本文選題：脊柱側(cè)彎　切入點(diǎn)：矯形術(shù)　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的評(píng)估多模式術(shù)中監(jiān)測(cè)(Mutimodal intraoperative monitoring,MIOM)在脊柱側(cè)彎矯形術(shù)中監(jiān)測(cè)神經(jīng)功能的有效性,探討術(shù)中監(jiān)測(cè)數(shù)據(jù)出現(xiàn)異常的影響因素。方法回顧性分析2009年1月至2017年2月在銀川國(guó)龍醫(yī)院接受矯形手術(shù)治療的70例脊柱側(cè)彎患者的病歷資料,術(shù)中采用體感誘發(fā)電位(Somatosensory evoked potential,SEP)+經(jīng)顱電刺激運(yùn)動(dòng)誘發(fā)電位(Transcranial electric stimulation motor evoked potential,TES-MEP)+自發(fā)性肌電圖(Free-run Electromyography,Free-run EMG)聯(lián)合的多模式監(jiān)測(cè),所有患者術(shù)前均無神經(jīng)功能障礙。測(cè)量患者術(shù)前、術(shù)后冠狀面主彎Cobb角及矢狀面胸椎后凸角大小并計(jì)算矯正率,記錄一般資料、手術(shù)時(shí)間、術(shù)中失血量、術(shù)中神經(jīng)電生理監(jiān)測(cè)結(jié)果、報(bào)警因素及改善措施、術(shù)后神經(jīng)功能損害及轉(zhuǎn)歸等。根據(jù)神經(jīng)電生理監(jiān)測(cè)結(jié)果分析術(shù)中監(jiān)測(cè)數(shù)據(jù)出現(xiàn)異常的影響因素。結(jié)果70例患者術(shù)中均成功進(jìn)行SEP+TES-MEP+Free-run EMG聯(lián)合監(jiān)測(cè)。側(cè)凸和后凸分別從術(shù)前平均56.7°±18.5°和52.9°±31.0°矯正至術(shù)后平均16.4°±6.8°和26.5°±17.6°,矯正率分別為70.4%±8.4%和50.9%±13.0%;手術(shù)時(shí)間2.5~6.5h,平均為(4.13±1.22)h;術(shù)中失血量150~3500ml,平均為(952.56±785.96)ml。術(shù)中神經(jīng)電生理監(jiān)測(cè)無假陰性發(fā)生。SEP+TES-MEP+Free-run EMG聯(lián)合監(jiān)測(cè)共有16例患者出現(xiàn)監(jiān)測(cè)報(bào)警,9例患者為真陽(yáng)性((截骨)矯形過程7例,置釘過程2例),其余7例與非手術(shù)因素有關(guān),靈敏度為100%(9/9),特異度為88.5%(54/61),假陽(yáng)性率為11.5%(7/61),假陰性率為0.0%(0/9)。12例患者術(shù)中SEP監(jiān)測(cè)異常,8例為真陽(yáng)性,靈敏度為88.9%(8/9),特異度為93.4%(57/61),假陽(yáng)性率為6.6%(4/61),假陰性率為11.1%(1/9)。10例患者術(shù)中TES-MEP監(jiān)測(cè)異常,7例為真陽(yáng)性,靈敏度為77.8%(7/9),特異度為95.1%(58/61),假陽(yáng)性率為4.9%(3/61),假陰性率為22.2%(2/9)。11例患者術(shù)中Free-run EMG監(jiān)測(cè)異常,8例為真陽(yáng)性,靈敏度為88.9%(8/9),特異度為95.1%(58/61),假陽(yáng)性率為4.9%(3/61),假陰性率為11.1%(1/9)。1例術(shù)前合并胸椎重度后凸畸形的神經(jīng)纖維瘤病患者,在矯形過程中SEP、TES-MEP和Free-run EMG均監(jiān)測(cè)報(bào)警,術(shù)后出現(xiàn)短暫性神經(jīng)功能障礙,表現(xiàn)為右下肢小腿前側(cè)麻木,給予藥物營(yíng)養(yǎng)神經(jīng)、理療等治療后恢復(fù)正常。結(jié)論1.MIOM應(yīng)用于脊柱側(cè)彎矯形術(shù)中可全面監(jiān)測(cè)脊髓及神經(jīng)根功能。2.MIOM靈敏度高,能及時(shí)發(fā)現(xiàn)潛在的神經(jīng)功能損傷,優(yōu)于單一監(jiān)測(cè)模式。3.脊柱側(cè)彎矯形手術(shù)MIOM監(jiān)測(cè)數(shù)據(jù)出現(xiàn)異常的影響因素較多,截骨矯形、置釘、胸椎后凸畸形為MIOM發(fā)生嚴(yán)重不良事件的危險(xiǎn)因素。
[Abstract]:Objective to evaluate the effectiveness of monitoring neurologic function in scoliosis orthopedic surgery with multiple mode intraoperative monitoring of Mutimodal intraoperative monitoring. Methods from January 2009 to February 2017, 70 patients with scoliosis underwent orthopedic surgery in Guolong Hospital of Yinchuan were retrospectively analyzed. The spontaneous electromyography (Free-run electromyography) and Free-run electromyography (Free-run EMG) were monitored by transcranial electric stimulation motor evoked potentialTES-MEP by somatosensory evoked potentialSEP during the operation. There were no neurological