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

二维码有效期 120s

摘要目的探讨联合术中神经电生理监护(intraoperative neurophysiological monitoring,IONM)预测脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者经颈前路椎间盘切除减压融合术(anterior cervical dis-cectomy and fusion,ACDF)中神经功能损伤的效能及相关影响因素.方法收集45例经ACDF治疗的CSM患者临床资料,分析联合IONM(SEP+MEP)监护结果与术后神经功能变化的关系,以及使用多因素logistics回归分析法探讨年龄、病程、术前神经功能(mJOA评分)、MRI T2像高信号、压迫节段数、最大椎管受压程度(maximal canal compromise,MCC)、脊髓压迫比(spinal cord compression ratio,SCCR)和脊髓横截面积(spinal cord cross-sectional area,SCCA)等因素对其预测效能的影响.结果术中联合监护报警5例,未报警40例;术后mJOA评分改善42例,加重3例,术后神经功能明显改善(P＜0.05);监护真阳性2例,假阳性3例,真阴性39例,假阴性1例;敏感度66.67％,特异度92.85％,阳性预测值40％,阴性预测值97.50％.术中联合监护结果与术后神经功能改变的关联性有统计学意义(P＜0.05).多因素logistics回归分析显示年龄、病程、术前mJOA评分、MRI T2像是否高信号、压迫节段数、压迫最严重部位MCC、SCCR和SCCA结果差异无统计学意义(P＞0.05).结论联合IONM可预测CSM患者ACDF术中的神经功能损伤,尽管术前因素对预测效能无显著影响,但术中应注意分辨手术操作、血压波动和低体温等因素的干扰.