脊髓手术D波导航：从监测到决策

李鹃; 奚健; 蒋星军

doi:10.11817/j.issn.1672-7347.2026.250622

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综述 | 更新时间：2026-05-05

脊髓手术D波导航：从监测到决策
D-wave-guided navigation in spinal cord surgery: From monitoring to decision-making
中南大学学报(医学版) 中南大学学报(医学版) 2026年51卷第2期页码：326-332
作者机构：

中南大学湘雅医院神经外科，长沙 410008
作者简介：

李鹃，Email: 2008110708@163.com, ORCID: 0009-0009-3000-0494
蒋星军，教授，Email: jiangxj@csu.edu.cn, ORCID: 0009-0004-4225-4743
基金信息：

国家重点研发计划(2023YFC2412504┫。This study was supported by the National Key Research and Development Program of China ┣2023YFC2412504)
DOI：10.11817/j.issn.1672-7347.2026.250622
中图分类号：
CSTR：
收稿：2025-11-13，

纸质出版：2026-02-28
稿件说明：

李鹃, 奚健, 蒋星军. 脊髓手术D波导航：从监测到决策[J]. 中南大学学报(医学版), 2026, 51(2): 326-332.

LI Juan, XI Jian, JIANG Xingjun. D-wave-guided navigation in spinal cord surgery: From monitoring to decision-making[J]. Journal of Central South University. Medical Science, 2026, 51(2): 326-332.
李鹃, 奚健, 蒋星军. 脊髓手术D波导航：从监测到决策[J]. 中南大学学报(医学版), 2026, 51(2): 326-332. DOI：10.11817/j.issn.1672-7347.2026.250622.

LI Juan, XI Jian, JIANG Xingjun. D-wave-guided navigation in spinal cord surgery: From monitoring to decision-making[J]. Journal of Central South University. Medical Science, 2026, 51(2): 326-332. DOI：10.11817/j.issn.1672-7347.2026.250622.

摘要

脊髓手术的核心目标是在最大安全切除病变部位的同时保护神经功能。直接波(direct wave，D波)监测作为评估皮质脊髓束(corticospinal tract，CST)功能完整性的金标准，已从被动监测工具发展为术中主动功能导航系统。为系统梳理D波导航功能的演进与应用，从以下3个方面进行阐述：技术革新(如硬膜下记录)保障了信号的稳定性与定量性；多模态整合(特别是与运动诱发电位协同)实现了突触前与突触后损伤的鉴别诊断；应用范围则已成功拓展至低龄儿童及多种复杂脊髓手术，突破了传统的年龄和病种限制。进一步探讨人工智能预警、影像融合导航等前沿方向，展望D波监测从经验依赖向数据驱动的智能化发展前景，可为提升脊髓手术的精准性与安全性提供理论支撑与实践指引。

Abstract

The primary goal of spinal cord surgery is to achieve maximal safe resection of lesions while preserving neurological function. Direct wave (D-wave) monitoring

regarded as the gold standard for assessing the functional integrity of the corticospinal tract (CST)

has evolved from a passive monitoring tool into an active intraoperative functional navigation system. To systematically review the evolution and clinical application of D-wave-guided navigation

this article discusses 3 key aspects. First

technological advancements

such as subdural recording techniques

have improved signal stability and enabled quantitative assessment. Second

multimodal integration

particularly in combination with motor evoked potentials

facilitates the differential diagnosis between presynaptic and postsynaptic injuries. Third

the scope of application has been successfully expanded to include very young children and a wide range of complex spinal cord surgeries

overcoming traditional limitations related to age and disease type. Furthermore

emerging directions such as artificial intelligence-based warning systems and image-guided fusion navigation are explored

highlighting the transition of D-wave monitoring from experience-based practice to data-driven intelligence. These developments may provide both theoretical support and practical guidance for improving the precision and safety of spinal cord surgery.

关键词

Keywords

references

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