Wen Haitao,Wang Qianyang,Chen Xiaoyan,et al.Application value of multi-mode neuroelectrophysiological monitoring during spinal cord loosening for tethered cord syndrome in children[J].Journal of Clinical Pediatric Surgery,2020,19(09):830-836.[doi:10.3969/j.issn.1671-6353.2020.09.014]
多模式神经电生理监测在儿童脊髓栓系松解术中的应用价值研究
- Title:
- Application value of multi-mode neuroelectrophysiological monitoring during spinal cord loosening for tethered cord syndrome in children
- 关键词:
- 神经管缺损/外科学; 多模式神经电生理监测; 儿童
- 分类号:
- R729;R651.2
- 摘要:
- 目的 探讨多模式神经电生理监测在儿童脊髓栓系松解术中的应用价值。方法 收集湖南省儿童医院神经外科2019年3月至2019年12月行手术治疗的64例脊髓栓系患儿临床资料，男38例，女26例。年龄1个月至13岁，平均（23.5±28.9）个月。患儿在进行脊髓栓系松解术的过程中均接受多模式[体感诱发电位（somatosensory evoked potential，SEP）、运动诱发电位（motor evoked potential，MEP）、肌电图（electromyography，EMG）和/或球海绵体括约肌反射（bulbocavernosus sphincter reflex，BCR）]神经电生理监测，术中根据神经电生理监测结果调整手术操作。结果 64例中有62例完全松解脊髓栓系，2例脊髓栓系术后再栓系患儿由于脊髓脂肪瘤粘连紧密行部分松解，4例术前、术中无法诱发出运动诱发电位，60例（93.75%）术前、术中可诱发出运动诱发电位并记录到肌肉动作电位，术后监测所有患儿未出现运动诱发电位消失或显著下降。44例脂肪瘤型脊髓栓系患儿术前脊髓直径（CORD）/硬脊膜囊直径（SAC）的值为（0.81±0.22），术后CORD/SAC的值为（0.38±0.16），差异有统计学意义（t=17.085，P<0.001）。术后随访中发现14例大小便功能异常患儿中改善7例，无改善6例，1例术后小便障碍加重出现尿潴留，经导尿训练后恢复；8例腰背部疼痛或双下肢神经功能异常患儿中，改善7例，无改善1例，无一例加重或脊髓栓系复发。结论 脊髓栓系松解术中应用多模式神经电生理监测（multimodal intraoperative monitoring，MIOM）可帮助术者鉴别正常神经组织，在保护神经组织的同时最大范围切除脂肪瘤，降低CORD/SAC值。
- Abstract:
- Objective To explore the efficacy of multi-mode neuroelectrophysiological monitoring during spinal cord loosening for tethered cord syndrome in children. Methods From March 2019 to December 2019,clinical data were collected and retrospectively analyzed for 64 children operated for tethered spinal cord.There were 38 boys and 26 girls with an average age of (23.5±28.9)(1-156) month.The intraoperative multi-mode examinations of nerve monitoring included somatosensory evoked potentials (SEP),motor evoked potentials (MEP),electromyography (EMG) and/or bulbocavernosus sphincter reflex (BCR).Operative handling was adjusted according to the results of neuroelectrophysiological monitoring. Results Sixty-two children with spinal cord tethered cord were completely released and 2 cases partially released due to an adhesion of spinal lipoma.MEP was not induced before and during operation in 4 cases.In 60 cases (93.75%),MEP was induced before and during operation and muscle action potential recorded.Postoperatively MEP showed no disappearance or a significant decrease.CORD/SAC was an important parameter of measuring postoperative adhesion.In 44 cases with tethered lipoma,CORD/SAC ratio was (0.81±0.22) pre-operation and (0.38±0.16) post-operation and it decreased with statistically significant difference (t=17.085,P<0.001).During postoperative follow-ups,urinary and fecal dysfunctions showed improvements (n=7) and non-improvements (n=6).One case of postoperative urinary retention recovered after catheterization training.Among 8 children with lower back pain or nerve dysfunction of lower extremities,there were improvement (n=7) and non-improvement (n=1).None had aggravation or recurrence. Conclusion During cord lysis,application of multimodal intraoperative monitoring (MIOM) may assist surgeons in differentiating normal nerve tissue,protecting nerve tissue,maximally removing lipoma and lowering CORD/SAC value.
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备注/Memo
收稿日期:2020-02-25。
基金项目:湖南省中医药科研计划项目（编号：2020108）；湖南省出生缺陷协同防治科技重大专项（编号：2019SK1010）；湖南省卫生健康委员会一般项目（编号：2017118）
通讯作者:吴水华,Email:292454021@qq.com