摘要
目的探讨体感诱发电位（SEP）、经头颅电刺激运动诱发电位（TES—MEP）与自发肌电图（EMG）监测技术在胸、腰、骶椎结核患者行结核病灶清除及植骨内固定术中联合应用的价值。方法对27例胸椎（T2-L2）结核患者行结核病灶清除及植骨内固定术中SEP联合TES—MEP监护，11例腰椎或腰骶椎结核患者（L3～S1）行术中SEP联合TES-MEP和自发EMG监护。通过观察SEP及TES—MEP波幅及潜伏期变化来判断患者感觉和运动通路状况，通过自发EMG反应来精确定位受激惹的神经根。结果①SEP监测成功率100％（38／38），TES—MEP监测成功率92．1％（35／38），联合监测成功率92．1％（35／38）；SEP阳性率7．9％（3／38），TES—MEP阳性率28．9％（11／38）；SEP联合TES—MEP均为阳性的比率5．3％（2／38）；SEP阴性，而TES—MEP阳性的比率为23．7％（9／38）；SEP阳性，而TES—MEP阴性的比率为2．6％（1／38）；联合监测假阴性率为0％（0／38），假阳性率为5．3％（2／38），术后神经功能损伤2例。②腰椎或腰骶椎结核手术中，自发EMG监测能准确判断腰椎神经根功能。共有5例患者出现肌电反应，其中4例发生在椎管及神经根减压时，1例发生在复位矫形时。结论①胸、腰、骶椎结核患者术中联合运用SEP和TES—MEP监测，排除各种干扰因素后，能准确地反映术中脊髓功能状况，提高监护效果；②术中自发EMG监测可准确及时地反映神经根功能，避免腰骶部结核患者术中神经根损伤。
Objective To investigate the efficacy of combined monitoring of motor evoked potentials with transcranial electrical stimulation （TES-MEP） , somatosensory evoked potentials （SEP） and spontaneous electromyo- graphy （s-EMG） in tuberculosis surgery involving the thoracic, lumbar and sacral vertebrae. Methods Twenty- seven patients with tuberculosis of the thoracic vertebrae （ T2-L2 ） received intra-operative SEP and TES-MEP monito- ring. Combined SEP, TES-MEP and spontaneous EMG monitoring were employed in 11 patients with tuberculosis of the lumbar or/and sacral vertebrae （ L3-S1 ）. SEP and TES-MEP were used to precisely observe the status of the sen- sory and motor pathways; s-EMG responses were used to more accurately localize nerve root irritation. Results （1） SEP monitoring was successful in all of the operations. TES-MEPs were successfully monitored in 35 of them （92.1%）. Combined motor and sensory monitoring was successfully achieved in 35 cases （92. 1% ）. Abnormal SEPs were observed in 3 cases （7.9%） , while abnormal MEPs were observed in 11 cases （28.9%）. Abnormality in both the SEP and TES-MEP occurred in 2 cases （5.3%）. There were 9 cases （23.7%） where the SEPs were nor- mal and the TES-MEPs were abnormal. In only 1 case （2.6%） was the SEP normal and the MEP abnormal. The false negative rate was 0% with combined SEP and TES-MEP monitoring, while the false positive rate was 5.3%. There were 2 cases complicated by post-operative neurological deficits. （2） Spontaneous EMG monitoring can accu- rately determine the functioning of lumbar nerve roots during lumbar or lumbosacral tuberculosis surgery. Among 5 ca- ses where EMG responses were observed, 4 cases occurred during the spinal canal and nerve root decompression, 1 case occurred in the orthopedic reset phase. Conclusions （ 1 ） During tuberculosis surgery involving thoracic, lumbar or sacral vertebrae, combined monitoring of SEPs and TES-MEPs can reflect the physiological and pathological conditio
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2014年第4期287-290,共4页
Chinese Journal of Physical Medicine and Rehabilitation
关键词
体感诱发电位
经颅电刺激
运动诱发电位
自发肌电图
术中监护
脊柱结核
Somatosensory evoked potentials
Transcranial electrical stimulation
Motor evoked poten-tials
Spontaneous electromyography
Intra-operative monitoring
Spinal tuberculosis
