术中神经监测在脊髓手术中的应用

林国中 王振宇 刘斌

（北京大学第三医院神经外科，北京 100191）

【摘要】 目的：探讨术中神经监测在脊髓手术中的应用。方法：对24例脊髓手术患者，根据监测方法不同分为4组。A组（腹侧肿瘤）行SEP+MEP+EMG监测，B组（髓内肿瘤）行SEP+MEP监测，C组（髓外硬膜下肿瘤）行SEP+EMG监测，D组（马尾神经病变）行EMG监测。分析术中监测情况与术后神经功能变化之间的关系。结果：A组3例，术中均有监测报警，手术结束前均恢复，但有1例出现术后神经功能恶化。B组6例, 术中均有监测报警，手术结束前5例恢复，1例未恢复者术后神经功能恶化。C组9例，7例术中监测报警，手术结束前均恢复，但有1例出现术后神经功能恶化。D组6例，术中均有监测报警，手术结束前均恢复，但有1例出现术后神经功能恶化。结论：术中神经监测可及时提醒术者神经系统存在功能损伤可能，从而采取补救措施，有助于减少术后神经功能恶化。但部分患者采取措施后监测虽恢复，仍出现不同程度的神经功能恶化，术中神经监测还需要进一步完善。

【关键词】：脊髓；术中神经监测；神经根

Preliminary application of intraoperative neurophysiological monitoring in spinal cord surgery Lin Guozhong, Wang Zhenyu, Liu Bin. Dept of neurosurgery, Peking University Third Hospital, Beijing 100191,China 【Abstract】 Objective: To study application of intraoperative neurophysiological monitoring in spinal cord surgery. Methods: 24 patients with spinal cord tumors were divided into 4 groups according to the method of monitoring. Group A (ventral tumors) were underwent SEP + MEP + EMG monitoring, Group B (intramedullary tumors) were underwent SEP + MEP monitoring, Group C (subdural extramedullary tumors) were underwent SEP + EMG monitoring, Group D (conus medullary and cauda equina lesions) were underwent EMG monitoring. The relationship between changes of intraoperative monitoring and postoperative neurological function was analysised. Results: All of the 3 patients in group A had intraoperative warning which recovered before the end of surgery. But neurological function was deteriorated in 1 case. All of the 6 patients in group B had intraoperative warning. 5 of these cases recovered before the end of surgery, 1 of these cases did not recover and neurological function was deteriorated in this case. 7 of the 9 patients in group C had intraoperative warning which recovered before the end of surgery. But neurological function was deteriorated in 1 case. All of the 6 patients in group D had intraoperative warning which recovered before the end of surgery. But neurological function was deteriorated in 1 case. Conclusions: Intraoperative neurophysiological monitoring was useful to reduce postoperative neurological deterioration. However, intraoperative neurophysiological monitoring need further improvement.

【Key words】: spinal cord; intraoperative neurophysiological monitoring; nerve root