多模式神经电生理监测在椎管内占位手术中的应用

doi:10.13418/j.issn.1001-165x.2017.03.020

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (3): 331-335.doi: 10.13418/j.issn.1001-165x.2017.03.020

多模式神经电生理监测在椎管内占位手术中的应用

陈艺¹，　叶劲²，　林志雄¹，　吴景明¹，　黎文¹，　卢永辉¹，　白波¹ ，　卢伟杰¹

1.广州医科大学附属第一医院骨科, 广东省骨科矫形技术与植入材料重点实验室，广州 510120;
2. 云浮市人民医院骨科，广东云浮 527399

收稿日期:2017-01-18 出版日期:2017-05-25 发布日期:2017-06-23
通讯作者: 叶劲，主任医师，硕士生导师，E-mail:yeking2006@163.com
作者简介:陈艺（1978-），女，外科学讲师，硕士，研究方向：术中神经电生理监测，E-mail:rechenyi@163.com

Multiple intraoperative monitoring of neuroelectrophysiology in surgical treatment for intraspinal occupying lesion

CHEN Yi¹, YE Jin², LIN Zhi-xiong¹, WU Jing-ming¹, LI Wen¹, LU Yong-hui¹, BAI Bo¹, LU Wei-jie¹

1.Department of Orthopaedics, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, Guangzhou 510120, China; 2. Department of Orthopaedics, Yunfu People’s Hospital, Yunfu 527399, China

Received:2017-01-18 Online:2017-05-25 Published:2017-06-23

摘要/Abstract

摘要：

目的　探讨体感诱发电位(CSEP)、经颅电刺激运动诱发电位(TES-MEP)与自由及激发肌电图（EMG）多模式联合监测技术在脊柱椎管内占位手术中应用的价值。方法　对47例脊柱椎管内占位患者(颈椎4例，胸椎14例，胸腰段13例，腰椎13例，骶椎3例)行占位病变切除术中采用CSEP+TES-MEP+自由EMG+激发EMG监护。结果　①CSEP和 TES-MEP：监测成功率各为100%和93.6%；阳性率分别为19.1%和17.0%；联合监测假阴性率及假阳性率均为0%；10例诱发电位阳性均与手术操作有关，8例及时报警采取措施后渐恢复，2例MEP阳性未能恢复，术后肌力下降；6例CSEP改善，术后症状好转。②自由和激发EMG：34例患者术中出现自由EMG，其中1例马尾神经严密包裹病变的患者，术后小便功能异常，术后渐恢复。结论　①椎管内占位术中联合运用CSEP和TES-MEP监测，排除各种干扰因素后，能准确地反映术中脊髓功能状况；②术中自由及激发EMG监测可准确探查和鉴别占位病变神经组织分布，实时反映神经受激惹情况，预防医源性神经损伤。

关键词: 体感诱发电位, 　经颅电刺激运动诱发电位, 　肌电图, 　术中监护, 　脊髓疾病

Abstract:

Objective　To investigate the efficacy of combined monitoring of motor evoked potentials withtrans-cranial electrical stimulation (TES-MEP), somatosensory evoked potentials(SEP), free and tirgger EMG for surgical treatment forintraspinal occupancy surgery occupying lesion. Method Combined SEP, TES-MEP, free and trigger EMG monitoring were employed in forty-two cases of surgical treatment forintraspinal occupancy surgery occupying lesion, including one cervicalcase, fourteen thoracic cases, thirteen thoracolumbar cases, eleven lumbar cases, and three sacral cases. SEP and TES-MEP were used to monitor the precise status of sensory and motor pathways in spinal cord. Free and trigger EMG responses were used to more accurately explore and distinguish distribution of nerve tissues in and around theintraspinal occupancy.All cases were performed after surgery. Results ①SEPwas successfully achieved in 47(100%)cases. TES-MEP was successfully achieved in 44(93.6%)cases. Combined motor and sensorymonitoring was successfully achieved in 44(93.6%)cases. The abnormality of SEP was observedin 10 cases(19.1%), while the abnormality of MEP was observed in eight cases(17.0%). False negative and positiverate were 0% with combined SEP and TES-MEP monitoring. 10 positive cases of evoked potential were all caused by operations. Eight of them recovered gradually after the alarm in time to take measures. The other two cases who were only positive in TES-MEP failed to recover and postoperative muscle strength decreased. The symptoms were alleviated in six cases with SEP waveforms getting better. ②34 cases of EMG?response was observed. Postoperative urination dysfunction occurred in one case in which the intraspinal lesion was wrapped by tight cauda equina. However, this patient recovered in the twelfth day after operation. Conclusions ①During surgical treatment for intraspinal occupancy surgery occupying lesion,combined application of SEP and TES-MEP can reflect the physiological and pathological conditions of spinal cord after ruling out the interfering factors, and improve the monitoring effect . ②Intraoperative monitoring of free and trigger EMG can not only accuratelyexplore and distinguish distribution of nerve tissues in and around the intraspinal occupancy, but also respond to the nerve irritation timely, and prevent iatrogenic nerve injuries.

Key words: Somatosensory evoked potential；　Motor evoked potentials；　Electromyography; , Intraoperative monitoring;　Spinal cord diseases

陈艺,叶劲,林志雄,吴景明,黎文,卢永辉,白波,卢伟杰. 多模式神经电生理监测在椎管内占位手术中的应用[J]. 中国临床解剖学杂志, 2017, 35(3): 331-335.

CHEN Yi, YE Jin, LIN Zhi-xiong, WU Jing-ming, LI Wen, LU Yong-hui, BAI Bo, LU Wei-jie. Multiple intraoperative monitoring of neuroelectrophysiology in surgical treatment for intraspinal occupying lesion[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(3): 331-335.

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多模式神经电生理监测在椎管内占位手术中的应用

Multiple intraoperative monitoring of neuroelectrophysiology in surgical treatment for intraspinal occupying lesion

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