多模式术中监测对脊柱手术效果的影响

文章编号] 2096-5532（2018）06-0672-05

EFFECT OF MULTIMODAL INTRAOPERATIVE MONITORING ON THE OUTCOME OF SPINAL SURGERY  RAO Shanshan， XU Shuang， SHANG Hui （Department of Spine Surgery， Shiyan Taihe Hospital， Shiyan 442000， China）

[ABSTRACT]ObjectiveTo investigate the effect of multimodal intraoperative monitoring on the outcome of spinal surgery and the potential risk factors for changes in neurological monitoring. MethodsA total of 120 patients who underwent spinal surgery were eolled， and neurophysiological monitoring was performed during surgery. Among these patients， 115 underwent motor evoked potential （MEP） monitoring （MEP group）， 76 underwent somatosensory evoked potential （SEP） monitoring （SEP group）， 89 underwent electromyography （EMG） monitoring （EMG group）， and 52 underwent MEP， SEP， and EMG monitoring （multimodal group）. Intraoperative alarms and nerve injury events were recorded. ResultsThe sensitivities and specificities of intraoperative nerve monitoring alarm in the MEP， SEP， EMG， and multimodal groups were 85.7%/88.2%， 62.5%/95.6%， 63.6%/94.9%， and 90.9%/97.6%， respectively， and the multimodal group had significantly higher sensitivity and specificity than the other three groups （χ2=3.92-7.83，P<0.05）. Among the 15 patients with neurological defects， 1 had permanent nerve injury， 6 had transient nerve injury， and 8 had reversible nerve injury. During preoperative neuromonitoring， the patients who underwent osteotomy or had a Cobb angle of ≥90° had a significantly higher proportion of patients with alarms than those who did not undergo osteotomy or had a Cobb angle of <90° （χ2=7.00 and 5.16，P<0.05）. ConclusionMultimodal intraoperative monitoring can improve the sensitivity of nerve injury monitoring during spinal surgery， and osteotomy and a Cobb angle of ≥90° are potential risk factors for changes in neurological monitoring.

[KEY WORDS]monitoring， intraoperative; spinal diseases; neurophysiological monitoring

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