Abstract:

Objective　To investigate the application value of intraoperative neuroelectrophysiological monitoring (IONM) in patients undergoing spinal surgery, in order to provide guidance for improving the effectiveness and safety of spinal surgery. Methods　A total of 200 patients who were planned to undergo spinal surgery were selected from Xi'an Honghui Hospital and Xi'an Daxing Hospital from May 2022 to May 2023. The patients were randomly divided into an intraoperative monitoring group and a reference group with 100 cases in each group by the computer numbered odd-even number method. There were 55 males and 45 females in the intraoperative monitoring group, aged 32-74 (58.92±10.35) years, with a body mass index (BMI) of 18-30 (23.15±2.09) kg/m². There were 57 males and 43 females in the reference group, aged 33-73 (59.14±10.62) years, with a BMI of 18-30 (23.27±2.15) kg/m². Conventional spinal surgery was performed in both groups. IONM technique was applied in the monitoring group, while no IONM technique was applied in the reference group. The perioperative indexes, spinal cord nerve function (evaluation time was 1 day before surgery and 7 days after surgery), serum inflammatory factors (evaluation time was 1 day before surgery and 1 day after surgery), and postoperative complications were compared between the two groups. Statistical methods used were χ² test and t test. Results　The time of postoperative anal exhaust, the time of getting out of bed, and the length of hospital stay in the monitoring group were shorter than those in the reference group [(10.84±1.56) hours vs. (15.20±2.30) hours, (3.84±0.69) days vs. (5.71±0.83) days, (9.47±1.66) days vs. (12.84±2.30) days], with statistically significant differences (t=15.69, 17.33, and 11.88, all P<0.05). The Japanese Orthopaedic Association Evaluation Treatment Score (JOA) of the two groups 7 days after surgery were higher than those 1 day before surgery (both P<0.05), and that in the intraoperative monitoring group was higher than that in the reference group [(25.94±2.30) points vs. (21.50±2.57) points], with a statistically significant difference (t=12.87, P<0.05). The incidence of postoperative complications in the monitoring group was lower than that in the reference group [6.00% (6/100) vs. 20.00% (20/100)], with a statistically significant difference (χ²=8.67, P<0.05). The levels of serum inflammatory factors in the two groups 1 day after surgery were higher than those 1 day before surgery, but those in the monitoring group were lower than those in the reference group (all P<0.05). Conclusion　The application of IONM technology in spinal surgery can promote the patients' early recovery, improve the spinal nerve function, reduce the risk of complications, and alleviate the inflammation.

Key words:

Spinal surgery, Intraoperative neuroelectrophysiological monitoring, Spinal cord injury, Spinal nerve function, Inflammatory factors,  , Japanese Orthopaedic Association Evaluation Treatment Score

摘要：

目的　研究术中神经电生理监测（IONM）技术在脊柱手术患者中的应用价值，旨在为提升脊柱手术的有效性与安全性提供指导依据。方法　选取西安市红会医院和西安大兴医院2022年5月至2023年5月收治的200例拟行脊柱手术患者开展前瞻性研究。以电脑编号奇偶数字法随机分为术中监测组及参考组各100例。术中监测组男55例，女45例；年龄32～74（58.92±10.35）岁；体重指数（BMI）为18～30（23.15±2.09）kg/m²。参考组男57例，女43例；年龄33～73（59.14±10.62）岁；BMI 为18～30（23.27±2.15）kg/m²。两组均开展常规脊柱手术，术中监测组术中应用IONM技术，而参考组术中不应用IONM技术。对比两组各项围手术期指标、脊髓神经功能（评估时机为术前1 d及术后7 d）、血清炎症因子水平（评估时机为术前1 d及术后1 d）、术后并发症。统计学方法采用χ²检验、t检验。结果　术中监测组术后肛门排气时间、下床活动时间及住院时间均短于参考组［（10.84±1.56）h比（15.20±2.30）h、（3.84±0.69）d比（5.71±0.83）d、（9.47±1.66）d比（12.84±2.30）d］，差异均有统计学意义（t=15.69、17.33、11.88，均P<0.05）。两组术后7 d的日本骨科协会评估治疗分数（JOA）评分均较术前1 d高（均P<0.05），且术中监测组高于参考组［（25.94±2.30）分比（21.50±2.57）分］，差异有统计学意义（t=12.87，P<0.05）。术中监测组术后并发症发生率低于参考组［6.00%（6/100）比20.00%（20/100）］，差异有统计学意义（χ²=8.67，P<0.05）。两组术后1 d血清炎症因子水平虽均较术前1 d高，但术中监测组均较参考组低（均P<0.05）。结论　在脊柱手术中应用IONM技术可促进患者早日康复，改善脊髓神经功能，降低并发症发生风险，减轻炎症反应。

关键词:

脊柱手术, 术中神经电生理监测, 脊髓损伤, 脊髓神经功能, 炎症因子, 日本骨科协会评估治疗分数