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| 合并骨质疏松颈椎病后路减压术颈5神经损伤的MEP监测研究 |
| MEP monitoring study of the 5th cervical nerve injury during posterior cervical decompression in cervical spondylosis combined with osteoporosis |
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| DOI：10. 3969/j. issn. 1006-7108. 2012. 12. 011 |
| 中文关键词: 颈椎后路减压术 颈5神经损伤 神经电生理监测 |
| 英文关键词:Posterior cervical decompression The 5 th cervical nerve injury Neurophysiological monitoring |
| 基金项目:陕西省社发公关项目（2012k16 -09 -08 );西安市卫生局科技计划项目（j2011041 ) |
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| 中文摘要: |
| 目的 评估应用经颅电刺激运动诱发电位行术中脊髓监测在预测颈椎后路减压术后部分节段运动麻痹的价值。方法64例患者，男47例、女17例，平均年龄64岁，合并骨质疏松，在本中心行经颅电刺激运动诱发电位术中脊髓监测下颈椎后路减压术。经颅电刺激经针型电极进行传送，胸髓及双侧三角肌、肱二头肌、肱三头肌的诱发电位被完整记录。结果 术中诱发电位在57例患者的上述 所有肌群被成功记录，在其余的7例患者中诱发电位未被完整记录。在57例患者中无一例出现诱发电位波幅的明显降低。所有患者的临床症状在术后均有明显的改善；然而,有3例患者出现短暂的术后颈5神经。结论 在经颅电刺激运动诱发电位的监测中无异常出现，即使在合并有短暂的术后颈5神经麻痹的患者。这些结果提示颈椎后路减压手术后颈5神经麻痹与术中神经根或者脊髓的 损伤无明显的关联,虽然其确切的机制尚不清楚。术者应清楚颈椎后路减压手术后颈5神经麻痹是 一可能的并发症，即使术中无明显的神经损伤。 |
| 英文摘要: |
| Objective To evaluate the application of transcranial electric motor evoked potential ( MEP ) intraoperative monitoring of cervical spinal cord in predicting partial segment palsy after posterior cervical decompression. Methods A total of 64 patients, including 47 men and 17 women, with a mean age of 64 years old, were enrolled. They were all combined with osteoporosis. All the patients received posterior cervical spinal decompressions with transcranial MEP intraoperative monitoring of spinal cord. Transcranial electrical stimulation delivered through needle electrodes. Evoked potentials of spinal cord, bilateral deltoid, biceps, and triceps were recorded completely. Results Intraoperative evoked potentials of muscles in 57 patients were successfully recorded. Evoked potentials in the remaining 7 patients were not completely recorded. No case showed significant decrease of evoked potential amplitude in 57 patients. Clinical symptoms of all patients had significant improvement after surgery. However, 3 patients had transient postoperative 5th cervical nerve palsy. Conclusion There is no abnormalities during the transcranial electrical stimulation MEP monitoring, even if in the patients who had short-term the 5th cervical nerve palsy postoperatively. These results suggest that postoperative 5th cervical nerve palsy after posterior cervical decompression has no significant association with intraoperative nerve root or spinal cord injury, although the exact mechanism is still unclear. Surgeons should realize that postoperative 5th cervical nerve palsy after posterior cervical decompression is a possible complication，even there is no evident nerve damage during operation. |
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