MSCTA在上颈椎后路内固定手术中的应用价值  

The application value of MSCT angiography in posterior approach of upper cervical vertebrae

作　　者：戴贵东[1] 梁卡丽[2] 肖正远[1] 兰永树[1] 

机构地区：[1]泸州医学院附属医院放射科,四川泸州646000 [2]泸州医学院附属中医院放射科

出　　处：《实用放射学杂志》2014年第11期1802-1804,1809,共4页Journal of Practical Radiology

基　　金：泸州市科技局2013年资助项目（2013-S-48）.

摘　　要：目的探讨MSCTA在上颈椎后路内固定手术中的应用价值。方法选择51例怀疑或确诊为上颈椎病变患者行颈部CTA检查，其中23例通过上颈椎后路内固定手术并完成CTA复查。所有原始数据均在AW4．4工作站上进行后处理重建。通过容积重建（VR）、最大密度投影（MIP）及多平面重组（MPR）等方式显示椎体、椎动脉及周围的解剖结构及彼此的空间位置关系、优势椎动脉分布、椎动脉发育、走行异常等。术后通过VR、MIP和MPR等方式显示螺钉置入情况，分析螺钉穿破椎弓根上壁、下壁、内壁、外壁、椎体前壁及枕骨的情况并且对术后症状进行随访。使用SPSS19．0统计软件包进行数据录入和统计分析。结果VR、MIP和MPR图像上均能够清晰地观察到双侧椎动脉走行变异情况，以及椎动脉与周围结构的空间位置关系。椎动脉的显示：一侧优势动脉25例，均势26例；椎动脉发育异常13侧，椎动脉走行异常4例；椎弓根细小病例16例，伴同侧椎动脉优势9例。23例术后螺钉影像显示良好，置入螺钉113枚，C1置入20枚，C2 36枚，C3 15枚，C4 2枚，枕骨40枚。螺钉准确置入83枚，螺钉偏置30枚，其中与椎动脉关系密切3例，与脊髓关系密切1例。23例术后均无明显异常症状。结论MSCTA检查能够准确反映上颈椎血管解剖特点及变异情况，为内固定手术提供参考依据；术后CTA检查能准确了解螺钉的置入情况，对手术效果的评价具有重要的价值。Objective To explore the application value of multi-slice CT angiography （MSCTA） in posterior approach of upper cervical vertebrae. Methods Fifty-one patients with suspected or conformed upper cervical disease were collected and performed cervical CT A examination. Twenty three patients underwent internal fixation surgery of posterior upper cervical and reviewed with CTA examination. Volume Render （VR）, Maximum Intensity Projection （MIP） and Multi-planar Reformation （MPR） were used to show the courser and anatomical variation of vertebra artery, the shape of vertebrae, the relationship between the vertebra artery and adjacent structure, advantage artery. The distribution of screw placement, including perforation of the anterior wall, the inner wall, the outer wall, the upper wall, the interior wall and the inner wall of occipital were observed by VR, MIP and MPR after surgery, especially the relationship between the screw and vertebra artery, the screw and spinal cord. Comparing the correlation between the screw placement and postoperative symptoms. SPSS19.0 statistical packages were used for statistical analysis. Results VR, MIP and MPR can show the courser and nearby space relationship of cervical artery. The number of advantage artery was 25, equilibration was 26, dysplasia variation was 13, course variation was 4. The number of tiny pedicle was 16, including 9 cases of ipsilateral advantage artery. The postoperative data analysis of 23 patients showed that： C1- 20, C2 - 36, C3 -15, C4 - 2, occipital 40. The number of accurate screw placement was 83. Different type of perforation was 30, including 3 screws closing to vertebra artery, 1 screw closing to spinal cord. All 23 patients were asymptomatic after surgery. Conclusion MSCTA can reflect the morphology of cervical vertebral, the spatial relationship between cervical vertebral and surrounding structure, which can provide an accurate reference for clinical screw placement and improve the accuracy. The postoperative CT A can show screw place

关 键 词：上颈椎 计算机体层成像 血管成像 内固定术 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学] R814.42[医药卫生—外科学]