The effect from different numbers of segmental arteries ligation to the spinal cord in the clinical practice of posterior vertebral column resection correction
The effect from different numbers of segmental arteries ligation to the spinal cord in the clinical practice of posterior vertebral column resection correction
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不同数量节段动脉结扎脊髓在后路椎体切除矫正临床中的效果
DOI：
10.1007/s00586-017-5067-x
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发表时间：
2017-03
影响因子：
2.8
通讯作者：
Shi Zhiyue
中科院分区：
文献类型：
--
作者：
Zhao Zhi;Xie Jingming;Wang Yingsong;Bi Ni;Li Tao;Zhang Ying;Shi Zhiyue
目的采用后路脊柱切除术（PVCR）治疗重度脊柱后凸，不可避免地要结扎和切断多条脊髓节段动脉（SA）以暴露和止血，但这会增加神经系统的风险。本研究的目的是探讨术中脊髓监测（IOM）的变化后，结扎不同数量的SA在PVCR.Methods21例严重脊柱后凸患者包括PVCR矫正治疗。术中根据结扎SA的不同数目，分别记录IOM的变化。结果21例患者平均结扎1.9对脊髓节段。随着结扎次数的增加，SSEP波幅和潜伏期的变化更明显：1 ~ 3对结扎，波幅平均下降百分比为53.20 ~ 78.15%，潜伏期平均增加百分比为1.23 ~ 1.40%，波幅下降的平均持续时间为3.23 ~ 5.2min;但无异常MEP改变。无术后或迟发性神经功能缺损。相关性分析表明，SA结扎次数与SSEP波幅降低百分比之间存在显著相关性（r= 0.945，P < 0.0001），以及结扎SA数量与SSEP变化持续时间之间的关系（r= 0.945，P = 0.0002）。恢复时间越长，SSEP波幅下降越明显，脊髓损伤的危险性也将大大增加。在基于脊柱短缩的PVCR矫正中，为了神经安全性，SA结扎的数量应尽可能少。
PurposeIn using posterior vertebral column resection (PVCR) to treat severe kyphoscoliosis, it is unavoidable to ligate and cut off several segmental arteries (SAs) of the spinal cord for exposure and hemostasis, but which would raise the neurological risks. The aim of this study is to explore the changes of intraoperative spinal cord monitoring (IOM) following ligating different numbers of SAs in PVCR.MethodsTwenty-one consecutive patients with severe kyphoscoliosis were included and treated by PVCR correction. In operation, according to ligate different numbers of SAs, the IOM changes were recorded, respectively. Examinations of the covariance between different numbers of SAs ligations and IOM changes were performed to reveal the effect to the spinal cord by SAs ligations.ResultsIn all the 21 cases, averaging 1.9 pairs of SAs were ligated. With the increased numbers of ligations, SSEP amplitudes and latencies were changed more obviously: from 1 to 3 pairs ligations, the mean decreased percentages of amplitudes were from 53.20 to 78.15%, the mean increased percentages of latency were from 1.23 to 1.40%, and the mean durations of decreased SSEP amplitudes were from 3.23 to 5.2 min; but without abnormal MEP changes. None occurred postoperative or delayed neurological deficit. Correlation analysis identified significant correlations between the number of SAs ligation and decreased percentage of SSEP amplitude (r= 0.945,P< 0.0001), and between the number of SAs being ligated and the duration of SSEP change (r= 0.945,P= 0.0002).ConclusionsFollowing the increased number of SAs ligation, the amplitude of SSEP is decreased more obviously with a much longer duration of recovery and the risk to spinal cord will be increased greatly. In the PVCR correction on the basis of spinal shortening, the numbers of SAs ligations should be as less as possible for neurological safety.
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影响因子：
3
作者：
J. Ohnishi;S. Hamada
通讯作者：
J. Ohnishi;S. Hamada
影响因子：
3
作者：
Kato, Satoshi;Kawahara, Norio;Fujimaki, Yoshiyasu
通讯作者：
Fujimaki, Yoshiyasu
影响因子：
2.8
作者：
Xie, Jingming;Wang, Yingsong;Liu, Luping
通讯作者：
Liu, Luping
影响因子：
3
作者：
Nambu, K;Kawahara, N;Tomita, K
通讯作者：
Tomita, K
DOI：
10.2106/jbjs.f.01476
发表时间：
2007-11
期刊：
The Journal of bone and joint surgery. American volume
影响因子：
--
作者：
Daniel M. Schwartz;J. Auerbach;J. Dormans;J. Flynn;D. Drummond;J. Bowe;S. Laufer;Suken A. Shah;J. R. Bowen;P. Pizzutillo;Kristofer J. Jones
通讯作者：
Daniel M. Schwartz;J. Auerbach;J. Dormans;J. Flynn;D. Drummond;J. Bowe;S. Laufer;Suken A. Shah;J. R. Bowen;P. Pizzutillo;Kristofer J. Jones