摘要
目的 在下腰椎滑脱复位内固定术中应用节段性皮神经刺激体感诱发电位 (SEP)监护 ,最大限度复位滑脱、解除症状的同时 ,减少术后并发症。方法 利用节段性皮神经刺激SEP技术对 5 2例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 ,为手术监护提供参考。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 >4 0 % ,提示预后良好 ;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～ 2 0min内恢复到基础电位 ,应在电位出现波动时停止复位 ,术后仍可恢复部分功能和改善症状。④若术中监测电位潜伏期延长 >5 % ,或波幅降低 >10 % ,或部分成分消失或波形离散提示术后出现疼痛和运动障碍加重 ,术中应做必要调整。该方法术中监护指标改善与术后功能恢复状态符合率达 93.75 %。结论 节段性皮神经刺激SEP是下腰椎滑脱复位内固定术中监护 ,指导减压、复位、固定的客观而有效的方法。
Objective To discuss whether it is effective to monitor the internal fixation lumbar spondy lolisthesis surgery by using the somatosensory evoked potentials (SEP) technique of segmental dermonerve stimulation. Methods 52 patients involving the lumbar spondylolisthesis had been surgically treated and assisted by using the SEP index of preanaesthetization. The inspection had been proceeded at pre and intraoperation; a longterm followup period had been taken after operation; the retrospectivel study on the intraoperational potential changes had been performed among patients, whose function had been improved after operation. As a whole the effective assessment index of intraoperational monitor had been established, providing reference for the lumbar spondylolisthesis surgery. Results Taking the SEP index value of postanesthetic patients before operation as the standard, the changes of intraoperational potential may indicate the following status:The latency period decreasing in 10%～15% or the amplitudes increasing in 40% indicated that the outlook of recovery was good enough and the prognosis was favoured . The latency period decreasing in less than 10% or the amplitudes increasing in less than 30% indicated that part of the function could be reduced.The latency period extending over 5%, and the amplitudes increasing more than 10%together with the dispersion of wave, indicated that the pain would be appeared and the dysfunction of motion would be occurred after operation. The accuracy of index may attain to 93.75%. Conclusions The SEP intraoperational guardianship of segmental dermonerve stimulation is the objective and effective method in lumbar spondylolisthesis surgery.
出处
《脊柱外科杂志》
2003年第5期274-277,共4页
Journal of Spinal Surgery
关键词
腰椎滑脱
体感诱发电位
术中监护
somatosensory evoked potentials
intraoperational guardianship
lumbar spondylolisthesis
