踝关节镜检查期间非侵入性牵引对 SSEP 的影响。

The Effects of Noninvasive Traction on SSEPs During Ankle Arthroscopy.

机构信息

The Orthopaedic Institute, Gainesville, FL, USA.

Southern California Orthopedic Institute, Van Nuys, CA, USA.

出版信息

Foot Ankle Int. 2020 Nov;41(11):1355-1359. doi: 10.1177/1071100720943866. Epub 2020 Aug 5.

DOI:10.1177/1071100720943866

PMID:32755233

Abstract

BACKGROUND

The purpose of this study was to evaluate the effects of noninvasive ankle distraction on intraoperative somatosensory evoked potentials (SSEPs) and peripheral nerve sensibility of the foot during ankle arthroscopy.

METHODS

Twenty patients undergoing ankle arthroscopy were prospectively evaluated using noninvasive ankle traction. All had preoperative clinical examination with baseline neurologic evaluation and static 2-point discrimination (2PD) test. Intraoperative SSEPs were monitored continuously throughout surgery. Thirty pounds of traction was applied using noninvasive traction. A 50% decrease in amplitude or a 10% increase in latency was considered significant. At 2 weeks postoperatively, the 2PD test was repeated. Pre- and postoperative 2PD was compared and subsequently correlated with intraoperative SSEPs.

RESULTS

Three patients sustained significant SSEP signal alterations during surgery. The changes were transient and directly related to application of traction but returned to baseline without traction release. Abnormal postoperative 2PD testing was found in the operative extremity in 12 patients but resolved by the second postoperative visit. Only 2 of 12 had intraoperative SSEP changes. Eleven patients had abnormal postoperative 2PD testing in the nonoperative limb. Nine had changes in both limbs. Routine history and clinical examination did not suggest any neurologic injury. There was no statistically significant correlation between intraoperative SSEP alterations and subsequent development of abnormal postoperative 2PD testing.

CONCLUSION

Transient intraoperative SSEP changes occurred with noninvasive distraction but were reversible when using 30 pounds of traction. 2PD testing changes were common postoperatively but not correlated to changes in SSEP. Patients with increased 2PD did not have sensory changes detectable on clinical exam or subjective patient history.

LEVEL OF EVIDENCE

Experimental level II, prospective comparative study.

摘要

背景

本研究旨在评估踝关节镜检查过程中，非侵入性踝部牵引对术中体感诱发电位（SSEP）和足部周围神经感觉的影响。

方法

前瞻性评估 20 例接受踝关节镜检查的患者使用非侵入性踝部牵引。所有患者均行术前临床检查，包括基线神经学评估和静态 2 点辨别测试（2PD）。术中连续监测 SSEP。使用非侵入性牵引施加 30 磅的牵引力。振幅降低 50%或潜伏期增加 10%被认为具有显著意义。术后 2 周，重复 2PD 测试。比较术前和术后的 2PD，并随后与术中 SSEP 相关联。

结果

3 例患者在手术过程中出现明显的 SSEP 信号改变。这些变化是暂时的，与牵引的应用直接相关，但在不释放牵引的情况下恢复到基线水平。12 例手术肢体中有 12 例术后出现异常 2PD 测试，但在第二次术后就诊时得到解决。仅 2 例患者出现术中 SSEP 变化。11 例非手术肢体有异常的术后 2PD 测试。9 例患者在四肢均有变化。常规病史和临床检查均未提示有任何神经损伤。术中 SSEP 改变与随后发生的异常术后 2PD 测试之间无统计学显著相关性。