| 杨树龙,潘 宗,陈 振,刘晓印,马 荣,梁思敏,张建群,马宗军,丁小力,戈朝晖.体感诱发电位监测在腰椎管狭窄症斜外侧椎间融合术中的应用[J].中国脊柱脊髓杂志,2020,(10):921-930. |
| 体感诱发电位监测在腰椎管狭窄症斜外侧椎间融合术中的应用 |
| 中文关键词: 退行性腰椎管狭窄症 斜外侧椎间融合 体感诱发电位 |
| 中文摘要: |
| 【摘要】 目的：探讨术中体感诱发电位（SEP）监测在退行性腰椎管狭窄症斜外侧椎间融合（OLIF）术中的应用价值。方法：选择2017年7月～2019年2月在宁夏医科大学总医院采用OLIF联合Wiltse入路单侧椎弓根螺钉固定术治疗的92例单节段退行性腰椎管狭窄症患者进行回顾性研究，手术全程给予SEP监测。随访时间15.6±1.8个月（12～23个月）。根据Lee等的腰椎管狭窄MRI分级将患者分为1级组（31例）、2级组（33例）和3级组（28例）。记录分析各组椎间隙处理前及融合器置入后的SEP波幅值；测量手术前、末次随访时责任间隙硬膜囊面积、椎间隙高度及椎间孔高度；临床疗效评价采用腰腿痛VAS评分和腰椎JOA评分。影像学结果及临床疗效改善率与SEP波幅改善率的相关性采用Pearson相关性分析。结果：3组椎间隙处理前与融合器置入后SEP平均波幅值的差异有统计学意义（P<0.05）；1级组、2级组和3级组SEP波幅平均改善率分别为（48.32±7.37）%、（112.34±18.67）%和（28.05±6.78）%，其中3级组有3例患者SEP波幅无任何变化。3组术后末次随访时的椎间隙高度、椎间孔高度、硬膜囊面积及腰腿痛VAS评分和腰椎JOA评分均较术前明显改善，差异有统计学意义（P<0.05）；2级组末次随访时椎间隙高度、椎间孔高度、硬膜囊面积改变值大于1级组和3级组，差异有统计学意义（P<0.05）；3组之间末次随访时腰腿痛VAS评分和腰椎JOA评分改变值差异有统计学意义（P<0.05）。末次随访时，1级组、2级组和3级组腰椎JOA评分改善率分别为（87.0±36.2）%、（85.8±35.3）%和（46.1±26.2）%，优良率分别为93.5%（29/31）、84.8%（28/33）和50%（14/28）。1级组和2级组SEP波幅改善率与末次随访时硬膜囊面积、椎间隙高度、椎间孔高度、腰腿痛VAS评分和腰椎JOA评分的改善率呈正相关；3级组SEP波幅改善率与末次随访时硬膜囊面积、腿痛VAS评分和腰椎JOA评分的改善率呈弱相关。1级组优良病例SEP改善率均大于25.6%，2级组优良病例SEP波幅改善率均大于85.3%。结论：OLIF治疗1、2级腰椎管狭窄症术中SEP波幅改善率可以作为判断间接减压是否有效的参考指标，对于手术中判断腰椎管狭窄间接减压的程度具有一定的参考意义。 |
Value of somatosensory evoked potential in the treatment of lumbar spinal stenosis with oblique lumbar interbody fusion |
| 英文关键词:Degenerative lumbar spinal stenosis Oblique lumbar interbody fusion Somatosensory evoked potential |
| 英文摘要: |
| 【Abstract】 Objectives: To explore the value of intraoperative somatosensory evoked potential (SEP) monitoring in the treatment of degenerative lumbar spinal stenosis with oblique lateral interbody fusion(OLIF). Methods: The data of 92 patients who underwent combined OLIF and unilateral pedicle screw fixation for degenerative lumbar spinal stenosis with SEP monitoring the operation in General Hospital of Ningxia Medical University from July 2017 to February 2019 were retrospectively reviewed. According to Lee′s grading system of lumbar central canal stenosis, all patients were divided into grade 1 group (n=31), grade 2 group (n=33) and grade 3 group(n=28). Our follow-up study lasted 12-23 months, averaged 15.6±1.8 months． The amplitude of SEP was recorded and analyzed before disk excision and 5 minutes after implantation of fusion cage in each group. The cross-sectional area in the dura(CAD) was measured on T2WI axial MRI. The disk height(DH) and intervertebral foramen height(IFH) were measured on the lateral X-ray. Visual analog scale(VAS) score and JOA score of lumbar spine were used to evaluate the clinical effect. Pearson correlation analysis was used to analyze the correlation between the improvement rate of SEP amplitude and the improvement rate of the radiographic and clinical results. Results: There were significant changes in the average amplitude of SEP in the three groups before disk excision and after implantation of fusion cage under general anaesthesia(P<0.05). The average improvement rate of SEP amplitude in grade 1, grade 2 and grade 3 groups were (48.32±7.37)%, (112.34±18.67)% and (28.05±6.78)% respectively, while 3 patients in grade 3 group showed no changes in SEP amplitude. At the last follow-up, the DH, IFH, CAD, lumbocrural pain VAS score and JOA score of the three groups were significantly improved compared with those at pre-operation(P<0.05). The change values of DH, IFH and CAD in grade 2 group were larger than those in grade 1 group and grade 3 group(P<0.05); There were significant difference in the change values of lumbocrural pain VAS score and JOA score among the three groups(P<0.05). By the evaluation standard of JOA score, at the last follow-up, the average improvement rate of JOA score in grade 1, grade 2, and grade 3 groups were (87.0±36.2)%, (85.8±35.3)% and (46.1±26.2)% respectively, and the excellent and good rate were 93.5%(29/31), 84.8% (28/33) and 50%(14/28) respectively. The improvement rate of SEP amplitude in grade 1 and grade 2 groups were positively correlated with the improvement rate of DH, IFH, CAD, lumbocrural pain VAS score and JOA score. The improvement rate of SEP amplitude was weakly correlated with the improvement rate of CAD, leg pain VAS score and JOA score in the grade 3 group. The improvement rate of SEP amplitude in eligible cases in grade 1 group was more than 25.6%, and that in grade 2 group was more than 85.3%. Conclusions: The improvement rate of SEP amplitude during the OLIF procedure in the treatment of grade 1 and grade 2 lumbar spinal stenosis can be used as an important reference index to judge whether the indirect decompression is effective or not, and it has some reference value for evaluating the degree of indirect decompression in the operation. |
| 投稿时间：2020-04-20 修订日期：2020-08-29 |
| DOI： |
| 基金项目:2020宁夏重点研发计划项目（项目编号：2020BEG03034） |
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