dysfunction in all patients before operation. The Cobb angle of the main coronal curvature and the size of the sagittal thoracic kyphoid angle were calculated, the correction rate was calculated, the general data, the operation time, the blood loss during the operation, the monitoring results of intraoperative nerve electrophysiology, the alarm factors and the improvement measures were recorded. According to the results of electrophysiologic monitoring, the influencing factors of abnormal intraoperative monitoring data were analyzed. Results SEP TES-MEP Free-run EMG combined monitoring was performed successfully in 70 patients during operation. The scores of scoliosis and kyphosis were obtained. The average preoperative correction was 56.7 擄鹵18.5 擄and 52.9 擄鹵31.0 擄to the postoperative mean 16.4 擄鹵6.8 擄and 26.5 擄鹵17.6 擄, the correction rates were 70.4% 鹵8.4% and 50.9% 鹵13.0, respectively; the operation time was 2.5 to 6.5 hours, with an average of 4.13 鹵1.22h. the blood loss during operation was 1503500ml, with an average of 952.56 鹵785.96ml. A total of 16 patients were detected and alerted. 9 cases were true positive orthopedic procedure, 7 cases were orthopedic. The other 7 cases were related to non-operative factors, the sensitivity was 100 / 9 / 9, the specificity was 88.5 / 64 / 61, the false positive rate was 11.5g / 7 / 61g, the false negative rate was 0.00 / 9 / 12, the abnormal SEP monitoring was true positive in 8 cases. The sensitivity was 88. 9%, the specificity was 93. 4% / 67%, the false positive rate was 6. 6% / 61%, the false negative rate was 11. 1% and 9 / 9%, 7 cases were true positive. The sensitivity was 77.8 / 9, the specificity was 95.1a / 58 / 61, the false positive rate was 4.9C / 61g, the false negative rate was 22.2 / 9.11 cases, the abnormal Free-run EMG monitoring was true positive in 8 cases. The sensitivity was 88. 9%, the specificity was 95. 1% / 58 / 61, the false positive rate was 4. 9% / 61%, the false negative rate was 11. 1% / 9. 1 cases of neurofibromatosis with severe thoracic kyphosis before operation. SEPTES-MEP and Free-run EMG were monitored and alerted during the orthopedic procedure. The function of spinal cord and nerve root can be completely monitored by MIOM in scoliosis orthopedics. 2. The sensitivity of MIOM in spinal cord and nerve root is high. Potential neurological function injury can be detected in time, which is superior to single monitoring mode .3.There are many factors influencing abnormal MIOM monitoring data in scoliosis orthopedic surgery, osteotomy, orthopedics and nail placement. Thoracic kyphosis is a risk factor for severe adverse events in MIOM.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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