术中CT辅助颈椎前路显微减压术治疗颈椎病  

Intraoperative CT Assisted Anterior Cervical Microdecompression for Cervical Spondylosis

作　　者：魏梁锋 郑兆聪 薛亮 陈业煌 王守森 Wei Liangfeng;Zheng Zhaocong;Xue Liang(Department of Neurosurgery,No.900 Hospital of Joint Logistics Force,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第九〇〇医院神经外科,福州350025

出　　处：《中国微创外科杂志》2021年第1期47-51,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省科技计划引导性项目(2016Y0070)。

摘　　要：目的探讨术中CT辅助颈椎前路显微减压术治疗颈椎病的安全性和有效性。方法回顾性分析2017年2月~2019年6月因颈椎病行CT辅助颈椎前路显微减压术89例资料。通过术前1天、术后1周、术后3个月及术后1年4个时间点疼痛视觉模拟评分(Visual Analogue Scale,VAS)及颈椎病日本骨科协会(Japanese Orthopedic Association,JOA)评分评估手术疗效。术前、术中、术后末次随访采用CT重建测量C2-7矢状位轴向垂直距离(sagittal vertical axis,SVA)。结果术后VAS评分逐渐下降,JOA评分逐渐上升,术后1年VAS评分由术前(5.7±0.9)降至(0.4±0.3),JOA评分由术前(10.6±1.3)升至(15.7±1.6),任意2个时间点差异均有统计学意义(P=0.000)。按JOA评分改善率,治愈39例(43.8%),显效36例(40.4%),有效12例(13.5%),无效2例(2.2%);总有效率97.8%(87/89)。术中C2-7 SVA[(14.9±1.0)mm]和术后1年[(15.5±1.0)mm]均显著低于术前[(23.3±1.4)mm](P=0.000)。术中硬膜囊破裂3例(3.4%),即刻封堵,术后脑脊液漏1例。未发生明显神经损伤。无椎间隙感染和颈椎不稳,无植入物松动和脱落。结论CT用于颈椎病前路显微减压术中,使手术安全,减压精确,并有利于维护术后脊柱稳定性。Objective To investigate the safety and efficacy of anterior cervical microdecompression with the assistance of intraoperative CT in the treatment of cervical spondylosis.Methods A total of 89 patients with cervical spondylosis from February 2017 to June 2019 were continuously enrolled,who received surgical microdecompression treatment with the assistance of intraoperative CT.The efficacy was evaluated by the changes in the Visual Analogue Scale(VAS)score of pain and Japanese Orthopedic Association(JOA)score at 1 day before operation,1 week,3 months and 1 year after operation.The C2-7 sagittal vertical axis(SVA)was measured and compared on CT reconstruction images before,during operation and at the last follow-up after operation.ResultsAfter operation,the VAS score decreased and JOA score increased gradually.At 1 year after operation the VAS score decreased from(5.7±0.9)to(0.4±0.3)and the JOA score increased from(10.6±1.3)to(15.7±1.6).The difference between any two time points was statistically significant(all P=0.000).Efficacy of the whole group according to the JOA score recovery rate:39 cases(43.8%)were cured,36 cases(40.4%)were excellent,12 cases(13.5%)were effective,2 cases(2.2%)were ineffective,and the total effective rate was 97.8%(87/89).The C2-7 SVA during operation[(14.9±1.0)mm]and last follow-up[(15.5±1.0)mm]were significantly lower than before operation[(23.3±1.4)mm](all P=0.000).Dural sac rupture occurred in 3 cases(3.4%),and immediate closure was performed.Cerebrospinal fluid leakage postoperatively occurred in 1 case.No obvious nerve injury occurred during the operation.There was no intervertebral space infection,cervical instability or loosening and falling off of internal implants.Conclusion The application of intraoperative CT in anterior cervical microdecompression of cervical spondylosis makes the operation safe,accurate and sufficient,and helps maintain the stability of the spine after operation.

关 键 词：颈椎病 减压 矢状面平衡 显微手术 

分 类 号：R687.3[医药卫生—骨科学]