chen X,Sterio D,Ming X,et al.Success rate of motor evoked potentials for intraoperative neurophysiologic monitoring:effects of age,lesion location,and preoperative neurologic deficits[J].J Clin Neurophysiol,2007,24(3):281-285.
• [12]张乐乐,马华松,吴继功,等.术中电生理监测在脊柱侧凸翻修截骨手术中的应用[J].实用骨科杂志,2017,23(8):684-689.
• [13]Lenke LG,Sides BA,Koester LA,et al.Vertebral column resection for the treatment of severe spinal deformity[J].Clin Orthop,2010,468(3):687-699.
• [14]Wang S,Yang Y,Zhang J,et al.Frequent neuromonitoring loss during the completion of vertebral column resections in severe spinal deformity surgery[J].Spine J,2017,17(1):76-80.
• [15]Qiu Y,Wang S,Wang B,et al.Incidence and risk factors of neurological deficits of surgical correction for scoliosis:analysis of 1373cases at one Chinese institution[J].Spine,2008,33(5):519-526.
• [16]Colman MW,Hornicek FJ,Schwab JH.Spinal cord blood supply and its surgical implications[J].J Am Acad Orthop Surg,2015,23(10):581-591.
• [17]Auerbach JD,Lenke LG,Bridwell KH,et al.Major complications and comparison between 3-column osteotomy techniques in 105consecutive spinal deformity procedures[J].Spine,2012,37(14):1198-1210.
• [18]马华松,陈志明,杨滨,等.脊柱畸形后路截骨术神经并发症分析[J].中华外科杂志,2012,50(4):328-332.
• [19]Xie JM,Zhang Y,Wang YS,et al.The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities[J].Eur Spine J,2014,23(1):149-156.