Wang Shujie,Ren Zhifu,He Fang,et al.Effectiveness analysis of intraoperative electrophysiological monitoring for early-onset scoliosis[J].Journal of Clinical Pediatric Surgery,2020,19(02):120-124.[doi:10.3969/j.issn.1671-6353.2020.02.006]
早发性脊柱侧凸手术中神经功能监测的应用及意义探讨
- Title:
- Effectiveness analysis of intraoperative electrophysiological monitoring for early-onset scoliosis
- Keywords:
- Scoliosis; Transcranial Electric Motor Evoked Potential; Somatosensory Evoked Potential; Hemivertebra Resection; Vertebral Column Resection; Total Intra Venous Anesthesia
- 分类号:
- R726.8;R682.3;R338.8
- 摘要:
- 目的 探讨术中经颅电刺激运动诱发电位（transcranial electric Motor Evoked Potential，TceMEP）和体感诱发电位（somatosensory evoked potentials，SSEP）监测在早发性脊柱侧凸（early-onset scoliosis，EOS）脊柱截骨矫形手术中的应用价值，并分析此类手术中的神经电生理监测特点。方法 收集2015年9月至2016年12月由北京协和医院骨科收治的20例EOS和120例特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者进行回顾性研究，其中20例EOS患者平均年龄（2.65±0.11）岁，120例AIS患者平均年龄（13.9±0.51）岁。TceMEP、SSEP、自由运动肌电图（free-run EMG）和标准化的麻醉方案用于术中神经功能监测的研究。结果 EOS患儿采用后路半椎体或者全脊椎切除、短节段固定融合的手术方式。其中95.0%（19/20）的患儿获得术中稳定可靠的SSEP和TceMEP监测基线。1例（2岁，9 kg）直至手术截骨时未获得有效的TceMEP基线。本研究EOS患儿平均TceMEP基线波幅为（88.7±21.9）μV（范围：27~278 μV），显著低于AIS患者的（346.7±24.2）μV，差异有统计学意义（t=2.162，P<0.01）。AIS患者均采用后路内固定，脊柱侧弯矫形植骨融合的手术方式。结论 TceMEP，SSEP和free-run EMG监测方法针对EOS患儿是准确可行的。监测结果可以为手术团队提供准确的神经功能信息，防止术后神经系统并发症的发生。
- Abstract:
- Objective To explore the feasibility of combining intraoperative transcranial electric-stimulation motor evoked potential (TceMEP) and somatosensory evoked potentials (SSEP) monitoring during spinal osteotomy of early-onset scoliosis (EOS) and analyze the characteristics of intraoperative electrophysiological monitoring.Methods From September 2015 to December 2016,a total of 20 EOS children with a mean age of (2.65±0.11) years and 120 children of adolescent idiopathic scoliosis (AIS) with a mean age of (13.9±0.51) years were retrospectively reviewed.Transcranial motor evoked potentials (TceMEPs),somatosensory evoked potentials (SSEPs),free-run intra-operative electromyography (free-run EMG) and a standardized anesthesia protocol were applied for intraoperative electrophysiological monitoring.Results The procedures included posterior hemivertebra or vertebra column resection,instrumentation and short fusion surgery.And 95.0% (19/20) cases had stable and reliable intra-operative baseline levels of SSEP and TceMEP.One 2-year-old child with a body weight of 9 kg failed to achieve a baseline TceMEP until osteotomy.And AIS children underwent posterior instrumentation deformity correction and bone graft fusion.The average baseline amplitude of TceMEP was markedly lower than that of EOS[(88.7±21.9)(27-278) vs (346.7±24.2) μV] (t=2.162,P<0.01).The differences were statistically significant.Conclusion Combining TceMEP,SSEP and free-run EMG monitoring is both feasible and effective.It provides accurate information for surgical teams to prevent the postoperative occurrences of neurological deficits.
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备注/Memo
收稿日期:2019-12-16。
通讯作者:仉建国,Email:jgzhang_pumch@yahoo.com