Makarov M R, Delgado M R, Birch J G, Samchukov M L
Department of Neurology and Neurophysiology, Texas Scottish Rite Hospital for Children, Dallas 75219, USA.
J Pediatr Orthop. 1997 Sep-Oct;17(5):663-7. doi: 10.1097/00004694-199709000-00017.
Limb lengthening of the upper extremity using external fixation devices is associated with a high risk of neurovascular impairment. To aid early detection of nerve injury, intraoperative monitoring of neural function was performed in five patients undergoing Ilizarov-type circular external-fixator application. The apparatus was applied to the humerus in two cases and to the forearm in the other three cases. The function of ulnar, median, and radial nerves was assessed continuously throughout the surgery by using sensory-evoked potential (SEP) monitoring technique. The responses were elicited by stimulation of these nerves in the distal forearm with recording at Erb's point and over the anterior cervical spine. During apparatus application, radial-response attenuation was identified in two instances. No corrective actions were performed in one case, and the patient had symptoms of radial nerve deficit postoperatively. In the other case, prompt removal of the offending half-pin after the detection of electrophysiologic abnormalities resulted in subsequent response restoration and the avoidance of postoperative nerve dysfunction. Sensory-evoked potential monitoring proved to be a reliable indicator of nerve compromise during external fixation of upper extremities and may be considered a valuable surgical adjunct.
使用外固定装置进行上肢肢体延长与神经血管损伤的高风险相关。为了有助于早期发现神经损伤，对5例接受伊里扎洛夫式环形外固定器应用的患者进行了术中神经功能监测。该装置在2例中应用于肱骨，在另外3例中应用于前臂。在整个手术过程中，通过使用感觉诱发电位（SEP）监测技术持续评估尺神经、正中神经和桡神经的功能。通过在前臂远端刺激这些神经并在埃尔布点和颈椎前方进行记录来引出反应。在应用装置期间，有2例出现桡神经反应衰减。其中1例未采取纠正措施，患者术后出现桡神经缺损症状。在另一例中，在检测到电生理异常后迅速移除引起问题的半针，随后反应恢复，避免了术后神经功能障碍。感觉诱发电位监测被证明是上肢外固定期间神经损伤的可靠指标，可被视为一种有价值的手术辅助手段。
