广东医学2024，Vol.45Issue(9)：1160-1165,6.DOI:10.13820/j.cnki.gdyx.20240430
联合IONM对脊髓型颈椎病ACDF术中神经功能损伤的预测效能及影响因素分析
Analysis of the predictive efficacy and influencing factors of combined intraoperative neurophysiological monito-ring for nerve function injury during anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy
摘要
Abstract
Objective To investigate the efficacy of combined intraoperative neurophysiological monitoring(IONM)in predicting nerve function injury during anterior cervical discectomy and fusion(ACDF)surgery in patients with cervical spondylotic myelopathy(CSM)and analyze related influencing factors.Methods Clinical data from 45 CSM patients treated with ACDF surgery were collected.The relationship between the combined IONM(SEP+MEP)mo-nitoring results and postoperative nerve function changes was analyzed.Multivariate logistic regression analysis was used to explore the effects of age,disease duration,preoperative nerve function(mJOA score),high signal on MRI T2 images,number of compression segments,maximum canal compression(MCC),spinal cord compression ratio(SCCR),and spi-nal cord cross-sectional area(SCCA)on predictive efficacy.Results Intraoperative alarms were noted in 5 cases,and no alarms in 40 cases.Postoperative mJOA scores improved in 42 cases and worsened in 3 cases,showing significant im-provement in nerve function after surgery(P＜0.05).True positive cases:2;false positive cases:3;true negative ca-ses:39;false negative cases:1.Sensitivity:66.67％;specificity:92.85％;positive predictive value:40％;negative predictive value:97.50％.The association between intraoperative monitoring results and postoperative nerve function changes was statistically significant(P＜0.05).Multivariate logistic regression analysis showed no statistically significant differences in age,disease duration,preoperative mJOA score,high signal on MRI T2 images,number of compression segments,MCC,SCCR,and SCCA(P＞0.05).Conclusion Combined IONM can predict nerve function injury during ACDF surgery in CSM patients.Although preoperative factors do not significantly affect predictive efficacy,attention should be paid to differentiating surgical operations,blood pressure fluctuations,and hypothermia during surgery.关键词
术中神经电生理监护/体感诱发电位/运动诱发电位/经颈前路椎间盘切除减压融合术/脊髓型颈椎病Key words
intraoperative neuroelectrophysiological monitoring/somatosensory evoked potential/motor evoked potential/anterior cervical discectomy and fusion/cervical spondylotic myelopathy分类
医药卫生引用本文复制引用
彭波,彭智恒,曾俏燕,黄维渊,程龙,李广盛,孙欣..联合IONM对脊髓型颈椎病ACDF术中神经功能损伤的预测效能及影响因素分析[J].广东医学,2024,45(9):1160-1165,6.基金项目
广东省科技创新战略专项资金项目(2018A0303130105) （2018A0303130105）
广东省医学科学技术研究基金项目(A2016536) （A2016536）
