不同运动诱发电位预警标准对颈椎及胸椎节段的后纵韧带骨化减压术后运动功能的预测作用

doi:10.3969/j.issn.1006-5725.2025.18.017

摘要/Abstract

摘要：

目的探讨运动诱发电位（MEP）在颈椎和胸椎两个不同节段的后纵韧带骨化（OPLL）减压手术中的最佳预警阈值，及不同MEP参数对术后下肢运动功能的预测作用。方法回顾性分析2022年1月至2024年1月在医院诊断为颈椎或胸椎OPLL且行减压手术的227例患者临床资料，男131例，女96例，年龄（60 ± 10）岁。术中所有患者均全程使用神经电生理监测，记录减压过程中MEP波幅变化的最小值与入室基线的比值D_max，及减压结束后MEP终末波幅改变与入室基线的比值D_end，比较两个比值和术后即刻、1年下肢运动功能的相关性，根据医学研究理事会肌肉力量评分（MRC）标准，将术后评分结果与术前相比≥ 1分定义为术后运动功能障碍。应用Pearson相关系数评估D_max和D_end与术后即刻、1年下肢运动功能相关性，绘制D_max、D_end预测术后下肢运动功能障碍的受试者工作特征曲线（ROC曲线）。结果 227例患者中，186例为颈椎OPLL，41例为胸椎OPLL。其中颈椎组在术后即刻、1年的下肢运动功能障碍发生例数分别为7例（3.76%）、2例（1.08%），胸椎组分别为9例（21.95%）、3例（7.32%），胸椎组下肢运动功能障碍的发生率高于颈椎组（P < 0.001）。颈椎组双侧下肢运动诱发电位的基线诱发率为98.92%（368/372），胸椎组为96.34%（79/82）。颈椎组和胸椎组的D_end与术后即刻双侧下肢运动功能情况的Pearson相关系数均大于D_max，且差异有统计学意义（颈椎组r = 0.669、0.517，P = 0.001 2；胸椎组r = 0.882、0.727，P = 0.003 6），而颈椎组和胸椎组的D_end及D_max与术后1年双侧下肢运动功能情况的Pearson相关系数的差异无统计学意义（颈椎组r = 0.457、0.352，P = 0.088；胸椎组r = 0.760、0.625，P = 0.098）。颈椎组在术后即刻及1年D_end的cut-off值均为0.853，D_max的_{cut-off值分别为0.881、0.978；胸椎组在术后即刻及1年D_end的cut-off值分别为0.532、0.639，D_max的cut-off值分别为0.532、0.64。结论在OPLL手术中，MEP监测策略需根据手术节段调整，颈椎应侧重D_max以平衡高灵敏度与特异度，而胸椎可灵活选用D_max或D_end。颈椎OPLL术中需采用更高的MEP预警阈值（D_max：术后即刻0.881、1年0.978；D_end：0.853），而胸椎OPLL的预警阈值则显著更低（D_max/D_end：术后即刻0.532、1年0.640）。}

关键词: 后纵韧带骨化, 术中神经电生理监测, 诱发电位，运动, 胸椎手术, 颈椎

Abstract:

Objective To explore the optimal warning threshold of motor evoked potentials （MEP） in decompression surgery for ossification of the posterior longitudinal ligament （OPLL） at cervical and thoracic segments， and the predictive role of different MEP parameters on postoperative lower extremity motor function. Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital. There were 131 males and 96 females， with an average age of （60 ± 10） years. All patients underwent continuous neurophysiological monitoring during the operation， and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation （D_max） and the ratio of MEP terminal amplitude change to the baseline at the end of the operation （D_end） were recorded. The correlations between these two ratios and the lower extremity motor function immediately after the operation and at 1 year were compared. According to the Medical Research Council muscle strength score （MRC） standard， a postoperative score increase of ≥1 point compared to preoperative was defined as postoperative motor dysfunction. Pearson correlation coefficients were used to evaluate the correlations between D_max and D_end and the lower extremity motor function immediately after the operation and at 1 year. Receiver operating characteristic （ROC） curves were drawn to predict postoperative lower extremity motor dysfunction using D_max and D_end. Results Among the 227 patients， 186 had cervical OPLL and 41 had thoracic OPLL. The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases （3.76%） and 2 cases （1.08%） in the cervical group， and 9 cases （21.95%） and 3 cases （7.32%） in the thoracic group， respectively. The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group （P < 0.001）. The baseline induction rate of bilateral lower extremity MEPs was 98.92% （368/372） in the cervical group and 96.34% （79/82） in the thoracic group. The Pearson correlation coefficients of D_end with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of D_max， and the differences were statistically significant （cervical group： r = 0.669， 0.517， P = 0.001 2； thoracic group： r = 0.882， 0.727， P = 0.003 6）， while the differences in the Pearson correlation coefficients of D_end and D_max with the bilateral lower extremity motor function at 1 year were not statistically significant （cervical group： r = 0.457， 0.352， P = 0.088； thoracic group： r = 0.760， 0.625， P = 0.098）. The cut-off values of D_end for the cervical group were 0.853 immediately after the operation and at 1 year， and the cut-off values of D_max were 0.881 and 0.978， respectively. For the thoracic group， the cut-off values of D_end were 0.532 immediately after the operation and 0.639 at 1 year， and the cut-off values of D_max were 0.532 and 0.640， respectively. Conclusions In OPLL surgery， the MEP monitoring strategy should be adjusted according to the surgical segment. For the cervical segment， D_max should be emphasized to balance high sensitivity and specificity， while for the thoracic segment， D_max or D_end can be flexibly selected. Higher MEP warning thresholds are required for cervical OPLL surgery （D_max： 0.881 immediately after the operation and 0.978 at 1 year； D_end： 0.853）， while significantly lower thresholds are needed for thoracic OPLL （D_max/D_end： 0.532 immediately after the operation and 0.640 at 1 year）.

