术中超声在颈椎后路椎板成形术中的应用  

Application of Intraoperative Spinal Ultrasonography in Cervical Laminoplasty

作　　者：韦祎[1] 何达[1] 田伟[1] 刘波[1] 

机构地区：[1]北京积水潭医院脊柱科,北京100035

出　　处：《中国医学科学院学报》2012年第6期601-604,共4页Acta Academiae Medicinae Sinicae

摘　　要：目的探讨术中超声在颈椎后路椎板成形术中的应用价值。方法以30例行颈椎后路椎板成形术的多节段脊髓型颈椎病患者为研究对象,术前在MRI横断位上计算脊髓压缩率并记录日本骨科协会(JOA)评分,术中用超声检查脊髓减压的效果,术后随访并用Hirabayashi JOA恢复率评价神经功能的恢复情况,分析上述各种因素与术后神经功能恢复之间的关系。结果术中超声可以显示脊髓腹侧受压的范围和程度。根据术中超声动态观察减压后硬膜搏动时与其腹侧结构的相互关系,可将30例患者分为Ⅰ型(未接触)(2例)、Ⅱ型(接触可分离)(16例)和Ⅲ型(接触)(12例)3型,其中Ⅰ型和Ⅱ型为减压满意组(n=18),Ⅲ型为减压不满意组(n=12),减压满意组患者术后JOA恢复率为(73.3±21.0)%(31.3%～100.0%),明显高于减压不满意组患者的(43.2±33.1)%(0～83.3%),(t=3.05,P=0.005)。Pearson相关性分析结果显示,患者的年龄(r=-0.294,P=0.122)、术前JOA评分(r=0.059,P=0.759)、术前MRI压缩率(r=0.269,P=0.151)与术后JOA恢复率间均无明显相关性。结论术中超声能够有效评估颈椎后路椎板成形术神经减压的情况,对指导手术减压范围和评估手术预后有重要意义。Objective To investigate the clinical value of intraoperative ultrasonography in cervical laminoplasty.Methods Thirty patients underwent cervical laminoplasty for cervical compressive myelopathy in our hospital from April 2010 to April 2012.Spinal cord compression ratio was calculated in preoperative MRI axial images for every patient.The spinal cord decompression status was evaluated by intraoperative ultrasonography during cervical laminoplasty.The pre-and post-operative Japanese Orthopaedic Association Scoring System（JOA） score was recorded,and the recovery ratios of surgery were graded using the Hirabayashi equation.The relationship between the parameters and neural recovery was explored.Results The intraoperative ultrasonography was used to evaluate the ventral compression of the spinal cord.The ultrasonographic dynamic viewings were classified into three types based on the spinal cord contact with ventral structures after decompression：Type Ⅰ,non-contact（n=2）;Type Ⅱ,contact and apart（n=16）;and Type Ⅲ,contact（n=12）.The patients were divided into two groups：group A,showing Type Ⅰ or Ⅱ findings,representing satisfied decompression;and group B,showing Type 3 findings with insufficient decompression.The recovery ratio was（73.3±21.0）%（31.3%-100.0%） in group A,but decreased to（43.2±33.1）%（0-83.3%） in group B（t=3.05,P=0.005）.Pearson analysis showed that the patient age（r=-0.294,P=0.122）,preoperative JOA score（r=0.059,P=0.759）,and spinal compression ratio（r=0.269,P=0.151） was not correlated with Hirabayashi recovery ratio.Conclusion Intraoperative ultrasonography during laminoplasty is a feasible and promising method for evaluating spinal cord decompression status and predicting the prognosis following surgery.

关 键 词：椎板成形术 术中超声 脊髓压缩率 术前JOA评分 JOA恢复率 

分 类 号：R681.53[医药卫生—骨科学]