| 杨晓清,杨全中,张少甫,胡凡奇,王尧,龚雪,张雪松.术前脊髓监测异常患者脊柱截骨术中脊髓监测参数改变与预后关系[J].脊柱外科杂志,2017,15(1):34-38. |
术前脊髓监测异常患者脊柱截骨术中脊髓监测参数改变与预后关系  点此下载全文 (Fulltext) |
| 杨晓清 杨全中 张少甫 胡凡奇 王尧 龚雪 张雪松 |
| 解放军总医院脊柱外科, 北京 100853 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2017.01.007 |
| 摘要点击次数: 1252 |
| 全文下载次数: 548 |
| 摘要： |
| 目的 分析术前脊髓监测（SCM）异常患者行脊柱后路截骨手术术中SCM参数变化与患者预后的关系。方法 回顾性分析2011年1月-2013年1月在本院接受脊柱后路截骨手术的64例患者的临床资料。术前患者体感诱发电位（SEP）波幅<1 μV和/或SEP未能得到可靠波形和/或经颅电刺激运动诱发电位（MEP）波形不能引出为SCM异常。根据术前SCM结果将患者分为正常组（50例）和异常组（14例）。术中使用SEP和MEP行联合SCM，比较两组患者术后美国脊髓损伤协会（ASIA）分级下降的发生率。结果 正常组患者中12例术后出现ASIA分级下降，其中11例术中发生SCM异常；ASIA分级未下降者中6例术中发生SCM异常。正常组中SCM灵敏度为91.7%，特异度为84.2%。异常组患者中10例术后出现ASIA分级下降，其中9例术中发生SCM异常；4例ASIA分级未下降者术中均发生SCM异常。异常组中SCM灵敏度为90.0%，特异度为0。SCM改变相关因素为复位、截骨、出血、麻醉药物和肌松药过量。结论 欲行脊柱后路截骨术的患者，如果术前即出现SCM参数异常，术后出现神经系统并发症的概率较大，一旦术中再次出现SCM参数持续异常，预后往往较差，而SCM一过性恶化，患者术后未必出现神经系统并发症，对于这部分患者，医师需要术前充分准备、术中谨慎操作、术后密切关注。 |
| 关键词：脊柱后凸 脊髓损伤 截骨术 诱发电位 预后 |
| Relationship between change of intraoperative spinal cord monitoring parameters and prognosis in patients with abnormal spinal cord monitoring parameters before spinal osteotomy Fulltext |
| YANG Xiao-qing YANG Quan-zhong ZHANG Shao-fu Hu Fan-qi WANG Yao GONG Xue ZHANG Xue-song |
| Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China |
| Fund Project: |
| Abstract: |
| Objective To analyze the relationship between the change of interaoperative spinal cord monitoring(SCM) parameters and prognosis in patients with abnormal SCM parameters before spinal osteotomy. Methods The clinical data of 64 patients undergoing posterior osteotomy from January 2011 to January 2013 were retrospectively analyzed. Amplitudes of preoperative somatosensory evoked potential(SEP) was below 1 μV and/or SEP could not show a reliable waveform and/or motor evoked potentials(MEP) could not reveal abnormality of SCM. According to preoperative SCM results, the patients were divided into normal group (n=50) and abnormal group (n=14). SEP and MEP were used to monitor spinal cord function during the operation, and then the incidence rates of ASIA grade reduction were compared between the 2 groups. Results In the normal group, 12 patients' ASIA grading descended, and 11 of the 12 patients showed SCM abnormal changes, while there were 6 patients whose ASIA grade had no reduction, but their SCM parameters were abnormal during the surgery. In the normal group, the sensitivity of SCM was 91.7%, and the specificity was 84.2%. In the abnormal group, 10 patients' ASIA grade was reduced after the surgery, and 9 of the 10 patients had abnormal SCM parameters, while there were 4 patients whose ASIA grade had no reduction, but their SCM results were abnormal during the surgery. In the abnormal group, the sensitivity of SCM was 90.0%, and the specificity was 0. The relevant factors for SCM result change were reduction, osteotomy, blood loss, overdose of anesthetic drugs or muscle relaxants. Conclusion The patients who would receive posterior osteotomy with abnormal SCM before the operation may risk more neurologic complications. And once the intraoperative SCM abnormalities occur, the prognosis is bad. For these patients, doctors need to do full preparation before surgery, careful intraoperative operation, and postoperative close attention. |
| Keywords:Kyphosis Spinal cord injuries Osteotomy Evoked potentials Prognosis |
|
|
HTML
查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
|
|
