神经电生理监测技术在胸椎骨折椎弓根螺钉置入中的应用

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Abstract Objective To explore the values of intraoperative neurophysiological monitoring(IONM) in the placement of thoracic pedicle screws in thoracic fracture surgery. Methods From February 2015 to December 2016，a total of 18 patients suffering from thoracic fracture underwent posterior instrumentation and fusion in our hospital.They were 16 males and 2 females，with an average age of(32.6±12.3) years.Preoperative spinal cord function was graded by Frankel criteria.There were 1 case of grade A，2 cases of grade B，6 cases of grade C，8 cases of grade D and 1 case of grade E.Somatosensory evoked potentials(SEP) were tested before and 1 week after surgery.Pedicle screws were inserted under the monitoring of SEP and motor evoked potentials(MEP).The accuracy of pedicle screw placement was assessed according to postoperative CT scans.Results The average operation time was(167±36) min and intraoperative blood loss(EBL) was(423±141)mL.The Cobb angle of segmental kyphosis was corrected from(31.2±5.7)° to(10.6±4.9)° after surgery.A total of 144 screws were inserted in the 18 patients.No significant changes of SEP and MEP were observed in the placement of 86 screws(59.7％).Changes were detected but did not reach the alarm level in 40 screws(27.8％).Changes of 18 screws(12.5％) reached the alarm level.According to CT evaluation，the satisfactory rate of pedicle screw placement was 93.1％，while the perforation rate was 6.9％.The results of SEP evaluation were improved significantly 1 week after surgery.No neurologic?deterioration was found during and after surgery.Conclusion SEP and MEP monitoring can early detect the possible neurologic injury during the placement of thoracic pedicle screws.Neurologic defect could be reduced，if the operation is stopped when the monitoring reaches the alarm level.

Key words： somatosensory evoked potentials motor evoked potentials pedicle screws thoracic fracture

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	Dai Xiaoqing
	Rong Guoqiang

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Dai Xiaoqing,Rong Guoqiang. Application of Intraoperative Neurophysiological Monitoring in the Placement of Pedicle Screws in Thoracic Fracture Surgery[J]. sygkzz, 2018, 24(4): 324-384.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2018/V24/I4/324

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