摘要
背景:急性脊髓损伤行传统的椎管扩大减压术只能解除骨性压迫(即硬膜外的压力),而对于降低硬膜内的压力无明显的效果,故有学者提出了硬脊膜切开减压,但是对于该术式的治疗效果褒贬不一。目的:利用神经电生理监测技术预估硬脊膜切开减压手术治疗急性脊髓损伤的有效性,以及评价神经电生理监测在急性脊髓损伤手术治疗中的意义。方法:回顾性分析51例ASIA分级A、B级行手术治疗急性脊髓损伤患者的临床资料,根据术式分为2组,单纯骨性减压组32例行后路椎管扩大减压术,硬脊膜切开组19例在后路椎管扩大骨性减压基础上行硬脊膜内减压,所有患者在术中使用KEY PONIT多功能监测仪对脊髓功能进行体感诱发电位与运动诱发电位联合监测。对比分析两组术中各个时间点的神经电生理数据、手术前及术后6个月的脊髓功能评分。结果与结论:①硬脊膜切开组患者术后6个月的ASIA评分(236.47±31.29)明显高于单纯骨性减压组(205.48±26.28,P<0.05);②硬脊膜切开组患者在行硬脊膜切开减压术后,其运动诱发电位波幅较基线增加(82.30±30.01)μV,要明显高于单纯骨性减压后的运动诱发电位波幅变化[(6.1±25.6)μV,P<0.0001];③所有患者减压前后的运动诱发电位波幅变化与术后神经功能的转归基本一致。提示:急性脊髓损伤ASIA分级A、B级的患者在骨性减压的基础上行硬脊膜切开减压手术,可以进一步改善脊髓神经功能。急性脊髓损伤术中采用神经电生理监测可以反映脊髓的功能变化,且术中电生理指标与术后患者神经功能转归趋于一致。
BACKGROUND:Traditional spinal canal expansion and decompression for acute spinal cord injury can only relieve bony compression(i.e.,epidural pressure),but cannot obviously reduce intradural pressure.Therefore,durotomy with decompression is proposed;however,the therapeutic effect of this surgery is mixed.OBJECTIVE:Using intraoperative neurophysiological monitoring(IONM)to estimate the efficacy of durotomy for acute spinal cord injury and to evaluate the significance of IONM of nerve function during surgery for acute spinal cord injury.METHODS:The clinical data of 51 patients with acute spinal cord injury of American Spinal Injury Association(ASIA)grades A and B undergoing surgical treatment were retrospectively analyzed.According to the surgical procedures,they were divided into durotomy group(n=19,receiving durotomy with posterior spinal decompression)and bone decompression group(n=32,receiving posterior spinal decompression alone).The KEY PONIT multi-function monitor was used to monitor the spinal cord function in combination with somatosensory and motor evoked potentials.Intraoperative neurophysiological data and the spinal cord function scores before and 6 months after surgery were compared and analyzed between two groups.RESULTS AND CONCLUSION:The ASIA score was 236.47±31.29 in the durotomy group at 6 months postoperatively,which was significantly higher than that of the bone decompression group(205.48±26.28;P<0.05).The motor evoked potential amplitude of the patients in the duratomy group increased by(82.30±30.01)μV compared with the baseline,which was significantly higher than that after bone decompression alone[(6.1±25.6)μV,P<0.0001].Changes in motor evoked potential amplitudes after decompression were basically consistent with the outcomes of postoperative neurological function in all patients.These findings indicate that durotomy with bony decompression is recommended for patients with acute spinal cord injury of ASIA grades A and B,which can further improve spinal nerve function of such patients.T
作者
杨九杰
李治
王树杰
田野
赵伟
Yang Jiujie;Li Zhi;Wang Shujie;Tian Ye;Zhao Wei(Shenyang Medical College,Shenyang 110034,Liaoning Province,China;Department of Orthopedics,Affiliated Central Hospital of Shenyang Medical College,Shenyang 110034,Liaoning Province,China;Department of Orthopedics,Peking Union Medical College Hospital,Beijing 100000,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第8期1232-1236,共5页
Chinese Journal of Tissue Engineering Research
关键词
脊髓损伤
急性脊髓损伤
手术治疗
神经电生理监测
硬脊膜切开减压
髓内减压
运动诱发电位
spinal cord injury
acute spinal cord injury
surgical treatment
intraoperative neurophysiological monitoring
intramedullary decompression
motor evoked potential
