术中神经电生理监测在胸椎管狭窄症外科治疗中的应用进展

doi:10.24920/J1001-9294.2017.041

摘要/Abstract

摘要：

胸椎管狭窄症是由各种原因引起胸段椎管容积减小,进而使椎管内脊髓受压产生脊髓功能障碍,引起脊髓神经受损的一组临床症候群。相对于腰椎管狭窄症,胸椎管狭窄症的发病率较低,但是术后脊髓神经损伤的发生率较高,文献报道这一发生率可达到13.9%。术中神经电生理监测能实时反映脊髓或神经的功能状态,帮助指导术者下一步操作并及时采取补救措施,从而避免灾难性后果的发生。本文主要对胸椎管狭窄症手术进行神经电生理监测的理论依据、术中信号变化与术后脊髓功能状态的关系进行阐述,此外还对多模式神经电生理监测的应用、诱发电位的影响因素及补救措施进行了介绍。

关键词: 胸椎管狭窄症, 术中神经电生理监测, 运动诱发电位, 体感诱发电位, 预后

Abstract:

Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with lumbar spinal stenosis, while the incidence of spinal cord injury during thoracic decompression is relatively high. The reported incidence of neurological deficits after thoracic decompression reached 13.9%. Intraoperative neurophysiological monitoring (IONM) can timely provide information regarding the function status of the spinal cord, and help surgeons with appropriate performance during operation. This article illustrates the theoretical basis of applying IONM in thoracic decompression surgery, and elaborates on the relationship between signal changes in IONM and postoperative neurological function recovery of the spinal cord. It also introduces updated information in multimodality IONM, the factors influencing evoked potentials, and remedial measures to improve the prognosis.

Key words: thoracic spinal stenosis, intraoperative neurophysiological monitoring, motor evoked potentials, somatosensory evoked potentials, prognosis

Liu Yongsheng, Zhao Yu. Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis[J].Chinese Medical Sciences Journal, 2017, 32(4): 260-264.

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