短程高颈段脊髓电刺激术治疗脑损伤意识障碍患者10例
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R651.2

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江苏省科教能力提升工程(ZDXK202225)


The treatment of 10 patients with consciousness disorders due to brain injury using short⁃ term high cervical spinal cord stimulation
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    摘要:

    目的:分析短程高颈段脊髓电刺激术治疗脑损伤重度意识障碍患者的技术要点及该术式的临床诊疗价值。方法:回顾性总结南京医科大学第一附属医院神经外科于2023年6—9月开展的10例短程高颈段脊髓电刺激手术,解析手术过程技术要点,并结合随访分析其临床应用价值。结果:全麻下取俯卧位在胸8椎间隙经皮行硬脊膜外腔穿刺,在X线透视下动态调整脊髓刺激电极可顺利将其顶端置入颈2水平,进行为期2~3周的刺激治疗。刺激参数选择:频率5/70 Hz电压1~5 V;刺激小周期:开15 min,关15 min;刺激大周期:8点开机,20点关机。在术后4周进行随访,8例术前植物状态(vegetative state,VS)患者中1例到达微小意识状态(minimally conscious state,MCS)+,5例MCS-,2例仍为VS状态;2例术前MCS-患者中1例脱离微小意识,1例MCS+,均无手术相关并发症出现。结论:短程高颈段脊髓电刺激术微创、安全并且有效,有短程的治疗价值和诊断价值,在意识障碍促醒诊疗中有着广泛的应用前景,手术过程需要注意穿刺置入电极特有的难点和技术操作要领。

    Abstract:

    Objective:To analyze the technical key points of short-term high cervical spinal cord electrical stimulation in the treatment of severe consciousness disorders in patients with brain injury and clinical diagnostic and therapeutic value of this procedure. Methods:A retrospective analysis was conducted on 10 cases of short -term high cervical spinal cord stimulation performed at the Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University from June to September 2023. The technical key points of the surgical process were analyzed,and the clinical application value was evaluated through follow-up analysis. Results: Under general anesthesia,with the patient in the prone position,a percutaneous puncture of the thoracic 8 intervertebral space was performed to access the extradural space,and under X-ray fluoroscopy,the top of the spinal cord stimulation electrode was successfully placed at the level of C2. Stimulation therapy was conducted for 2-3 week,with stimulation parameters selected as follows:frequency 5/ 70 Hz,voltage 1-5V,small stimulation cycle:on for 15 min,off for 15 min,large stimulation cycle:on at 08:00 am,off at 20:00 pm. Follow-up was conducted at 4 weeks post-surgery,with 1 out of 8 patients in a vegetative state(VS)reaching a minimally conscious state (MCS)+,5 patients remaining MCS-,and 2 patients still in a VS status. Among the 2 patients who were MCS- preoperatively,1 patient recovered from a MCS,and 1 patient reached MCS+,with no surgery-related complications observed in either case. Conclusion:Short- term high cervical spinal cord stimulation is minimally invasive,safe and effective,with short-term therapeutic and diagnostic value. It has broad prospects for application in the diagnosis and treatment of consciousness disorders. Attention should be paid to the specific difficulties and technical aspects of electrode placement during the surgical procedure.

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王希,赵琳,张勇,毕立清,尤永平,季晶,颜伟.短程高颈段脊髓电刺激术治疗脑损伤意识障碍患者10例[J].南京医科大学学报(自然科学版),2024,(2):242-246

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  • 收稿日期:2023-10-17
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  • 在线发布日期: 2024-02-05
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