術(shù)中CT在頸椎后縱韌帶骨化癥前路手術(shù)中的應(yīng)用價(jià)值

陳勤+鐘鳴亮+伍耀宏+劉寧+陳榮春+廖琦+陳云生+邱沅林

【摘要】 目的：研究術(shù)中CT在頸椎后縱韌帶骨化癥（OPLL）前路手術(shù)中的價(jià)值。方法：選取2015年

3月-2016年12月贛州市人民醫(yī)院脊柱外科因OPLL進(jìn)行頸椎前路椎管減壓椎間植骨融合內(nèi)固定術(shù)（ACDF）患者7例及頸椎前路椎體次全切除椎管減壓鈦網(wǎng)植骨融合內(nèi)固定術(shù)（ACCF）患者9例，術(shù)中應(yīng)用CT在完成病灶切除后對(duì)手術(shù)區(qū)域進(jìn)行即時(shí)復(fù)查，評(píng)估骨化病灶切除效果并指導(dǎo)手術(shù)。統(tǒng)計(jì)術(shù)中CT對(duì)OPLL前路手術(shù)進(jìn)程及手術(shù)結(jié)果的影響；術(shù)前，術(shù)后3 d、3個(gè)月、6個(gè)月的JOA評(píng)分；術(shù)后6個(gè)月復(fù)查頸椎MRI。結(jié)果：本組病例中采用單間隙ACDF手術(shù)7例，ACCF手術(shù)9例；術(shù)中CT檢查發(fā)現(xiàn)，存在骨化病灶殘留8例，主要?dú)埩魠^(qū)域?yàn)樽甸g隙上緣以及骨化病灶椎體兩側(cè)；術(shù)中CT掃描次數(shù)1～3次，平均（1.7±0.8）次；術(shù)前JOA評(píng)分（9.6±1.5）分，術(shù)后6個(gè)月為（12.9±1.2）分，比較差異有統(tǒng)計(jì)學(xué)意義（P<0.01）；術(shù)后6個(gè)月復(fù)查頸椎MRI示椎管減壓充分，JOA評(píng)分神經(jīng)功能改善率為（81.5%±6.2%）。結(jié)論：在OPLL術(shù)中引入CT技術(shù)，可對(duì)手術(shù)區(qū)域進(jìn)行實(shí)時(shí)監(jiān)控并及時(shí)修正，降低了因骨化病灶切除不完全導(dǎo)致脊髓壓迫未能解除而產(chǎn)生殘留癥狀的手術(shù)風(fēng)險(xiǎn)，有助于提高手術(shù)安全性與有效性。

【關(guān)鍵詞】 術(shù)中CT； 頸椎后縱韌帶骨化； 頸椎前路手術(shù)

Clinical Value of Intraoperative CT in Anterior Cervical Operation for Ossification of the Posterior Longitudinal Ligament/CHEN Qin，ZHONG Mingliang，WU Yaohong，et al.//Medical Innovation of China，2017，14（32）：066-069

【Abstract】 Objective：To explore the value of intraoperative CT in anterior cervical operation for ossification of the posterior longitudinal ligament（OPLL）.Method：Because OPLL，7 cases of cervical anterior decompression and interbody fusion and internal fixation（ACDF） and 9 cases of anterior cervical corpectomy decompression and titanium mesh and bone graft fusion and internal fixation（ACCF） from March 2015 to December 2016 in our hospital were selected.After resection of the lesion，the CT was used to reviewed surgical area，to evaluated the effect of resection of ossifying foci and guided operation.The effect of intraoperative CT of OPLL anterior surgical procedure and surgical results were observed，the JOA score were counted before operation，after operation 3 days，3 months，6 months，and MR of cervical spine was reexamined after operation 6 months.Result：Among the 16 patients，there were 7 cases of single-level ACDF and 9 cases of ACCF，found by CT examination during the operation，8 cases of residual ossification，CT scanning in 1-3 times，the average was（1.7±0.8） times，the preoperative JOA score was（9.6±1.5） points，and after operation 6 months was（12.9±1.2） points，the difference was statistically significant（P<0.01），reexamination of cervical MRI showed adequate decompression of the vertebral canal，the neurological improvement rate of JOA score was （81.5%±6.2%）.Conclusion：The introduction of CT technology in OPLL operation，can be real-time monitoring of the operation area and timely correction，reduce the risk of residual symptoms resulting from incomplete compression of the spinal cord resulting from incomplete resection of the lesion，to improve the safety and effectiveness of operation.endprint

【Key words】 Intraoperative CT； OPLL； Anterior cervical operation

First-authors address：Ganzhou Hospital Affiliated to Nanchang University，Ganzhou 341000，China

doi：10.3969/j.issn.1674-4985.2017.32.016

頸椎前路手術(shù)是治療頸椎后縱韌帶骨化癥（OPLL）的一種重要治療手段[1]，相較于后路間接減壓手術(shù)，目前多數(shù)學(xué)者的觀點(diǎn)為前路手術(shù)可以通過切除病灶進(jìn)行椎管的直接減壓，神經(jīng)功能的恢復(fù)和遠(yuǎn)期臨床療效好[2-5]；但由于頸椎前路手術(shù)的解剖特點(diǎn)，手術(shù)難度與風(fēng)險(xiǎn)相對(duì)較高，操作視野相對(duì)較小較深，尤其是后縱韌帶骨化范圍大小及形態(tài)差異大，且骨化病灶多位于椎體后緣，部分學(xué)者提出頸椎前路椎管減壓椎間植骨融合內(nèi)固定術(shù)（ACDF）等前路手術(shù)有時(shí)很難完全切除骨化塊，從而導(dǎo)致減壓不充分和術(shù)后骨化進(jìn)展[2，6]，因此在術(shù)中明確手術(shù)減壓效果及骨化物切除情況顯得尤為關(guān)鍵。……