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[先天性多发性关节挛缩症患者与青少年特发性脊柱侧凸患者术中神经生理监测的比较]

[Comparison of intraoperative neurophysiological monitoring between patients with arthrogryposis multiplex congenita and adolescent idiopathic scoliosis].

作者信息

Li Y K, Qiu J Y, Shi B L, Liu Z, Mao S H, Qiao J, Zhu Z Z, Qiu Y

机构信息

Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2023 Jun 20;103(23):1774-1780. doi: 10.3760/cma.j.cn112137-20221215-02661.

Abstract

To compare the intraoperative neurophysiological monitoring (IONM) results between patients with arthrogryposis multiplex congenita (AMC) and adolescent idiopathic scoliosis (AIS) and to analyze the influence of congenital spinal deformity on IONM in AMC patients, thus to evaluate the efficiency of IONM in AMC patients. A cross-sectional study. The clinical data of 19 AMC patients underwent correction surgery from July 2013 to January 2022 in Nanjing Drum Tower Hospital were retrospectively reviewed. There were 13 males and 6 females with a mean age of (15.2±5.6) years, and the average Cobb angle of main curve was 60.8°±27.7°. And 57 female AIS patients of similar age and curve type with the AMC patients during the same period were selected as the control group, with an average age of (14.6±4.4) years and a mean Cobb angle of 55.2°±14.2°. The latency and amplitude of samatosensory evoked potentials (SSEPs) and transcranial electric motor evoked potentials (TCeMEPs) were compared between the two groups. The difference in IONM data between AMC patients with and without congenital spinal deformity was also evaluated. The success rates of SSEPs and TCeMEPs were 100% and 14/19 for AMC patients, 100% and 100% for AIS patients. The SSEPs-P40 latency, SSEPs-N50 latency, SSEPs-amplitude, TCeMEPs-latency, TCeMEPs-amplitude showed no significant difference between AMC patients and AIS patients (>0.05 for all). The side-difference of TCeMEPs-amplitude showed an increasing trend in AMC patients when compared with that in AIS patients, but there was no statistical difference between the two groups [(147.0±185.6) μV vs (68.1±311.4) μV, =0.198]. The SSEPs-amplitude value was (1.4±1.1) μV on concave side in AMC patients with congenital spinal deformity, and it was (2.6±1.2) μV on concave side in AMC patients without congenital spinal deformity (=0.041). The SSEPs-amplitude value was (1.4±0.8) μV on convex side in AMC patients with congenital spinal deformity, and it was (2.6±1.3) μV on convex side in AMC patients without congenital spinal deformity (=0.028). The values of SSEPs-P40 latency, SSEPs-N50 latency, SSEPs-amplitude, TCeMEPs-latency and TCeMEPs-amplitude are similar in AMC and AIS patients. The SSEPs-amplitude of AMC patients with congenital spinal deformity is lower than that of AMC patients without congenital spinal deformity.

摘要

比较先天性多发性关节挛缩症(AMC)患者与青少年特发性脊柱侧凸(AIS)患者的术中神经生理监测(IONM)结果,并分析先天性脊柱畸形对AMC患者IONM的影响,从而评估IONM在AMC患者中的有效性。横断面研究。回顾性分析2013年7月至2022年1月在南京鼓楼医院接受矫正手术的19例AMC患者的临床资料。其中男性13例,女性6例,平均年龄(15.2±5.6)岁,主弯平均Cobb角为60.8°±27.7°。同期选取57例年龄及曲线类型与AMC患者相似的女性AIS患者作为对照组,平均年龄(14.6±4.4)岁,平均Cobb角为55.2°±14.2°。比较两组体感诱发电位(SSEPs)和经颅电刺激运动诱发电位(TCeMEPs)的潜伏期和波幅。还评估了有和没有先天性脊柱畸形的AMC患者IONM数据的差异。AMC患者SSEPs和TCeMEPs的成功率分别为100%和14/19,AIS患者为100%和100%。AMC患者与AIS患者的SSEPs-P40潜伏期、SSEPs-N50潜伏期、SSEPs波幅、TCeMEPs潜伏期、TCeMEPs波幅差异均无统计学意义(均>0.05)。与AIS患者相比,AMC患者TCeMEPs波幅的侧别差异呈增加趋势,但两组间无统计学差异[(147.0±185.6)μV vs(68.1±311.4)μV,P=0.198]。有先天性脊柱畸形的AMC患者凹侧SSEPs波幅值为(1.4±1.1)μV,无先天性脊柱畸形的AMC患者凹侧为(2.6±1.2)μV(P=0.041)。有先天性脊柱畸形的AMC患者凸侧SSEPs波幅值为(1.4±0.8)μV,无先天性脊柱畸形的AMC患者凸侧为(2.6±1.3)μV(P=0.028)。AMC患者与AIS患者的SSEPs-P40潜伏期、SSEPs-N50潜伏期、SSEPs波幅、TCeMEPs潜伏期和TCeMEPs波幅的值相似。有先天性脊柱畸形的AMC患者的SSEPs波幅低于无先天性脊柱畸形的AMC患者。

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