脊髓栓系综合征手术中应用神经电生理监测的作用和意义(1)
【摘要】 目的：探讨在脊髓栓系综合征(tethered cord syndrome，TCS)显微手术中应用神经电生理监测的作用以及临床意义。方法：选取2014年1月-2016年12月在本院购买神经电生理监测仪前后被确诊为TCS行显微手术治疗并完成随访的连续患者132例，根据是否应用电生理监测分为试验组(术中应用电生理监测)和参照组(术中未应用电生理监测)，各66例。比较两组膀胱功能及下肢运动功能改善情况。结果：术后6个月，试验组膀胱功能改善率为63.6%，高于参照组的37.9%，比较差异有统计学意义( 字2=8.760，P=0.003)；试验组术后下肢运动功能改善率为72.7%，高于参照组的65.2%，但比较差异无统计学意义( 字2=0.884，P=0.347)。结论：在TCS显微手术中使用神经电生理监测，能有效提高患者膀胱改善率，有助于防止术中对神经的副损伤，有助于对终丝判定从而获得最大程度的松解，值得临床应用与推广。
【关键词】 脊髓栓系综合征； 显微手术； 神经电生理监测； 作用
, http://www.100md.com
【Abstract】 Objective：To explore the effect and significance of neurophysiological monitoring in microsurgery of tethered cord syndrome(TCS).Method：A total of 132 patients who were diagnosed as TCS microsurgical treatment and followed up from January 2014 to December 2016 before and after the purchase of the electrophysiological monitor in our hospital were selected.According to the application of electrophysiological monitoring，they were divided into experimental group(intraoperative electrophysiological monitoring) and reference group(no electrophysiological monitoring during operation)，66 cases in each group.The improvement of bladder function and lower extremity motor function between two groups were compared.Result：After operation 6 months，the improvement rate of bladder function in experimental group was 63.6%，which was higher than 37.9% of reference group，the difference was statistically significant( 字2=8.760，P=0.003).The improvement rate of lower limb motor function in experimental group was 72.7%，which was higher than 65.2% of reference group，but the difference was not statistically significant( 字2=0.884，P=0.347).Conclusion：Neuroelectrophysiological monitoring in TCS microsurgery can effectively improve the bladder improvement rate，prevent intraoperative nerve damage，is helpful to determine the fila terminale and to get the maximum release，which is worthy of clinical application and promotion.
, http://www.100md.com
【Key words】 Tethered cord syndrome； Microscopic surgery； Neurophysiological monitoring； Effect
First-author’s address：Shenzhen Hospital of Southern Medical University，Shenzhen 518000，China
doi：10.3969/j.issn.1674-4985.2018.02.025
脊髓栓系綜合征(tethered cord syndrome，TCS)是指脊髓的末端由于各类原因受限于椎管内的异常结构从而导致无法正常上升[1]，导致脊髓末端、马尾神经以及终丝长期受到牵拉损伤，最终引发一系列相关的神经功能性障碍的一种临床综合征[2]。这些临床综合征主要包括大小便失禁、下肢运动功能障碍以及双脚生长畸形等[3]。TCS致残率高，诊断治疗越早，疗效越好，一经确诊需要进行手术治疗[4]。张林等[5]研究报道，患有TCS的患者，进行终丝切断手术后有明显的改善。在手术治疗TCS过程中解除栓系因素是关键所在，如何提高辨别正常神经和栓系因素的准确率，以及如何确认繁多的马尾神经中的终丝成为医学界的关注焦点[6]。相关资料显示，神经电生理监测技术具有保护神经组织、准确地断定终丝的功能[7]。因此，本研究在脊髓栓系综合征显微镜手术中运用神经电生理监测，以探讨其作用以及临床意义，现报道如下。, http://www.100md.com(刘健刚 汪求精 刘明刚)
【关键词】 脊髓栓系综合征； 显微手术； 神经电生理监测； 作用
, http://www.100md.com
【Abstract】 Objective：To explore the effect and significance of neurophysiological monitoring in microsurgery of tethered cord syndrome(TCS).Method：A total of 132 patients who were diagnosed as TCS microsurgical treatment and followed up from January 2014 to December 2016 before and after the purchase of the electrophysiological monitor in our hospital were selected.According to the application of electrophysiological monitoring，they were divided into experimental group(intraoperative electrophysiological monitoring) and reference group(no electrophysiological monitoring during operation)，66 cases in each group.The improvement of bladder function and lower extremity motor function between two groups were compared.Result：After operation 6 months，the improvement rate of bladder function in experimental group was 63.6%，which was higher than 37.9% of reference group，the difference was statistically significant( 字2=8.760，P=0.003).The improvement rate of lower limb motor function in experimental group was 72.7%，which was higher than 65.2% of reference group，but the difference was not statistically significant( 字2=0.884，P=0.347).Conclusion：Neuroelectrophysiological monitoring in TCS microsurgery can effectively improve the bladder improvement rate，prevent intraoperative nerve damage，is helpful to determine the fila terminale and to get the maximum release，which is worthy of clinical application and promotion.
, http://www.100md.com
【Key words】 Tethered cord syndrome； Microscopic surgery； Neurophysiological monitoring； Effect
First-author’s address：Shenzhen Hospital of Southern Medical University，Shenzhen 518000，China
doi：10.3969/j.issn.1674-4985.2018.02.025
脊髓栓系綜合征(tethered cord syndrome，TCS)是指脊髓的末端由于各类原因受限于椎管内的异常结构从而导致无法正常上升[1]，导致脊髓末端、马尾神经以及终丝长期受到牵拉损伤，最终引发一系列相关的神经功能性障碍的一种临床综合征[2]。这些临床综合征主要包括大小便失禁、下肢运动功能障碍以及双脚生长畸形等[3]。TCS致残率高，诊断治疗越早，疗效越好，一经确诊需要进行手术治疗[4]。张林等[5]研究报道，患有TCS的患者，进行终丝切断手术后有明显的改善。在手术治疗TCS过程中解除栓系因素是关键所在，如何提高辨别正常神经和栓系因素的准确率，以及如何确认繁多的马尾神经中的终丝成为医学界的关注焦点[6]。相关资料显示，神经电生理监测技术具有保护神经组织、准确地断定终丝的功能[7]。因此，本研究在脊髓栓系综合征显微镜手术中运用神经电生理监测，以探讨其作用以及临床意义，现报道如下。, http://www.100md.com(刘健刚 汪求精 刘明刚)