Chiari Ⅰ型畸形手术前后诱发电位探究.docVIP

Chiari Ⅰ型畸形手术前后诱发电位探究 　【关键词】 Chiari,Ⅰ型畸形；,,手术；,,诱发电位 　　摘 要：［目的］研究ChiariⅠ型畸形患者手术前后的诱发电位的变化规律，观察手术前脊髓空洞的程度与诱发电位变化之间的关系。［方法］对2003年10月~2004年9月收治的15例Chiari Ⅰ型畸形患者，采取寰枕减压术、硬膜成形术，手术前第1~3 d和手术后第10~14 d分别检测BAEP、SEP、MEP，然后对这些患者经过6个月的随访，进行脊髓功能JOA评分和MRI复查。［结果］15例ChiariⅠ型畸形患者手术前14例SEP、MEP异常，手术后临床症状均有所缓解，脊髓功能JOA改善率为603％，MRI复查显示脊髓空洞明显缩小，诱发电位SEP检测P40N22、N20N13潜伏期与MEP检测中枢传导时间CMCT值和BAEP检测Ⅰ~Ⅴ峰间期，三者测的值比术前均缩短，差异有显著性。同时发现Chiari畸形患者的SEP与MEP检查测得皮层值术后比术前缩短，差异有显著性，而外周神经传导时间术后与术前比较却没有任何变化。［结论］诱发电位可以作为评价Chiari Ⅰ型畸形手术前后效果的客观而相对准确的检查方法。 关键词：Chiari Ⅰ型畸形； 手术； 诱发电位 Abstract：［Objective］To study the change rules of evoked potentials in preandpost operation of Chiari Ⅰ malformation patients,and observe the relationship between the syrinxs and evoked potentials［Method］During the period of October 2003 to September 2004,15 patients with Chiari Ⅰ malformation were collected,which underwent suboccipital craniectomy and duraplastyThe patients brainstem auditory evoked potentials and somatosensory evoked potentials and motor evoked potentials were were examined in 1~3 days before operation and 10~14 days after operationAfter six months followup,these patients underwent MRI countercheck and JOA grade［Result］The clinic symptoms were relaxed in 15 cases with Chiari Ⅰ malformationThe recovery rate of JOA score was 603%,and syrinx were reduced in MRI checkThere was shorten of cervicomedullary central conduction time in the examine of BAEP（Ⅰ~Ⅴ）and SEP（P40N22,N20N13）and MEP（CMCT）,which has markedly difference compare to foreoperationAt the same time,we discoveried it was shorten of cortical conduction time in the examine of BAEP and SEP and MEP,however,the peripheral conduction time were not ever change［Conclusion］Through the method of evoked potentials,improvement of Chiari Ⅰ malformation nerve function can be assessed preandpost operation Key words：Chiari Ⅰ malformation; Operation； Evoked potentials 在临床实践中，诱发电位常被用来评价脊髓感觉和运动通路的传导功能。本研究通过对15名Chiari Ⅰ型畸形患者行寰枕减压+硬膜成形术，手术前后进行脑干诱发电位（brainstem auditory evoked poten