颈椎后路椎管扩大成形后的脊髓形态——术中超声检查与术后磁共振的比较  

Morphology of Cervical Spinal Cord After Laminoplasty,Comparison between Intraoperative Ultrasonography and Postoperative Magnetic Resonance Imaging

作　　者：江凌[1] 姜亮[2] 王金锐[1] 于淼[2] 刘忠军[2] 

机构地区：[1]北京大学第三医院超声诊断科,100191 [2]北京大学第三医院骨科,100191

出　　处：《中国超声医学杂志》2014年第3期193-197,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的在脊髓型颈椎病中,脊髓受压往往来源于脊髓腹侧。颈后路椎管扩大成形术为间接脊髓减压方法。本研究描述颈椎后路术中超声监测的颈脊髓形态,探讨颈后路术中超声检查的临床意义。方法 20例脊髓型颈椎病患者,行颈后路椎管扩大成形术,术中椎管减压完成后行实时超声检查,观察颈脊髓及硬膜囊的声像图表现,测量脊髓未受压及受压最严重处的硬膜囊、脊髓矢状径并与术后颈椎磁共振(magnetic resonance imaging,MRI)上对应节段的硬膜囊、脊髓矢状径比较。结果椎管成形术脊髓减压完成后,去除了椎板等骨性结构的遮挡,术中超声能够清晰显示颈脊髓硬膜囊和脊髓的形态。术中超声测量20例患者的受压最严重处颈髓节段的硬膜囊及脊髓的矢状径测量值分别的(8.57±1.85)mm与(4.79±1.09)mm,术后相应颈髓节段MRI测量,受压最严重处颈髓节段的硬膜囊及脊髓的矢状径测量值分别为(8.53±1.54)mm与(4.67±0.85)mm(硬膜囊、脊髓矢状径测量值P值分别为0.94和0.68)。术中超声测量脊髓未受压处硬膜囊与脊髓的矢状径为(11.4±1.19)mm与(6.45±1.3)mm,术后相应颈髓节段MRI测量未受压处颈髓节段的硬膜囊及脊髓的矢状径分别为(10.89±1.53)mm与(6.1±0.69)mm(硬膜囊、脊髓矢状径测量值P值分别为0.25和0.29)。术后MRI测量与术中超声测量的数值均无显著性差异。结论术中超声检查能够清晰显示颈椎硬膜囊与脊髓的形态,测量数值与术后MRI提供的影像结果一致。颈后路术中超声能够实时判断硬膜囊、脊髓腹侧受压情况,并提供硬膜囊减压完全与否的即刻影像学依据。Objective Spinal cord is always compressed ventrally in cervical spondylotic myelopathy（CSM）. The laminoplasty is an indirect decompression of spinal cord. Our research is to describe the morphology of spinal cord in intraoperative ultrasonography （IOUS） during laminoplasty, in order to investigate the clinical value of IOUS in the surgery. Methods Twenty patients with confirmed CSM underwent laminoplasty, After the decompression operation, the appearance of the decompressed section of spinal cord and dural sac were observed in IOUS. The sagittal and diam- eters of the normal and the most compressed dural sac and spinal cord, which compare with the corresponding segment of the cervical spine in MRI. Results IOUS clearly showed the shape of the normal and the decompressed sections of the dural sac and spinal cord. In the 20 patients. The sagittal diameter of the compressed were （8.57 ± 1.85） mm and （4.79± 1.09） mm respectively. After operation, MRI measurements corresponding cervical spinal cord segments, were （8.53±1.54） mm and （4.67±0.85） ram. （The P values of the dura mater and spinal cord mearsuring in sagittal diameters were 0.94 and 0.68） The sagittal diameter of the normal were （11.4±1.19） mm and （6.45±1.3） mm by ultresound. After operation, MRI measurements corresponding cervical spinal cord segments, were （10.89±1.53） mm and （6. 1±0.69） ram. （The P values of the dura sac and spinal cord mearsuring in sagittal diameters were 0.25 and 0.29. ）The measurements of the ultrasound had no significant difference in those of MRI. Conclusions IOUS can clearly show the morphology of the dural sac and spinal cord in cervical vertebra. Those measurements provided bv ul-trasound is agreed with those by MRI image. IOUS in laminaoplasty can also confirm the location and nature o{ corre sponed sections of dural sac and spinal cord.

关 键 词：术中超声 颈椎后路椎管扩大成形术 脊髓形态 磁共振显像 

分 类 号：R687.3[医药卫生—骨科学]