术中神经电生理监测在脊髓栓系松解术中的应用

摘要

目的:探讨术中神经电生理监测(Intraoperative neurophysiological monitoring,IONM)在脊髓栓系松解术中对患者神经功能的保护作用.方法:150例确诊为脊髓栓系(Tethered cord,TC)或脊髓栓系综合征(Tethered cord syndrome,TCS)患者,在术中神经电生理监测下行脊髓栓系松解术,回顾病例资料、神经电生理监测数据与术后随访结果进行临床总结.结果:148例患者获得术后随访,111例病情好转,35例稳定,2例患者病情恶化,其中1例下肢肌力减退,1例大便失禁.结论:通过术中神经电生理的监测和神经功能定位手段,可较有效辨别正常神经根与病变组织,保证神经通路完整性,有效减少医源性神经功能损伤,提高患者术后生存质量.%Objective:Describe and discuss the value of intraoperative neurophysiological monitoring(IONM)with surgical detethering.Methods:Medical records,IONM data and outcome of follow-up of 150 patients with TCS or TC undergoing microsurgical detethering were systematically collected and analyzed.Results:148 patients were followed up.In patients having neurologic deficits,111 patients improved,35 patients remained stability,2 patients became worse,one of them had lower extremity weakness,another had Bowel/bladder dysfunction.Conclusion:Mapping technique should be one of the components of IONM during surgery for the tethered cord syndrome to prevent postoperative neurological deficits,monitoring technique can keep full integrity neural pathway.The use of these techniques can decrease the rate of surgical iatrogenic injury and improve quality of life in TCS patients.