摘要
目的观察脊柱外科手术术中神经生理学监测(intraoperative neurophysiological monitoring,IONM)的有效性和安全性。方法检索中国知网、维普、中华医学期刊全文数据库、PubMed、Web of Science数据库中脊柱外科手术中应用神经生理学监测的临床研究,检索时间为2014年1月至2025年3月。提取术中神经损伤发生率、手术前后日本骨科协会(Japanese Orthopaedic Association,JOA)评分、病灶清除率等指标。采用Stata18.0统计学软件进行meta分析。组间异质性较小时采用固定效应模型进行分析,组间异质性较大时采用随机效应模型。结果共17篇文献的1865例患者纳入meta分析。其中中文文献13篇、英文文献4篇,2篇为随机对照试验、15篇为观察性研究,均为高质量文献。Meta分析结果显示监测组术中神经损伤的发生率低于未监测组[OR=0.52,95%CI(0.37,0.74),P<0.001]。两组术前JOA评分的差异无统计学意义[SMD=0.01,95%CI(0.37,0.74),P=0.971],而监测组术后JOA评分大于术前,差异有统计学意义[SMD=5.34,95%CI(0.29,10.39),P=0.038]。未监测组手术前后JOA评分的差异无统计学意义[SMD=3.51,95%CI(-0.56,7.59),P=0.091]。两组病灶清除率的差异无统计学意义[OR=1.17,95%CI(0.88,1.57),P=0.281]。结论脊柱手术中使用IONM可降低术中神经损伤的发生率并改善功能评分。
ObjectiveTo observe the efficacy and safety of intraoperative neurophysiological monitoring(IONM)in spinal surgery.MethodsClinical studies on the application of IONM in spinal surgery were retrieved from CNKI,VIP,Chinese Medical Journal Full-text Database,PubMed,and Web of Science,with the retrieval time ranging from January 2014 to March 2025.The incidence of intraoperative nerve injury,preoperative and postoperative Japanese Orthopaedic Association(JOA)score,and lesion clearance rate were collected.Meta-analysis was performed using Stata 18.0 statistical software.When the heterogeneity between groups was small,the fixed-effect model was used for analysis,and when the heterogeneity between groups was large,the random-effect model was used.ResultsA total of 17 studies involving 1,865 patients were included in the meta-analysis.Among them,there were 13 Chinese literatures and 4 English literatures,2 randomized controlled trials and 15 observational studies,all of which were of high quality.The results of meta-analysis showed that the incidence of intraoperative nerve injury in the monitoring group was lower than that in the non-monitoring group[OR=0.52,95%CI(0.37,0.74),P<0.001].There was no statistically significant difference in preoperative JOA scores between the two groups[SMD=0.01,95%CI(0.37,0.74),P=0.971].However,the postoperative JOA score in the monitoring-group was higher than the preoperative score,and the difference was statistically significant[SMD=5.34,95%CI(0.29,10.39),P=0.038].There was no statistically significant difference in JOA scores before and after surgery in the non-monitoring group[SMD=3.51,95%CI(-0.56,7.59),P=0.091].There was no statistically significant difference in lesion clearance rate between the two groups[OR=1.17,95%CI(0.88,1.57),P=0.281].ConclusionThe use of IONM in spinal surgery can reduce the incidence of intraoperative nerve injury and improve functional scores.
作者
李钰
王大川
Li Yu;Wang Dachuan(Department of Spine Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250014,China)
出处
《中华骨科杂志》
北大核心
2025年第16期1059-1065,共7页
Chinese Journal of Orthopaedics
关键词
脊柱
手术
术中生理生理学监测
META分析
Spine
Surgery
Intraoperative neurophysiological monitoring
Meta-analysis
