中国神经再生研究(英文版) ›› 2023, Vol. 18 ›› Issue (2): 422-427.doi: 10.4103/1673-5374.346458

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

体感和运动诱发电位联合监测识别手术致机械性原发性脊髓损伤的类型

  

  • 出版日期:2023-02-15 发布日期:2022-08-09
  • 基金资助:
    国家自然科学基金项目(81871768);天津市自然科学基金项目(18JCYBJC29600);广东省卫健委高水平医院项目(HKUSZH201902011)

Identification of injury type using somatosensory and motor evoked potentials in a rat spinal cord injury model

Rong Li1, 2, Han-Lei Li3, Hong-Yan Cui3, Yong-Can Huang4, Yong Hu1, 5, *   

  1. 1Department of Orthopedics and Traumatology, The University of Hong Kong -Shenzhen Hospital, Shenzhen, Guangdong Provinve, China; 2Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Provinve, China; 3Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; 4Shenzhen Engineering Laboratory of Orthopedic Regenerative Technologies, Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Provinve, China; 5Department of Orthopedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
  • Online:2023-02-15 Published:2022-08-09
  • Contact: Yong Hu, PhD, yhud@hku.hk.
  • Supported by:
    This work was supported by the National Natural Science Foundation of China, No. 81871768 (to YH); Natural Science Foundation of Tianjin, China, No. 18JCYBJC29600 (to HYC); and High Level-Hospital Program, Health Commission of Guangdong Province, China, No. HKUSZH201902011 (to YH).

摘要:

脊柱手术存在由于脊髓术中创伤而造成损伤的风险。如能及时发现手术操作引起的神经功能损害,就可提早预防脊髓神经损害,防止不可逆神经功能损伤。由于不同类型的脊髓损伤会脊髓不同区域造成损害,进而可能导致体感诱发电位和运动诱发电位信号反应的不同。因此实验拟对T12-T13水平挫伤、错位及牵拉损伤SD大鼠模型进行电生理及组织病理学观察,结果显示,挫伤导致的背侧白质组织损伤最为严重,且能明显减弱体感诱发电位和运动诱发电位反应;错位导致损伤脊髓外侧沿延喙尾轴丧失有髓轴突,且运动诱发电位反应衰减比挫伤更为明显;牵拉损伤后,虽然可见细胞外空腔,但无实质性的结构改变,而体感诱发电位反应略有下降,运动诱发电位反应消失。相关性分析结果显示脊髓损伤的组织学表现与电生理学结果存在显著相关性,且损伤类型有关。因此体感和运动诱发电位联合监测能识别不同模式挫伤、错位及牵拉脊髓损伤类型。

https://orcid.org/0000-0003-0305-5616 (Yong Hu)

关键词: 脊髓损伤, 异质性, 损伤机制, 电生理学, 体感诱发电位, 运动诱发电位, 组织病理学, 挫伤, 错位, 牵拉

Abstract: The spinal cord is at risk of injury during spinal surgery. If intraoperative spinal cord injury is identified early, irreversible impairment or loss of neurological function can be prevented. Different types of spinal cord injury result in damage to different spinal cord regions, which may cause different somatosensory and motor evoked potential signal responses. In this study, we examined electrophysiological and histopathological changes between contusion, distraction, and dislocation spinal cord injuries in a rat model. We found that contusion led to the most severe dorsal white matter injury and caused considerable attenuation of both somatosensory and motor evoked potentials. Dislocation resulted in loss of myelinated axons in the lateral region of the injured spinal cord along the rostrocaudal axis. The amplitude of attenuation in motor evoked potential responses caused by dislocation was greater than that caused by contusion. After distraction injury, extracellular spaces were slightly but not significantly enlarged; somatosensory evoked potential responses slightly decreased and motor evoked potential responses were lost. Correlation analysis showed that histological and electrophysiological findings were significantly correlated and related to injury type. Intraoperative monitoring of both somatosensory and motor evoked potentials has the potential to identify iatrogenic spinal cord injury type during surgery.

Key words: contusion injury, dislocation injury, distraction injury, electrophysiology, heterogeneity, histopathology, injury mechanism, motor evoked potential, somatosensory evoked potential, spinal cord injury