Jiang Wenbin,Wang Junlu,Zhan Qijia,et al.Application of somatosensory evoked potential during operations of fatty filum[J].Journal of Clinical Pediatric Surgery,2022,21(10):929-935.[doi:10.3760/cma.j.cn101785-202204096-006]
终丝脂肪变性患儿脊髓栓系松解术中体感诱发电位的应用价值
- Title:
- Application of somatosensory evoked potential during operations of fatty filum
- Keywords:
- Cauda Equina; Pathology; Neurosurgical Procedures; Neurophysiological Monitoring; Somatosensory Evoked Potential; Child
- 摘要:
- 目的 探索终丝脂肪变性(fatty filum,FT)患儿手术中体感诱发电位(somatosensory evoked potential,SSEP)的应用价值。方法 回顾性分析上海市儿童医院2016年1月至2021年12月确诊并行脊髓栓系松解术治疗的48例FT患儿临床资料,其中男29例,女19例;年龄2个月至12岁。25例因排便或排尿异常、3例因背部疼痛就诊后确诊FT,另有20例因筛查发现背部皮肤异常确诊FT。患儿均接受脊髓栓系松解术治疗,并在脊髓栓系松解前及松解后1 h分别进行双下肢SSEP监测。随访患儿术后康复情况,并与术前症状进行比较,评定出症状改善、无变化或加重。根据术前影像学提示脊髓圆锥位于L1~L2椎间盘以上或以下,将患儿分为圆锥正常组或圆锥低位组。比较两组患儿脊髓栓系松解前后双下肢SSEP参数变化(主要为P37潜伏期、N45潜伏期及P37-N45波幅),并探索年龄与SSEP参数的相关性。结果 25例排便或排尿异常患儿手术后末次随访时症状改善24例,无变化1例;3例术前腰背部疼痛患儿术后均症状改善。圆锥低位组25例患儿术前双下肢P37-N45波幅中位数较圆锥正常组更低(左侧:0.3 μV比0.7 μV,P<0.01;右侧:0.5 μV比0.8 μV,P<0.05)。脊髓栓系松解后所有患儿双下肢P37-N45波幅较术前增大(左侧:1.1 μV比0.6 μV,P<0.0 001;右侧:1.1 μV比0.6 μV,P<0.0001)。年龄与脊髓栓系松解后双下肢P37-N45波幅的变化幅度呈负相关(左侧:r=-0.45,右侧:r=-0.44,P值均＜0.01),该负相关性主要体现在圆锥低位组患儿中(左侧:r=-0.51,P<0.05;右侧:r=-0.57,P<0.01)。结论 脊髓栓系松解术能改善FT患儿的临床症状。SSEP波幅能监测和发现脊髓圆锥低位FT患儿的潜在神经功能损伤。尽早手术解除异常的脊髓圆锥牵拉,可能有助于受损神经功能的恢复。
- Abstract:
- Objective To explore the value of somatosensory evoked potential (SSEP) during operations in children with fatty filum (FT).Methods From January 2016 to December 2021,clinical data were retrospectively reviewed for 48 FT children operated at Shanghai Children’s Hospital.There were 29 boys and 19 girls with an age range from 2 months to 12 years old.The major symptoms included lower urinary tract/bladder symptoms (n=25),low back pain (n=3) and other cases were screened because of dermal sinus,anal/urinary system malformations & low conus (detected by obstetric ultrasound,n=20).The values of P37-N45 amplitude before and after surgery were compared and the correlations between age/radiological features and SSEP parameters examined.Results Among 25 children with an onset of urinary/bowel dysfunctions,24 patients had improved symptoms and 1 case showed no change during the last follow-up.The symptoms of 3 children with preoperative low back pain relieved postoperatively.The median amplitude of P37-N45 was lower in 25 children with low conus position (0.3 μV vs.0.7 μV at left side with P<0.01,0.5 μVvs.0.8 μV at right side with P<0.05).Among all cases,the median amplitude of P37-N45 post-operation was higher than that pre-operation (P<0.0 001).The postoperative change of P37-N45 amplitude was negatively correlated with age (r=-0.45 at left side while r=-0.44 at right side,both P<0.01) and the trend was more obvious in FT with low conus (r=-0.51 at left side with P<0.05 while r=-0.57 at right side with P<0.01).Conclusion Loosening operation relieves the clinical symptoms of FT patients.P37-N45 amplitude hints at potential neurological impairment.Surgery at an earlier age may accelerate the recovery of impaired neurological function.
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备注/Memo
收稿日期:2022-4-30。
基金项目:上海市2020年度"科技创新行动计划"(20Y11905800);上海交通大学"交大之星"计划医工交叉研究基金(YG2021QN117);上海市儿童医院院级课题国家自然科学基金培育专项(2020YGZQ05)
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