【摘要】 背景:目前皮质体感诱发电位(SEP)被认为是颈椎手术中重要的监护手段。目的:分析SEP在颈椎病手术监护中的应用价值及判断颈椎病预后中的作用。设计:病例分析。单位:复旦大学附属华山医院骨科。对象:1999-01/2000-06复旦大学附属华山医院骨科SEP监护下进行颈椎病手术患者75例,男48例,女27例;年龄35～73岁。方法:75例颈椎病术中进行SEP监护,分析其特征、结果及SEP变化与神经功能恢复之间的关系。主要结局观察:患者术前的JOA评分及术前、术中及术后的SEP变化。结果:其中14例(18.7%)术中波幅有轻度下降,潜伏期轻度延长,手术结束时又恢复到接近术前水平;51例(68%)术前、术中几乎无变化;9例(12%)术中有明显恢复。以上多数患者神经功能恢复良好,1例(1.3%)术中有波幅下降和潜伏期延长,术后症状加重。术前JOA评分平均(11.6±3.09)分,术后(13.75±3.25)分。在症状改善明显患者中,术后随访3～6个月,SEP均有潜伏期缩短或波幅明显增高,而改善不明显者,SEP的变化亦不明显。结论:SEP尽管有一定的局限性,但其变化与患者的神经功能恢复有一定的关系,在颈椎病术中监护及预后判断中的作用是肯定的。更多还原

【Abstract】 BACKGROUND:Somatosensory evoked potential(SEP) is considered as an important monitoring method in cervical cord operation at present. OBJECTIVE:To analyze the applicable merit of SEP as intraoperative monitoring method in cervical spondylotic myelopathy(CSM),and its role in the judgment of prognosis. DESIGN:Case analysis SETTING:Department of Orthopaedics,Huashan Hospital of Fudan University. PARTICIPANTS:Totally 75 cases that received CSM surgery under SEP monitoring including 48 male and 27 female patients aged between 35 and 73 years old were selected from the Department of Orthopaedics of Huashan Hospital affiliated to Fudan University. METHODS:SEP was used as intraoperative monitoring system in 75 CSM patients for the analysis of its characteristics, results and the relationship between SEP changes and the restoration of neurological function. MAIN OUTCOME MEASURES:Preoperative JOA evaluation and preoperative,intraoperative and postoperative SEP changes. RESULTS:Totally 14 cases(18.7%) had slight decreased amplitude or prolonged latency during the operation,which recovered nearly to the preoperative level at the end of the operation.A total of 51 cases(68%) had no changes during the operation. Nine cases(12%) had an obvious recovery in amplitude or latency during the operation. Most of the above patients had a good postoperative recovery of neurological functions. One case(1.3%) suffered from intraoperative decreased amplitude and prolonged latency,which had aggravated postoperative symptoms.Preoperative mean JOA score was(11.6±3.09) points and postoperative mean score was(13.75±3.25) points.In those cases with significant improved symptoms, the amplitude or latency of SEP improved in a 3 to 6-month follow-up time.However,SEP results had no significant changes in the patients without obvious recovery. CONCLUSION:Although SEP has its limitation,it has certain relationship with the restoration of neurological functions,which is still a valuable method in monitoring cervical surgery and judging of prognosis.更多还原