Dyna CT在颈椎损伤手术中的应用  

The application of intra-operative Dyna CT in the surgery of cervical injury

作　　者：李靖远[1] 潘冬生[1] 宋振全[1] 李晋江[1] 赵明光[1] 张海松[1] 林军[1] 

机构地区：[1]沈阳军区总医院神经外科,辽宁沈阳110016

出　　处：《中华神经外科疾病研究杂志》2017年第6期494-497,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的评估Dyna CT术中辅助应用在颈椎损伤手术中的价值。方法回顾性分析2014年5月至2017年3月沈阳军区总医院神经外科应用Dyna CT辅助颈椎损伤手术的患者共52例,其中上颈椎损伤(C_(1-2))15例。下颈椎损伤(C_(3-7))37例。全麻成功后,固定体位和头架(颈椎后路),先行基准Dyna CT扫描。颈椎前路手术中,椎间盘摘除和骨减压操作后行第二次Dyna CT扫描。Cage或钛笼置入并再次Dyna CT扫描。颈椎后路手术中,常规侧块或椎弓根螺钉置入和脊髓减压后行二次Dyna CT扫描。前路或后路手术中,对于合并有骨折脱位者,复位矫正后需再次Dyna CT扫描,对于骨减压范围不充分,植入物位置不良或复位矫正不满意者均需进一步操作直到Dyna CT确定满意为止。结果颈前入路10例,颈后入路39例,前后联合入路3例。颈前入路根据术中Dyna CT对减压不充分者进行再次或多次骨减压5例;调整Cage位置1例;合并脱位者6例,其中对复位不满意再次或多次矫正3例。颈椎后路植入椎弓根螺钉14枚,根据Dyna CT调整螺钉2枚;植入侧块螺钉254枚,根据Dyna CT调整螺钉12枚;合并脱位者15例,根据Dyna CT对脱位矫正不满意者进行再次或多次复位纠正8例。术中平均使用Dyna CT 3.76次。术后随访1~3个月,行MRI及三维CT检查,术后影像学均证实减压充分、固定及骨折脱位复位满意。术后1 w行日本骨科协会JOA评分,平均恢复率为63.42%。本组无因减压不充分或固定复位不满意而二次翻修手术病例,术后发生切口感染2例,脑脊液漏1例,神经损伤1例。无与Dyna CT相关并发症。结论术中Dyna CT的应用可减少颈椎损伤手术中因减压不充分、固定和骨折脱位复位不满意而造成手术效果差,降低需要二次手术的机率和并发症的发生率,提高了颈椎外伤手术的安全性及精确性,有效改善颈椎损伤患者的预后。Objective This study was to assess the value of intra-operative Dyna CT in the surgery of cervical injury. Methods The clinical data of 52 patients With cervical injury, who underwent intra- operative Dyna CT-assisted cervical surgery in the Neurosurgery Department of General Hospital of Shenyang Military Region from May 2014 to March 2017 were analyzed retrospectively. A total of 15 cases were upper cervical injury （C1-2 ）, and 37 cases were lower cervical injury （C3-7 ）. After general anesthesia was induced, body position and head brace were fixed and a baseline CT scan was performed. In the surgery anterior cervical approach, after discectomy and bone decompression, a second Dyna CT scan was performed. After cage implantation, another was performed. In the surgery posteriol cervical approach, after spinal cord decompression and pedicle or lateral mass screw implantation, a second CT scan was performed. In the cases with cervical dislocation, a Dyna CT scan was also performed after dislocation reduction. Further operation and Dyna CT scan were necessary to ensure satisfactory results if insufficient bone removal, implantations malposition or unsatisfied reduction was found in the images. Results The surgeries were performed with anterior cervical approach in 10 cases, posterior approach in 39 cases and combined anterior and posterior approach in 3 cases. In the surgeries of anterior approach, further bone decompression was performed in 5 cases, cage position adjusted in 1 case, and further dislocation reduction were performed in 3 of 6 cases with cervical dislocation. In the surgeries of position posterior approach, screws position was adjusted in 2 of 14 pedicle screws, and in 12 of 254 lateral mass screws. Further bone decompression was performed in 5 cases, cage position adjustment in 1 case, and further dislocation reduction was performed in 8 of 15 cases with cervical dislocation. Every patient received 3.76 times CT scans on average. The patients were followed up for 1 to 3 months and received CT

关 键 词：Dyna CT 颈椎损伤 减压术 复位 螺钉固定 

分 类 号：R68[医药卫生—骨科学]