TES-MEP和CSEP联合应用评价脊柱手术患者脊髓功能的临床价值-东南大学学报医学版

TES-MEP和CSEP联合应用评价脊柱手术患者脊髓功能的临床价值

单位：华中科技大学同济医学院附属武汉中心医院脊柱外科, 湖北武汉 430014

分类号：R741.044;R651.2

出版年·卷·期（页码）：2017·36·第三期（399-403）

摘要：

目的：探讨联合应用皮层体感诱发电位（CSEP）、经颅电刺激运动诱发电位（TES-MEP）监测在脊柱外科手术中的临床价值。方法：对186例脊柱外科手术患者进行回顾性分析，所有患者在脊柱手术中同时接受足拇短屈肌TES-MEP、双侧胫前肌及CSEP监测，对比TES-MEP及CSEP监测结果与术后脊髓感觉与运动功能检测结果的差异，计算其诊断学效能指标。结果：TES-MEP术中监测运动功能阳性的灵敏度为100.00%、特异度为98.09%，监测感觉功能阳性的灵敏度为79.31%、特异度为94.27%；CSEP术中监测运动功能阳性的灵敏度为86.21%、特异度为96.82%，监测感觉功能阳性的灵敏度为93.10%、特异度为98.09%；TES-MEP联合CSEP术中监测运动功能和感觉功能阳性的灵敏度均为100.00%、特异度均为99.36%。结论：脊柱外科手术中联合应用CSEP、TES-MEP能够提高脊髓运动功能、感觉功能阳性的监测水平。

Objective:To investigate the clinical value of combined application of cortical somatosensory evoked potential(CSEP)and transcranial electrical stimulation motor evoked potentials(TES-MEP)monitoring in spinal surgery. Methods:Retrospective analysis of 186 cases of surgical patients was conducted and all the patients received foot hallux brevis TES-MEP, bilateral anterior tibial muscle and CSEP monitoring in spinal surgery.The difference between the TES-MEP and CSEP monitoring results and the postoperative spinal cord sensory and motor functions was compared,and the diagnosis efficiency index was calculated. Results:The sensitivity and specificity of monitoring motor function in TES-MEP were 100% and 98.09%. The sensitivity of monitoring sensory function in TES-MEP was 79.31%, and the specificity was 94.27%; the sensitivity and specificity of monitoring motor function in CSEP were 86.21% and 96.82%, respectively. The sensitivity of monitoring sensory function in CSEP was 93.10%, and the specificity was 98.09%. The sensitivity and specificity of monitoring motor function and sensory function were 100% and 99.36% in TES-MEP+CSEP. Conclusion:Combined application of CSEP and TES-MEP in spinal surgery can improve the monitoring level of motor function and sensory function of spinal cord.

参考文献：

[1] TANIGUCHI M,CEDZICH C,SCHRAMM J.Modification of cortical stimulation for motor evoked potentials under general anesthesia:technical description[J].Neurosurgery,1993,32(2):219-226.
[2] 梁兵,杨枭雄,宋科冉,等.外科手术脊髓松解减压对脊髓损伤患者功能恢复的影响[J].中国骨与关节杂志,2016,5(4):290-296.
[3] 史图龙,汪萌,尚咏.多模式联合监测在脊髓型颈椎病手术中的临床应用[J].山西医科大学学报,2015,46(2):181-184.
[4] 李亚楠,曹依群,戴冬伟,等.假瘤样脱髓鞘病变-脊髓手术的误区[J].中华神经外科疾病研究杂志,2014,13(1):51-54.
[5] 杨德刚,李建军,杨明亮,等.脊髓切开术治疗创伤性脊髓损伤的手术时机研究进展(英文)[J].首都医科大学学报,2015,36(1):147-150.
[6] 高明勇,陶海鹰,卫爱林,等.急性成人颈段无骨折脱位型脊髓损伤非手术治疗与早期外科干预的对比分析[J].中国骨与关节损伤杂志,2015,30(1):7-10.
[7] 郝定均,黄大耿.急性颈脊髓损伤的最佳手术时机[J].中国脊柱脊髓杂志,2015,25(4):293-295.
[8] 赵福江,陈志明,马华松,等.分期手术治疗先天性脊柱侧凸合并脊髓纵裂和脊髓拴系的安全性与近期疗效[J].中国脊柱脊髓杂志,2015,25(2):122-127.
[9] 朱庆三,赵东旭,李野,等.老年无骨折脱位型颈脊髓损伤的诊治及围手术期管理[J].脊柱外科杂志,2014(5):284-288.
[10] 沈超,陶惠人,惠华,等.一期手术治疗合并脊髓纵裂畸形的先天性脊柱侧凸[J].中华外科杂志,2014,52(6):431-435.
[11] 唐彦超,于淼,刘晓光,等.术前MRI测量脊髓受压程度与脊髓型颈椎病手术疗效的相关性[J].中国脊柱脊髓杂志,2014,24(8):742-746.
[12] 杜成华,孙志刚,姜岩,等.显微外科手术治疗儿童脊髓纵裂Ⅰ型的效果[J].医学研究杂志,2016,45(1):163-165.
[13] 李忠群,杨增华,常青.脊髓圆锥内畸胎瘤的手术治疗[J].颈腰痛杂志,2015,36(2):162-163.
[14] 谢文伟,李再学,王志坤,等.外伤性下颈椎脊髓损伤的手术治疗策略[J].中国骨与关节损伤杂志,2016,31(3):289-290.
[15] 马晓生,姜建元,吕飞舟,等.无骨折脱位颈脊髓中央损伤综合征的手术疗效及其影响因素[J].中国脊柱脊髓杂志,2015,25(4):298-303.

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