【摘要】 背景:临床大量病例证实,下腰椎滑脱复位内固定术中满意的复位、融合及内固定,与患者术后症状体征及功能恢复程度并非一致。目的:研究体感诱发电位(SEP)在下腰椎滑脱复位内固定术中监护的应用,对改善患者术后症状及提高脊柱功能的作用。设计:随机对照研究。单位:一所大学医院的脊柱外科病房。对象:2000-06/2003-12暨南大学医学院第二附属医院(深圳市人民医院)脊柱外科收治的下腰椎滑脱症患者52例,男23例,女29例,年龄18～68岁。随机分为对照组20例和监测组32例。方法:对照组利用节段性皮神经刺激体感诱发电位(SEP)技术对下腰椎滑脱复位内固定术前,术中监测和术后远期随访,对术后功能改善优良患者的术中电位变化情况进行回顾性研究,确定术中有效的监护指标,从而为监测组手术监护提供参考。主要观察指标:①术后脊柱功能评定结果。②体感诱发电位潜伏期及波幅检测结果。结果:以患者术前麻醉后SEP指标值为基础,术中监测电位指标变化表现形式:①滑脱复位后,若潜伏期缩短10%～15%或波幅增加>40%,提示愈后良好。②监测电位指标平稳,或潜伏期缩短<10%,或波幅增加<30%,可继续完成复位,术后可有部分神经根功能恢复和症状改善。③复位过程中,监测电位指标出现暂时性波动,可在15～20min内恢复到基础电位,应在电位出现?更多还原

【Abstract】 BACKGROUND:Many clinical cases have proved that the satisfactory reposition,fu sion and internal fixation in the internal fixation for inferior lumbar spondylo listhesis are not consistent with the postoperative symptoms and physical signs, and functional restoration. OBJECTIVE:To investigate the application of somatosensory evoked potential(SEP ) in the monitoring during internal fixation for inferior lumbar spondylolisthes is,and the effects of SEP monitoring on the improvement of postoperative symptom s and the spinal functions as well. DESIGN:A randomized controlled trial. SETTING:Inpatient department of spinal surgery,an affiliated hospital of a uni versity. PARTICIPANTS:Fifty two patients with inferior lumbar spondylolisthesis includ ing 23 male and 29 female cases aged between 18 and 68 years old were admitted b y the Department of Spinal Surgery,Second Affiliated Hospital(Shenzhen People’s Hospital)of Jinan University,from June 2000 to December 2003.All cases were rand omly divided into control group(n =20) and monitor group (n=32). METHODS:SEP induced by segmental stimulation in cutaneous nerve was used in th e control group for preoperative and intraoperative monitoring, and postoperativ e follow up.The intraoperative potential changes in patients with excellent and good improvement in postoperative functions had been retrospectively investigate d to confirm the effective indices for intraoperative monitoring, which thereby provided references for intraoperative monitoring in patients of monitor group. MAIN OUTCOME MEASURES:①Evaluation of postoperative spinal function;②SEP late ncy and amplitude. RESULTS:SEP values after postoperative anesthesia were set as basis. The manif estations of intraoperative potential alterations:①If the latency reduced 10% -15%or the amplitude increases more than 40%after fixation,it suggested favor able prognosis;②The potential indices were stable during monitoring, or the red uction of latency was less than 10%,or the increase of amplitude was less than 30%,the fixation could be continued,and partial functions of nerve root and sym ptoms could be improved after surgery;③During the surgery,if potential indices had transient fluctuation,which could be recovered to basic potential within 15 to 20 minutes,fixation should be stopped during the fluctuation. Still partial f unctions of nerve root and symptoms could be improved after surgery;④If the int raoperative latency prolonged more than 5%,or amplitude reduced more than 10%, or part of the components disappeared,or the wave shape dispersed,it might sugge st postoperative aggravation of pain and dyskinesia.So intraoperative adjustment was necessary.The coincident rate of the improvement of the indices of intraope rative monitoring and the improvement of postoperative spinal function reached 9 3.75%. CONCLUSION:SEP induced by segmental stimulation in cutaneous nerve is an objec tive and effective method in the monitoring and instruction of decompression,rep osition,fixation of internal fixation for inferior lumbar spondylolisthesis, whi ch has important merits in the improvement of the function of nerve root and the restoration of spinal function.更多还原