术中椎间盘造影辅助确定无骨折脱位型颈脊髓损伤的责任节段  

Intraoperative discography for determining responsible segments in cervical spinal cord injurywithout fracture and dislocation

作　　者：张继东[1] 夏群[1] 吉宁[1] 刘艳成[1] 宁尚龙[1] 

机构地区：[1]天津医院脊柱外科,300211

出　　处：《中华创伤杂志》2013年第1期25-29,共5页Chinese Journal of Trauma

摘　　要：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。MRIT2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110min，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。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 disceetomy, 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 discswere 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. O） 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 ±

关 键 词：脊柱损伤 颈椎 椎间盘 外科手术 计算机辅助 责任节段 

分 类 号：R651.2[医药卫生—外科学]