Key words: ossification of posterior longitudinal ligament, intraoperative neurophysiological monitoring, evoked potentials， motor, thoracic surgery, cervical spine

中图分类号:

R681.5

李莉,李欢,陈凯,刘佳,沈文文,王雨晴,吴秀芳,白玉树,李强,刘建民. 不同运动诱发电位预警标准对颈椎及胸椎节段的后纵韧带骨化减压术后运动功能的预测作用[J]. 实用医学杂志, 2025, 41(18): 2898-2905.

Li LI,Huan LI,Kai CHEN,Jia LIU,Wenwen SHEN,Yuqing WANG,Xiufang WU,Yushu BAI,Qiang LI,Jianmin LIU. Predictive effects of different motor evoked potential warning thresholds on motor function recovery following decompression for cervical and thoracic ossification of the posterior longitudinal ligament[J]. The Journal of Practical Medicine, 2025, 41(18): 2898-2905.

图/表 5

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项目	颈椎组	胸椎组	P值
病例数	186	41
性别			0.451
男	110（59.14）	21（51.22）
女	76（40.86）	20（48.78）
年龄（x ± s）/岁	59.5 ± 10.2	60.0 ± 10.1	0.387
病程（x ± s）/月	31.9 ± 17.14	16.24 ± 12.0	0.999
椎体节段数M（IQR）	3（1）	3（2）	0.572
双侧MEP基线诱发率	368（98.92）	79（96.34）	0.221
糖尿病史	28（15.05）	8（19.51）	0.479
手术时长M（IQR）/min	105（55）	120（80）	0.004
平均动脉压≤ 60 mmHg	14（0.08）	9（21.95）	0.006
估计出血量M（IQR）/L	0.11（0.15）	0.30（0.10）	< 0.001

时间	变量	AUC	95%CI	约登指数	cut-off值	灵敏度	特异度
术后即刻	颈椎D_max	0.987	0.964~1.000	0.926	0.881	0.929	0.997
	胸椎D_max	0.820	0.726~0.915	0.573	0.532	0.938	0.635
	颈椎D_end	0.939	0.900~0.884	0.566	0.853	0.929	0.955
	胸椎D_end	0.850	0.764~0.937	0.605	0.532	0.938	0.667
术后1年	颈椎D_max	0.998	0.995~1.000	0.994	0.978	1.000	0.994
	胸椎D_max	0.783	0.590~0.976	0.504	0.640	0.833	0.671
	颈椎D_end	0.954	0.933~0.975	0.944	0.853	1.000	0.944
	胸椎D_end	0.845	0.705~0.984	0.669	0.639	0.853	0.836

变量	OR（95%CI）	P值
性别	2.208（0.707 ~ 6.895）	0.173
年龄	0.992（0.937 ~ 1.050）	0.783
病程	0.952（0.895 ~ 1.011）	0.109
糖尿病	1.002（0.218 ~ 4.608）	0.998
手术方式	0.890（0.224 ~ 3.532）	0.868
手术时长	0.998（0.982 ~ 1.014）	0.788
平均动脉压	0.267（0.066 ~ 1.079）	0.064
估计出血量	1.005（1.000 ~ 1.010）	0.037
D_max	47.462（2.928 ~ 769.247）	0.007