体感诱发电位在检测脊柱侧弯手术中因体位不当继发臂丛神经病变的临床应用价值。
Clinical usefulness of somatosensory evoked potentials for detection of brachial plexopathy secondary to malpositioning in scoliosis surgery.
作者信息
Labrom Robert D, Hoskins Marilyn, Reilly Christopher W, Tredwell Stephen J, Wong Peter K H
机构信息
Department of Orthopaedic Surgery, British Columbia's Children's Hospital and Faculty of Medicine, Vancouver, Canada.
出版信息
Spine (Phila Pa 1976). 2005 Sep 15;30(18):2089-93. doi: 10.1097/01.brs.0000179305.89193.46.
STUDY DESIGN
A retrospective longitudinal study of 434 consecutive pediatric patients who underwent surgical correction of scoliosis, while being monitored for positional brachial plexopathy.
OBJECTIVE
To evaluate the effectiveness of intermittent monitoring of ulnar nerve somatosensory evoked potentials (SSEPs) for detecting brachial plexus injury caused by malpositioning during scoliosis surgery.
SUMMARY OF BACKGROUND DATA
Continuous intraoperative SSEP monitoring for spinal cord function has been well reported, and is widely accepted as the standard for spinal deformity correction surgery to detect and avoid neurologic injury. The use of SSEPs for the monitoring of ulnar nerve function intraoperatively as an indicator of brachial plexus function is becoming more accepted as a valid and useful technique to minimize intraoperative neurologic injuries during deformity corrections.
METHODS
A review was conducted to assess the effect of ulnar nerve SSEP monitoring, as a measure of brachial plexus function, during anterior, posterior, or combined approach surgeries. The type of scoliosis, type of surgery and positioning, and surgical event at noted amplitude decrease were included in an analysis of variance for repeated measures, and a Student t test was performed for significant differences.
RESULTS
A total of 27 patients had ulnar nerve amplitude decreases of > or =30%, resulting in a point prevalence of 6.2% for positional brachial plexopathy during positioning for all scoliosis surgeries. A significant difference was noted between the types of positioning, with prone positioning accounting for a higher rate of brachial plexopathy compared with anterior approach positioning (P < 0.01). No statistical difference exists as to the type of scoliosis present and the incidence of brachial plexopathy (P < 0.01).
CONCLUSIONS
Avoidance of neurologic injury to the brachial plexus during scoliosis surgery is possible by early detection with ulnar nerve SSEP monitoring.
研究设计
对434例连续接受脊柱侧弯手术矫正并同时监测是否发生体位性臂丛神经病变的儿科患者进行回顾性纵向研究。
目的
评估间歇性监测尺神经体感诱发电位（SSEP）在检测脊柱侧弯手术中因体位不当导致的臂丛神经损伤方面的有效性。
背景数据总结
术中连续SSEP监测脊髓功能已有充分报道，并被广泛接受为脊柱畸形矫正手术检测和避免神经损伤的标准。术中使用SSEP监测尺神经功能作为臂丛神经功能指标，作为一种有效且有用的技术，在畸形矫正过程中尽量减少术中神经损伤，正越来越被人们所接受。
方法
进行一项综述，以评估在前路、后路或联合入路手术中，将尺神经SSEP监测作为臂丛神经功能指标的效果。将脊柱侧弯类型、手术类型和体位以及记录到振幅下降时的手术事件纳入重复测量方差分析，并进行Student t检验以确定显著差异。
结果
共有27例患者尺神经振幅下降≥30%，导致所有脊柱侧弯手术体位摆放期间体位性臂丛神经病变的时点患病率为6.2%。不同体位类型之间存在显著差异，俯卧位导致臂丛神经病变的发生率高于前路手术体位（P < 0.01）。脊柱侧弯类型与臂丛神经病变发生率之间无统计学差异（P < 0.01）。
结论
通过尺神经SSEP监测早期发现，可避免脊柱侧弯手术中臂丛神经的神经损伤。
Zotero 插件