中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2013年
1期
25-29
,共5页
张继东%夏群%吉宁%刘艳成%宁尚龙
張繼東%夏群%吉寧%劉豔成%寧尚龍
장계동%하군%길저%류염성%저상룡
脊柱损伤%颈椎%椎间盘%外科手术,计算机辅助%责任节段
脊柱損傷%頸椎%椎間盤%外科手術,計算機輔助%責任節段
척주손상%경추%추간반%외과수술,계산궤보조%책임절단
Spinal injuries%Cervical vertebrae%Intervertebral disk%Surgery,computerassisted%Responsible segment
目的 对于术前MRI不能完全确定颈椎间盘损伤节段的无骨折脱位型颈脊髓损伤患者,术中颈椎间盘造影辅助确定损伤椎间盘节段,进一步确定需要手术减压融合的责任节段.方法 选择2007年1月-2011年12月收治的无骨折脱位型颈脊髓损伤患者85例,其中术前MRI不能完全确定损伤责任节段患者16例纳入本研究.术前日本骨科学会(JOA)评分为(9.1±1.8)分.术前X线片、CT、MRI均未见明显颈椎骨折、脱位.MRI T2加权像均可见颈脊髓内高信号影像,其中9例MRI可见颈前软组织出血肿胀.患者均存在颈椎间盘突出.所有患者在可疑损伤节段均接受术中C形臂X线机颈椎间盘造影,造影见颈椎间盘纤维环破裂,造影剂外渗为确定损伤的评判标准.单纯颈椎间盘撕裂患者接受颈椎间盘切除、椎间融合器融合、钛板内固定术；合并多节段颈椎间盘突出或后纵韧带骨化的患者接受颈椎前路椎体次全切除、钛网植骨或钛板内固定术,固定范围包括撕裂的颈椎间盘. 结果 造影确认损伤椎间盘19个,其中C3/4椎间盘2个,C4/5椎间盘4个,C5/6椎间盘8个,C6/7椎间盘5个.其中前纤维环破裂11例,而前纵韧带完好.随访(24.4±10.0)个月,术后2周、3个月、末次随访JOA评分分别为(13.3±1.5)分、(14.5±1.6)分、(15.1±1.5)分,改善率分别为53％、68％、76％.手术时间平均110 min,平均出血量120ml.术后肩背部疼痛3例,声音嘶哑1例,均经保守治疗后2周内缓解.术中、术后未见深部感染、神经功能障碍恶化、椎动脉损伤或内固定失败等严重并发症. 结论 术中颈椎间盘造影能够辅助诊断常规影像学方法难以确诊的椎间盘内撕裂,可作为无骨折脱位型颈脊髓损伤患者早期手术确定责任节段的影像学诊断的补充方法.
目的 對于術前MRI不能完全確定頸椎間盤損傷節段的無骨摺脫位型頸脊髓損傷患者,術中頸椎間盤造影輔助確定損傷椎間盤節段,進一步確定需要手術減壓融閤的責任節段.方法 選擇2007年1月-2011年12月收治的無骨摺脫位型頸脊髓損傷患者85例,其中術前MRI不能完全確定損傷責任節段患者16例納入本研究.術前日本骨科學會(JOA)評分為(9.1±1.8)分.術前X線片、CT、MRI均未見明顯頸椎骨摺、脫位.MRI T2加權像均可見頸脊髓內高信號影像,其中9例MRI可見頸前軟組織齣血腫脹.患者均存在頸椎間盤突齣.所有患者在可疑損傷節段均接受術中C形臂X線機頸椎間盤造影,造影見頸椎間盤纖維環破裂,造影劑外滲為確定損傷的評判標準.單純頸椎間盤撕裂患者接受頸椎間盤切除、椎間融閤器融閤、鈦闆內固定術；閤併多節段頸椎間盤突齣或後縱韌帶骨化的患者接受頸椎前路椎體次全切除、鈦網植骨或鈦闆內固定術,固定範圍包括撕裂的頸椎間盤. 結果 造影確認損傷椎間盤19箇,其中C3/4椎間盤2箇,C4/5椎間盤4箇,C5/6椎間盤8箇,C6/7椎間盤5箇.其中前纖維環破裂11例,而前縱韌帶完好.隨訪(24.4±10.0)箇月,術後2週、3箇月、末次隨訪JOA評分分彆為(13.3±1.5)分、(14.5±1.6)分、(15.1±1.5)分,改善率分彆為53％、68％、76％.手術時間平均110 min,平均齣血量120ml.術後肩揹部疼痛3例,聲音嘶啞1例,均經保守治療後2週內緩解.術中、術後未見深部感染、神經功能障礙噁化、椎動脈損傷或內固定失敗等嚴重併髮癥. 結論 術中頸椎間盤造影能夠輔助診斷常規影像學方法難以確診的椎間盤內撕裂,可作為無骨摺脫位型頸脊髓損傷患者早期手術確定責任節段的影像學診斷的補充方法.
