中文摘要：

目的探讨术中神经电生理监测（intraoperativeneumphysiologicalmonitoring，IONM）在脊柱肿瘤手术中的应用特点及临床价值。方法回顾性分析2012年9月至2015年6月119例行脊柱肿瘤手术应用IONM的患者资料，术中联合应用躯体感觉诱发电位（somatosensoryevokedpotentials，SEP）、经颅电刺激运动诱发电位（transcranialelectricalstimula，tionmotorevokedpotentiMs，TcE-MEP）及自由和激发肌电图（electromyography，EMG）联合监测脊髓神经。男64例，女55例；年龄4~80岁，平均44．8岁。原发脊柱肿瘤59例（其中神经源性肿瘤28例），脊柱转移瘤60例。根据是否手术操作导致异常报警和术后脊髓神经功能转归判断IONM报警的真、假阳性和真、假阴性，并进行统计学分析。结果119例患者手术时间2~12h，平均4．8h；术中出血量50-7000ml，平均1800ml。术后均获得随访，随访时间4-36个月，平均12．6个月。IONM发生异常报警17例（其中神经源性肿瘤11例），3例纠正手术操作后报警撤销及5例术后脊髓神经损伤表现者为真阳性（包括3例选择性切除神经），9例其他或不明原因报警且脊髓神经未损伤者为假阳性；102例未报警患者脊髓神经亦未损伤，为真阴性；无假阴性病例。IONM的敏感性为100．0％，特异性为91．9％，约登指数O．92，假阴性率为0．0％，假阳性率为9．1％，阳性预测值47．1％，阴性预测值100．0％。结论全身系统性变化导致的假阳性事件及神经选择性切除导致的真阳性事件是脊柱肿瘤手术中应用IONM的特点；IONM能动态监测术中脊髓神经传导束的完整性，在预测患者术后神经功能转归方面可信度更高，具有较高的应用价值。

英文摘要：

Objective To summarize the application features of IONM in spine tumor surgery and evaluate its value. Methods From September 2012 to June 2015, a total of 119 patients who underwent spine tumor surgery with IONM at the Sun Yat-sen Memorial Hospital were retrospectively analyzed. IONM includes somatosensory evoked potentials （SEP）, transcranial- electrical stimulation motor evoked potentials （TEE-MEP） and spontaneous, triggered electromyography （EMG）. There were 64 males and 55 females with an average age of 44.8 years （range 4-80 years）. 59 cases were primary tumors （included 28 cases of neurogenic tumors） and 60 were spinal metastasis. We judged the IONM alarm of true, false positive and negative cases based on whether related to surgery and postoperative neurological function. The statistical indexes were calculated and analyzed. Results The operation time was 2-12 h with an average of 4.8 h and the blood loss was 50-7 000 ml with an average of 1 800 ml. All the patients were followed up for average of 12.6 months （range 4-36 months）. IONM alarmed in 17 cases （included 11 cases of neuro- genic tumors）, in which 8 cases were true positive results including 3 cases directly related to revocable operative maneuvers and 5 cases with definitely spinal cord or peripheral nerve injury, 9 cases were false positive results without certain cause or nerve inju- ry, other 102 cases were true negative results and there was no false negative case. The sensitivity was 100.0%, specificity was 91.9%, Youden index was 0.92, false positive rate was 9.1%, false negative rate was 0.0%, positive predictive value was 47.1%, and negative predictive value was 100.0%. Conclusion The application features of IONM in spine tumor surgery were many sys- tematic changes resulted false positive cases and selectively nerve resection related several true positive cases. IONM can effec- tively monitor the spinal cord and peripheral nerves and predict the postoperative neurological function. It has high application val