术中电生理监测在脊柱侧凸翻修截骨手术中的应用

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摘要目的探讨经颅电刺激运动诱发电位(transcranial electric motor evoked potentials，TCeMEP)和体感诱发电位(somatosensory evoked potentials，SSEP)监测在脊柱侧凸翻修截骨手术中的应用价值。方法回顾性分析2011年3月至2016年3月于我科全麻下行脊柱侧凸翻修截骨术的患者176例，均行SSEP监测，其中134例同时应用TCeMEP监测。分别统计单独SSEP、单独TCeMEP及TCeMEP联合SSEP监测的真阳性率、假阳性率、真阴性率、假阴性率、阳性预测值、阴性预测值、敏感性及特异性。结果单独SSEP成功监测162例(92.0％)，TCeMEP成功监测109例(81.3％)。134例应用TCeMEP联合SSEP监测患者，有124例(92.5％)采用任意一种监测方式成功监测。162例成功监测的患者中共有14例报警，报警率为8.6％(14/162)。最终残留神经损伤患者3例，占1.9％(3/162)。统计单独SSEP监测组的敏感性和特异性分别为72.7％和98.7％，单独TcMEP组为90.9％和98.0％，而联合TcMEP及SSEP监测组的敏感性为最高100％，特异性为98.2％。联合TcMEP及SSEP监测组阳性及阴性预测值为85.7％和100％，高于单独SSEP组(80.0％和98.0％)及单独TcMEP组(83.3％和99.0％)。结论脊柱侧凸翻修截骨术手术操作复杂，联合TcMEP及SSEP监测较单一监测能更早地发现神经损害，降低手术风险。我们建议对于脊柱侧凸翻修截骨患者应常规应用TcMEP及SSEP进行联合监测。

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关键词 ：运动诱发电位, 体感诱发电位, 术中电生理监测, 脊柱侧凸, 翻修术

Key words： somatosensory evoked potentials motor evoked potentials intraoperative neurophysiological monitoring kyphoscoliosis revision surgery

基金资助:首都临床特色应用研究与成果推广(Z151100004015018)

通讯作者: 马华松

作者简介: 张乐乐(1983－ )，男，主治医师，解放军第306医院骨科，100101。

引用本文:

张乐乐，马华松，吴继功，高博，王加旭，马树伟，孙荣智. 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.
Zhang Lele，Ma Huasong，Wu Jigong，et al. Application of Intraoperative Neurophysiological Monitoring in Kyphoscoliosis Osteotomy Revision Surgery. sygkzz, 2017, 23(8): 684-689.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I8/684

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