목적 대우술전MRI불능완전학정경추간반손상절단적무골절탈위형경척수손상환자,술중경추간반조영보조학정손상추간반절단,진일보학정수요수술감압융합적책임절단.방법 선택2007년1월-2011년12월수치적무골절탈위형경척수손상환자85례,기중술전MRI불능완전학정손상책임절단환자16례납입본연구.술전일본골과학회(JOA)평분위(9.1±1.8)분.술전X선편、CT、MRI균미견명현경추골절、탈위.MRI T2가권상균가견경척수내고신호영상,기중9례MRI가견경전연조직출혈종창.환자균존재경추간반돌출.소유환자재가의손상절단균접수술중C형비X선궤경추간반조영,조영견경추간반섬유배파렬,조영제외삼위학정손상적평판표준.단순경추간반시렬환자접수경추간반절제、추간융합기융합、태판내고정술；합병다절단경추간반돌출혹후종인대골화적환자접수경추전로추체차전절제、태망식골혹태판내고정술,고정범위포괄시렬적경추간반. 결과 조영학인손상추간반19개,기중C3/4추간반2개,C4/5추간반4개,C5/6추간반8개,C6/7추간반5개.기중전섬유배파렬11례,이전종인대완호.수방(24.4±10.0)개월,술후2주、3개월、말차수방JOA평분분별위(13.3±1.5)분、(14.5±1.6)분、(15.1±1.5)분,개선솔분별위53％、68％、76％.수술시간평균110 min,평균출혈량120ml.술후견배부동통3례,성음시아1례,균경보수치료후2주내완해.술중、술후미견심부감염、신경공능장애악화、추동맥손상혹내고정실패등엄중병발증. 결론 술중경추간반조영능구보조진단상규영상학방법난이학진적추간반내시렬,가작위무골절탈위형경척수손상환자조기수술학정책임절단적영상학진단적보충방법.
Objective To employ intraoperative discography to determine the injured intervertebral disc segments that can not be identified on the preoperative MRI in patients with cervical spinal cord injury without fracture and dislocation for confirming the responsible segments needing surgical decompression and fusion.Methods The study involved 85 patients with cervical spinal cord injury without fracture and dislocation treated from January 2007 to December 2011,among which sixteen patients had not been identified with the responsible segments by preoperative MRI.The average preoperative Japanese Orthopedic Association (JOA) score was (9.1 ± 1.8) points.There was no obvious fracture or dislocation of the cervical spine on preoperative X-ray film,CT and MRI,but all patients displayed high intense signal in cervical spinal cord on MRI T2 weighted imaging.Besides,MRI revealed hemorrhagic swelling of anterior cervical soft tissue in nine patients and cervical intervertebral disk hernia in all patients.Annulus fibrosus rupture of cervical intervertebral disc with contrast leakage in intraoperative discography of suspected injury segments in all patients under direction of C-arm X-ray machine was set as the injury criterion.The patients with pure ruptured discs received cervical discectomy,interbody fusion and titanium plate fixation.The patients associated with multilevel cervical intervertebral disc hernia or ossification of posterior longitudinal ligament underwent anterior cervical corpectomy,bone graft with titanium cageand titanium plate fixation of ruptured discs.Results Nineteen injured discs were identified eventually by discography,including 2 discs at C3/4,4 at C4/5,8 at C5/6 and 5 at C6/7.Moreover,anterior annulus fibrosus rupture with intact anterior longitudinal ligament was found in 11 patients.The follow-up lasted for (24.4 ± 10.0) months.JOA scores were (13.3 ± 1.5) points and (14.5 ± 1.6) points at two weeks and three months after operation,and (15.1 ± 1.5) points at the last follow-up,indicating a relevant improvement rate of 53％,68％ and 76％ respectively.Mean operation time was 110 minutes and blood loss was 120 ml.Three patients had pain on shoulder and back and one patient had hoarse voice,but all the patients were relieved in two weeks after conservative treatments.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury or internal fixation failure were noticed intra-or post-operatively.Conclusion For the intradiscal rupture that is hard to be determined by the conventional imaging methods,intraoperative discography can be used as an auxiliary method of imaging diagnosis in early surgical determination of responsible segments for cervical spinal cord injury without fracture and dislocation.
