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中文摘要：
目的评估多模式术中神经电生理监测（intraoperativeneurophysiologiealmonitoring，IONM）对重度胸椎畸形全椎体截骨术中脊髓功能监测的有效性，探讨影响术中监测数据变化的危险因素及原因。方法回顾性分析2010年1月至2015年3月接受后路全椎体截骨（posteriorveaebralcolumnresection，PVCR）术治疗的82例重度胸椎畸形患者的病历资料，男45例，女37例；年龄8-66岁，平均22.6±9．6岁。术后至少随访1年，平均40．7±18．2个月。病因分类：特发性36例、先天性20例、结核性4例、神经纤维瘤型9例、神经肌肉型13例。术中均采用体感诱发电位（somatosensoryevokedpotentials，SEP）＋运动诱发电位（motorevokedpotentials，MEP）＋下传神经性源诱发电位（descendingneurogenicevokedpotentials，DNEP）多模式监测，采用触发肌电图（triggerEMG，tEMG）和自发肌电图（spontaneousEMG，sEMG）对椎弓根钉置入准确性及神经根安全性进行评估。根据神经电生理监测结果进行脊髓损伤危险因素及原因分析，并提出针对性的预防处理对策。结果所有患者术中均成功进行SEP＋MEP＋DNEP＋tEMG＋sEMG联合监测。侧凸和后凸分别从术前平均122．3°±1527．6°和123．4°±27．8°矫正至术后平均55．1°±21．5°和53．8°±19．7°，矫正率分别为55．4％和56．2％，平均截骨（1．33±0．6）个椎体。27例（32．9％）术中发生39例次阳性监测事件，其原因为椎弓根螺钉置入异常6例次、术中低血压2例次、截骨操作碰触5例次、骨刀截骨震荡4例次、骨性压迫7例次、截骨端半脱位4例次、止血纱布压迫脊髓3例次、脊髓皱褶4例次、矫形4例次。经术中及时处理后，术后有11例出现新的神经功能障碍（不全瘫1例、一过性脊髓损伤8例和神经根损伤2例）。阳性监测事件的危险因素包括术前侧凸和后凸角度较大、术中截骨缩短距离较长、术前需行Halo重?
英文摘要：
Objective To evaluate the effect of muhimodality intraoperative neurophysiological monitoring （IONM） for severe thoracic posterior vertebral column resection （PVCR） surgery, and detail the risk factors of intraoperafive monitoring events at various surgery procedures. Methods Monitoring data at various surgery procedures in 82 severe thoracic posterior verte- bral column resection cases treated in our center between January 2010 and March 2015 were reviewed. This series of cases including 37 female and 45 male, the initial age averaged 22.6±9.6 years （range 8-66 years）. All patients were followed up for minimum 1 year （average 40.7±18.2 months, range 12-74 months）. The etiologies of spinal deformity were idiopathic in 36 cas- es, congenital in 20 patients, tuberculosis in 3 Patients, neurofibromatosis in 9 patients, and neuromuscular in 13 cases. The function of spinal cord and nerve root were assessed by SEP＋MEP＋ DNEP and tEMG＋sEMG combined monitoring during oper- ation, respectively. The monitoring outcomes and the risk factors of cord monitoring events were recorded and analyzed, and then prevention measures were suggested according to our clinical practice and literature review. Results In these cohort cas- es, combined monitoring of SEP＋MEP＋DNEP＋tEMG＋sEMG was successfully achieved in all 82 cases. On average, the major coro- nal curve was corrected from a preoperative 122.3°±27.6° to a postoperative 55.1°±21.5°, with a correction rate of 55.4%. The sag- ittal kyphosis was corrected from a preoperative 123.4°±27.8° to a postoperative 53.8°±19.7°, with a correction rate of 56.2%. Theaverage resection vertebra was 1.33±0.6 levels with 11 meshes and 18 cages being planted into 29 patients. The average intra-oper- ative blood loss and surgery time were 2911±1358 ml and 505±105 rains. There were 39 monitoring changes occurred in 27 cases out of 82 （32.9%）. Results indicated that neurological monitoring events were more likely to occur in patients with larger scoli
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