Feng Lei,Zhang Xuejun,Qi Xinyu,et al.Application of intraoperative neurophysilogical monitoring during hemivertebra resection for congenital scoliosis in children[J].Journal of Clinical Pediatric Surgery,2018,17(09):673-676.
神经电生理监测技术在小儿先天性脊柱侧弯半椎体切除术中的应用
- Title:
- Application of intraoperative neurophysilogical monitoring during hemivertebra resection for congenital scoliosis in children
- Keywords:
- Congenital scoliosis; Hemivertebra resection; IONM; Somatosensory evoked potential; Motor evoked potential
- 文献标志码:
- A
- 摘要:
- 目的 探讨神经电生理监测(intraoperative neurophysiological monitoring,IONM)在小儿先天性脊柱侧弯半椎体切除术中的应用价值。方法 以2017年8月至2018年7月我院134例确诊为先天性脊柱侧弯的患儿为研究对象，在神经电生理监测下行脊柱后路椎弓根钉置入+半椎体切除+矫形术。术中监测方法主要包括体感诱发电位(somatosensory evoked potentials,SEP)和运动诱发电位(motor evoked potentials,MEP)，置钉前获得基线。在排除线路故障、麻醉、血压下降、低体温等外界因素后，符合“基线相比SEP 波幅下降50%”、“潜伏期延长 10%”、“MEP 波幅下降 70%”中任意一条则认为达到预警判定标准。 结果 134例患儿中，SEP引出率为100%，MEP引出率为97.8%（3例未正常引出），其中16例（12%）矫形过程中可见SEP波幅出现不同程度下降，但均未达到预警标准，且术后无肢体感觉异常。5例（3.7%）出现MEP波幅下降，其中1例（0.7%）在置钉过程中出现一侧MEP波幅下降，4例（2.9%）在切除半椎体后矫形过程中脊柱侧弯凹侧MEP波幅逐渐下降且超过预警标准，均按要求及时放慢或停止操作，3例波幅逐渐恢复，1例波幅仍未见恢复，进行术中唤醒，证实该侧下肢肌力下降，及时调整内固定后波幅基本恢复正常。所有患儿术后均未见异常神经症状。 结论 小儿先天性脊柱侧弯术中神经损伤好发于置钉、半椎体切除、矫形等关键步骤中，SEP和MEP联合监测可早期发现可能的神经系统损伤，并及时停止可能造成病情恶化的操作，最大限度降低损伤程度，为改善患儿预后提供安全有效的保障。
- Abstract:
- Objectives To analyze the necessity of intraoperative neurophysiological monitoring during congenital scoliosis who were treated with posterior hemivertebra resection. Methods A prospective database was reviewed, evaluated the results of neurophysiological intraoperative monitoring (IONM) in a large population of patients who underwent posterior hemivertebra resection for congenital scoliosis. Intraoperative monitoring of SEPs and transcranial electrical stimulation MEP was performed in 134 successive patients (63 males and 71 females). Acceptable baseline responses were obtained before screw insertion. Anesthetic,intraoperative body temperature, blood pressure were examined in patients with and without waveform deterioration. A neurophysiological alert was defined as a reduction in amplitude (unilateral or bilateral) of at least 50% or latent period extending by 10% for SEP and of 70% for MEP compared with baseline. Results All of the patients had the baseline of SEP，97.8%(3 failed) of the patients had the baseline of MEP .Sixteen patients (12%) exhibited an intraoperative waveform change of SEP, they were recorded intraoperatively with no postoperative neurologic deficits. Five patients (3.7%) exhibited an intraoperative waveform change,and these occurred after screw fixation(0.7%), during rotation maneuver after hemivertebra resection (2.9%), and after intervertebral compression (7%). Most waveform changes recovered after decreased correction or rest. No patient had a motor deficit postoperatively. Conclusions Spinal cord injury often occurred during screw insertion , hemivertebra resection ,and after intervertebral compression. Combined SEP and MEP monitoring could afford the surgical team an opportunity to perform rapid intervention to prevent injury progression or possibly to reverse impending neurologic sequelnce.
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