摘要
目的探讨三维CT对脊髓型颈椎病(cervicalspondyloticmyelopathy,CSM)的术前评估的临床价值及在手术计划制定中的辅助作用。方法采用三维CT技术检查146例CSM患者,观察颈椎椎管的病理改变,测量椎管矢状径及Pavlov比率,评价椎管狭窄的程度,根据个性化颈椎的三维模型,设计个性化的手术方案,确定手术入路、螺钉安全角度和距离,标记螺钉的入点和椎管的减压范围。传统对照组122例。术后观察并发症,采用Odom标准对临床疗效进行评价。结果发现本组患者椎间盘突出129例(88.3%)、椎体后部缘骨质增生109例(74.7%)、黄韧带肥厚褶皱61例(41.8%)、后纵韧带钙化27例(18.5%)、小关节突骨质增生31例(21.2%)、椎板增厚29例(19.9%)、椎体滑脱18例(12.3%),经手术治疗所有患者术中无死亡,无喉返神经损伤、植入骨块移位、感染等并发症。术后6个月复查X线片示全部病例植骨融合良好,无钛板或螺钉松动或断裂现象。Odom临床疗效评定优良率为95.9%,对照组为84.4%,两者疗效有差别显著性(P<0.05)。结论三维CT能对CSM作出准确、全面的评估,并能辅助制定手术计划,具有重要的临床价值。
Objective To study the effect of three-dimensian spiral computer tomograph（3DCT） on the preoperative evaluation and the surgical plan of cervical spondylotic myelopathy（CSM）. Methods To adopt 3DCT technique to examine 146 patients with CSM, observing the pathological changes of cervical vertebral canal, measuring sagittal diameter of spinal canal and Parlor ratio and evaluating the spinal stanosis. Based on individual cervical 3DCT model, to design individual surgical plan, confirming the surgical route, safe angle and distance of bolt and marking the entrance of bolt and the range of decompression of spinal canal. After operation, to observe complication and to adopt Odom criterion for clinical assessment. There were 122 cases in the control group. Results One hundred and twenty：nine cases （88.3%） had intervertebral disc protrusion, 109 cases （74. 7% ） had hyperesteogeny in the rear of the vertebral body, 61 cases （41.8%） had incrassate ligamento tlava, 27 cases （18.5%） had posterior longitudinal ligament calcification, 31 cases （21.2%） had hyperosteogeny in the articular process, 29 cases （ 19.9% ） had the incrassate lamina of vertebra, and 18 cases （ 12.3% ） had dislocation of vertebral body. Death, recurrent laryngeal nerve injury, graft bone block shift and infection were not found after operation. Six months after operation, X-rays showed graft bone block fused well and no Ti-board or bolt was loose or broken. Odom criterion showed fine rate was 95.9% and that of the control group was 84.4%. There were significant differences between the two groups （ P 〈0.05）. Condusion 3DCT can evaluate CSM correctly and totally and assist to design surgical plan, which has an important clinical value.
出处
《脊柱外科杂志》
2006年第1期12-16,共5页
Journal of Spinal Surgery
关键词
颈椎
X线计算机体层摄影术
三维成像
cervical vertebrae
X-ray computed tomography
three-dimensional imaging
