|摘要||目的 应用皮层体感诱发电位技术,观察颈椎脱位颅骨牵引复位过程中患者脊髓功能的改变,避免因过度牵引造成脊髓损伤. 方法 2004年6月至2006年10月12例颈椎脱位患者在全身麻醉下行颅骨牵引复位前路植骨融合内固定术,术中进行皮层体感诱发电位监测.观察皮层电位潜伏期及波幅变化.牵引重量从5kg开始,每间隔5～10 min增加重量2.5 kg直至复位成功.牵引重量5～20 kg,平均13.5 kg.在牵引前(麻醉后)、牵引过程中,复位后进行皮层体感诱发电位监测.将电位信号分为改善[波幅增加50%和(或)潜伏期缩短10%]、异常[波幅下降50%和(或)潜伏期延长10%]无变化. 结果 牵引复位过程中10例患者皮层电位潜伏期、波幅改善,且临床复位效果满意;2例曾出现皮层电位波幅下降50,波形改变,立即减轻重量,改变体位,5 min后波形、波幅恢复.12例患者术后神经损害均未加重.8例患者获得3～6个月随访,按照ASIA法分类,转变情况为:术前B级4例,术后转成C级2例,2例无变化;术前C级2例,术后1例无变化,1例失访;术前D级4例,3例转成E级,1例失访.8例中有3例于术后6个月复查体感诱发电位,皮层电位潜伏期缩短,其中2例恢复至正常标准,波幅、波形改善. 结论 应用皮层体感诱发电位监测颈椎脱位颅骨牵引复位前路植骨融合内固定治疗,避免了过度牵引可能带来的脊髓损伤问题,具有重要的临床意义.
Objective To explore somatosensory evoked potential (SEP) used to monitor the di-aplasis of cervical dislocation to avoid invasion to spinal cord by excessive skull traction. Methods SEP was applied to observe the changes of cortex potential and amplitude during the anterior interbody fusion for 12patients who underwent diaplasis of cervical dislocation by skull traction under complete anesthesia. Traction weight was 5.0 kg at first, and in case of necessity 2. 5 kg was added in 5-10 minutes until success of di-aplasis. In the 12 cases, the traction weight ranged from 5 to 20 kg and averaged 13.5 kg. After anesthesia,spinal cord function was monitored by SEP before traction, during traction and after diaplasis. SEP signals were interpreted as improvement if the amplitude increased 50% and/or the latent period decreased 10%, as abnormity if the amplitude declined 50% and/or the latent period delayed 10%, and as unchanged.Results In 10 cases whose cortex potential latent period and amplitude were improved, the diaplasis was successful. In 2 cases whose amplitude declined 50% and amplitude shape changed, the body position was changed and the weight was reduced at once. After 5 minutes, their amplitude and amplitude shape returned to normal. No nerve damage occurred in the 12 cases after operation. Eight cases were followed up for 3 to 6 months. According to ASIA grading system, of the 4 cases of degree B before operation, 2 changed to degree C and 2 unchanged after operation. Of the 2 cases of degree C before operation, 1 unchanged, and 1 was lost in follow-up. Of the 4 cases of degree D before operation, 3 changed to degree E, and 1 was lost in follow-up. SEP reexamination 6 months after operation revealed that the cortex potential latent period was shortened in 3 of the 8cases, and 2 cases recovered to normal with improved amplitude and amplitude shape. Conclusion When SEP is used to monitor the spinal cord function during anterior interbody fusion and diaplasis of cervical dislo-cation by skull traction under complete anaesthesia, it can avoid spinal cord injury by overweight traction.|