Makarov M R, Delgado M R, Birch J G, Samchukov M L
Department of Neurology, University of Texas Southwestern Medical Center, Dallas, USA.
J Pediatr Orthop. 1996 Mar-Apr;16(2):155-60. doi: 10.1097/00004694-199603000-00004.
The efficacy of somatosensory evoked potentials (SSEPs) to detect acute peripheral nerve injury during external-fixator application in the lower extremities was evaluated in 40 children with 42 Ilizarov surgical procedures. The study included patients who were either clinically normal or who had preexisting neuropathy but consistent and reliable SSEP responses preoperatively. SSEPs were recorded from the popliteal fossa and lumbar regions after alternating stimulation of the peroneal and posterior tibial nerves at the ankle. SSEP changes due to anesthesia, Ilizarov apparatus application, and other intraoperative variables are described. Significant deterioration or total loss of SSEP response during surgery occurred in four cases. Two of these patients were normal preoperatively and had symptoms of neurologic deficit postoperatively; the other two had exacerbations of pre-existing neuropathy. In general, the peroneal nerve was at greater risk for injury during surgery. SSEP monitoring proved to be technically feasible in external-fixation procedures on the lower extremities and may be a practical tool for detection of intraoperative nerve compromise.
在40名接受42例伊里扎洛夫手术的儿童中，评估了体感诱发电位（SSEPs）在下肢应用外固定器期间检测急性周围神经损伤的有效性。该研究纳入了术前临床正常或已有神经病变但体感诱发电位反应持续且可靠的患者。在踝关节交替刺激腓总神经和胫后神经后，从腘窝和腰部记录体感诱发电位。描述了麻醉、应用伊里扎洛夫器械及其他术中变量引起的体感诱发电位变化。手术期间有4例患者出现体感诱发电位反应显著恶化或完全消失。其中2例患者术前正常，术后出现神经功能缺损症状；另外2例患者原有神经病变加重。总体而言，手术期间腓总神经受伤风险更高。体感诱发电位监测在下肢外固定手术中证明在技术上是可行的，可能是检测术中神经损伤的实用工具。
