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医学临床研究  2022, Vol. 39 Issue (3): 328-331    DOI: 10.3969/j.issn.1671-7171.2022.03.03
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髓内MRI信号异常的脊髓型颈椎病患者术中神经电生理的变化及其意义
林向全, 郑忠, 林勤, 李超雄**
福建省福州市第二医院骨科,福建 福州 350007
Changes and Significance of Intraoperative Neurophysiology in Patients with Cervical Spondylotic Myelopathy with Abnormal Intramedullary MRI Signal
LIN Xiang-quan, ZHENG Zhong, LIN Qin, et al
Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007
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摘要 【目的】探讨核磁共振成像(Magnetic Resonance Imaging,MRI)异常信号的脊髓型颈椎病(Cervical Spondylotic Myelopathy,CSM)患者术中神经电生理监测(Intraoperative Neurophysiological Monitoring,IONM)指标,运动诱发电位(Motor Evoked Potentials,MEPs)和体感诱发电位作(Somatosensory Evoked Potentials, SEPs)的变化,分析异常MRI信号与IONM变化的关系。【方法】共收集本院2019年1月至2021年1月150例异常MRI信号的CSM患者临床及IONM数据,根据其信号特征分为两组。A组:T2WIs高信号(120例);B组:T2WIs高信号同时T1WIs低信号(30例)。记录手术重要节点的IONM数据。【结果】A组:9例IONM改变,1例暂时性神经损伤,无新发永久神经损伤;B组:18例IONM改变,5例暂时性神经损伤,2例新发永久性神经损伤。两组间IONM改变差异有统计学意义(MEPs, 5/120 vs 12/30,P<0.05; SEPs, 4/120 vs 6/30,P<0.05)。此外,B组减压前后IONM波幅存在差异有统计学意义[MEPs,(134±30.2)μV vs (65±26.2)μV, P<0.05;SEPs,(2.4±0.9)μV vs (1.3±0.7)μV,P<0.05]。【结论】CSM患者T2WIs高信号同时T1WIs低信号比单独T2WIs高信号更易出现IONM改变,从而导致神经损伤的发生。在CSM脊髓减压过程中要注意IONM改变,必要时需要采取适当的手术干预措施。
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林向全
郑忠
林勤
李超雄
关键词 脊髓疾病/并发症颈椎病/外科学磁共振成像    
Abstract:【Objective】To investigate the changes of intraoperative neuroelectrophysiological monitoring (IONM) indexes, motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) in patients with cervical spondylotic myelopathy (CSM) with abnormal MRI signals, and to analyze the relationship between abnormal MRI signals and IONM changes.【Methods】The clinical and IONM data of 150 CSM patients with abnormal MRI signals from January 2019 to January 2021 were collected and divided into two groups according to their signal characteristics. Group A: T2WIs high signal (120 cases); Group B: T2WIs high signal and T1WIs low signal (30 cases). The IONM data of important surgical nodes were recorded. 【Results】 Group A: 9 cases had IONM changes, 1 case had temporary nerve injury, and there was no new permanent nerve injury; Group B: 18 cases of IONM changes, 5 cases of temporary nerve injury and 2 cases of new permanent nerve injury. There was significant difference in IONM between the two groups (MEPs, 5/120 vs 12/30,P<0.05; SEPs, 4/120 vs 6/30,P<0.05). In addition, there was significant difference in IONM amplitude before and after decompression in the group B [MEPs,(134±30.2) μV vs (65±26.2) μV, P<0.05;SEPs, (2.4±0.9) μV vs (1.3±0.7) μV, P<0.05].【Conclusion】In CSM patients, high T2WIs signal and low T1WIs signal are more prone to IONM changes than high T2WIs signal alone, resulting in nerve injury. In the process of CSM spinal cord decompression, we should pay attention to the changes of IONM, and take appropriate surgical intervention measures when necessary.
Key wordsSpinal Cord Diseases/CO    CERVICAL SPONDYLOSIS/SU    Magnetic Resonance Imaging
收稿日期: 2022-02-16     
中图分类号:  R274  
基金资助:福建省自然科学基金面上项目(2019J01548)
通讯作者: ** E-mail:E-mail:lichaox0591@163.com   
引用本文:   
林向全, 郑忠, 林勤, 李超雄. 髓内MRI信号异常的脊髓型颈椎病患者术中神经电生理的变化及其意义[J]. 医学临床研究, 2022, 39(3): 328-331.
LIN Xiang-quan, ZHENG Zhong, LIN Qin, et al. Changes and Significance of Intraoperative Neurophysiology in Patients with Cervical Spondylotic Myelopathy with Abnormal Intramedullary MRI Signal. JOURNAL OF CLINICAL RESEARCH, 2022, 39(3): 328-331.
链接本文:  
http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.03.03     或     http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I3/328
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