脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究  

Prediction of spinal cord decompression after cervical laminoplasty： the SC-line

作　　者：王向阳[1] 徐华梓[1] 池永龙[1] 林焱[1] 黄其衫[1] 毛方敏[1] 倪文飞[1] 王胜[1] 徐晖[1] 

机构地区：[1]温州医学院附属第二医院骨科医院脊柱外科,325027

出　　处：《中华外科杂志》2011年第6期526-529,共4页Chinese Journal of Surgery

摘　　要：目的 探讨颈椎后路开门手术后脊髓减压程度的预测及方法.方法 收集2008年3月至2009年8月25例行颈椎单开门椎管成形术患者术前、术后的MRI图像.根据脊髓前方的压迫程度可分为0～4分;其中＞3分（3和4分）表明有脊髓压迫,＜3分表明脊髓无压迫.在开门节段上位椎体下终板做一水平线与脊髓前方成一交点,在开门节段下位椎体上终板做一水平线与脊髓前方成交点,两交点的连线为脊髓线（SC线）,根据SC线与前方致压物关系分为3型：Ⅰ型为致压物在SC线前方,Ⅱ型为致压物与SC接触,Ⅲ型为致压物超过SC线.在MRI图像上分析术前脊髓受压节段的压迫程度评分和SC线分型,并分析术后脊髓减压程度与SC线分型的关系.结果 脊髓受压节段SC线分型为Ⅰ型者术后减压满意,术前评分为（3.82±0.39）分,术后为（1.15±0.50）分;Ⅱ型者术后大部分得到减压,术前评分为（3.90±0.32）分,术后为（2.70±0.48）分;Ⅲ型者术后减压不满意,术前评分为（4.00±0.00）分,术后为（3.50±0.55）分.三组间术后评分差异有统计学意义（P＜0.01）.结论 SC线及其分型能较好地预测术后脊髓减压效果并能指导手术计划.Objectives To report a new index （the SC-line） and a new classification for predicting of postoperative spinal cord decompression after cervical laminoplasty. Methods From March 2008 to August 2009, MRI images of 25 patients treated with cervical laminoplasty were retrospectively studied.Using T2-weighted images of the cervical spine, point A was anterior point of the spinal cord at inferior endplate level of cranial compressed vertebra. Point B was anterior point of the spinal cord at superior endplate level of caudal compressed vertebra. The SC-line was defined as a line that connects A and B.Posterior surface of compressor at compression level did not exceed the line in Type Ⅰ , connected the line in Type Ⅱ , and exceeded it in Type Ⅲ . Twenty-five patients who underwent cervical laminoplasty were classified into 3 groups according to the SC-line classification. The posterior shift of the spinal cord after the posterior decompression procedure was evaluated by using a modified gradation of degree of anterior spinal cord compression by MRI finding. The relationship between the degree of anterior spinal cord compression after surgery and the SC-line types were analyzed. Results Preoperative cervical SC-line classification showed high correlations to the degree of spinal cord decompression. There were 3. 82 ± 0. 39 points in Type Ⅰ before surgery, 3. 90 ±0. 32 points in Type Ⅱ , and 4. 00 ±0. 00 points in Type Ⅲ , respectively. After surgery, there were 1. 15 ±0. 50 points in Type Ⅰ , 2. 70 ±0. 48 points in Type Ⅱ , and 3. 50 ±0. 55 points in Type Ⅲ, respectively. Significant differences were found between each Type （ F = 42. 49, P ＜ 0. 01; Type Ⅰ vs. Type Ⅱ ： P＜0. 01;Type Ⅰvs. Type Ⅲ： P ＜0. 01;Type Ⅱ vs. Type Ⅲ： P =0.038）. Conclusion SC-line can be used to predict the degree of postoperative spinal cord decompression following cervical laminoplasty.

关 键 词：颈椎 脊髓 椎管成形术 减压 

分 类 号：R687.3[医药卫生—骨科学]