摘要
目的探讨神经电生理监测技术应用于胸椎骨折微创椎弓根螺钉置入术中的价值。方法选择2019年6月至2022年5月福建省建瓯市立医院收治的胸椎骨折患者60例,分别在微创椎弓根螺钉置入期间加入神经电生理监测技术,观察所有患者的手术结果(手术成功率、手术时长、失血量、后凸Cobb角),同时比较手术前后胫后神经体感诱发电位(SEP)的潜伏期、波幅、运动神经传导速度(MCV)、感觉神经传导速度(SCV)、日常生活能力(ADL)、视觉模拟评分(VAS)。结果患者手术均成功,手术时间97~185 min,失血量100~300 ml,术后Cobb角明显小于术前(t=19.960,P<0.05)。60例患者共置入螺钉412枚,242枚(58.74%)螺钉置入时SEP和运动诱发电位(MEP)无明显波动。置入过程中,SEP和MEP监测发生变化但未达到报警标准的108枚(26.21%),62枚(15.05%)螺钉置入时SEP和MEP均达到报警标准,待SEP和MEP恢复后再缓慢操作。术后患者胫后神经SEP潜伏期较术前降低,波幅较术前升高(P<0.001),MCV和SCV均较术前升高(P<0.001)。患者的ADL评分较术前升高,VAS评分低于术前(P<0.001)。结论神经电生理监测技术在微创椎弓根螺钉置入中能够早期发现神经受损情况,最大程度降低对神经系统的损害,改善预后。
Objective To explore the value of neuroelectrophysiological monitoring technology in minimally invasive pedicle screw placement for thoracic vertebral fractures.Methods Sixty patients with thoracic vertebral fracture admitted to Fujian Jian'ou Municipal Hospital from June 2019 to May 2022 were enrolled in the study.Neuroelectrophysiological monitoring technique was used during minimally invasive pedicle screw placement.The surgical outcomes(surgical success rate,surgical duration,blood loss,and kiphosis Cobb angle)of all patients were observed.The latency and amplitude of somatosensory evoked potential(SEP),motor conduction velocity(MCV)and sensory conduction velocity(SCV)of posterior tibial nerve,ability of daily living(ADL),visual analog score(VAS)before and after surgery were compared.Results All patients underwent surgery successfully,with a surgical time of 97-185 minutes and a blood loss of 100-300 ml.The Cobb angle after surgery was significantly smaller than that before surgery(t=19.960,P<0.05).A total of 412 screws were implanted in 60 patients,of which 242(58.74%)had no significant fluctuations in SEP and motor evoked potential(MEP).108 screws(26.21%)in which SEP and MEP monitoring changed but did not meet alarm standards during implantation,and 62 screws(15.05%)meet the alarm standard.The operation was performed slowly after the recovery of SEP and MEP.The postoperative latency of SEP of posterior tibial nerve was decreased and amplitude was increased(P<0.001),and both MCV and SCV were increased(P<0.001).Postoperative ADL score was higher than preoperative score,and VAS score was lower than preoperative score(P<0.001).Conclusion Neuroelectrophysiological monitoring technology in minimally invasive pedicle screw placement can detect nerve damage early,minimize the damage to the nervous system,and improve the prognosis.
作者
邹彬彬
Zou Binbin(Department of Orthopedics,Jian'ou Municipal Hospital,Jian'ou City,Fujian Province,353100,China)
出处
《现代电生理学杂志》
2023年第2期94-97,共4页
Journal of Modern Electrophysiology
关键词
胸椎骨
脊柱骨折
电生理学
监测
手术中
内固定器
Thoracic vertebrae
Spinal fractures
Electrophysiology
Monitoring,intraoperative
Internal fixators
