MRI测量颈胸角在选择颈胸段脊柱手术入路中的临床应用

Clinical application of MRI measurement for selecting the optimal approach in 76 patients with cervicothoracic junction diseases

目的 :探讨在颈胸段脊柱术前应结合患者的颈胸段MRI的个体特征和疾病情况 ,选择手术创伤最小的手术入路。方法 :共 76例患者 ,其中 2 6例为颈胸段脊柱损伤 ,35例为颈胸段脊柱肿瘤 ,脊髓型颈椎病 12例 ,以及 3例颈胸段椎板减压术后后凸畸形。男 4 7例 ,女 2 9例。平均年龄 4 5 5岁 ,年龄范围 19～ 6 5岁。同时抽取 95套颈胸段MRI片。作胸骨上切迹向后水平延长线和胸骨上切迹向后上方至C7T1椎间盘前缘中点的连线 ,测量两线之夹角 ,称为颈胸角 (cervicothoracicangle ,CTA)。结果 :CTA平均为 4 7 6 4°(范围 2 5°～ 73°)。大于此平均角度且病灶在胸骨切迹水平线以上时可考虑低位下颈椎入路 ,5 0例 ;CTA较小 ,且病灶范围广 ,或尚累及T3 、T4,可以考虑经胸骨柄入路 ,13例 ;病灶范围广泛 ,经全胸骨入路 3例 ;Ⅰ期或Ⅱ期前后联合入路 5例 ;经右侧肩胛下后外侧胸腔入路 5例。结论 :颈胸段脊柱手术应尽量选择低位下颈椎入路等创伤较小的入路 ,其次考虑经胸骨柄入路。长节段脊柱受累的患者才考虑经右侧肩胛下后外侧胸腔或经全胸骨等创伤较大的入路。术前可以结合患者的病灶累及范围和颈胸手术角等MRI影像学表现 ,从而利于选择最合适的手术入路 ,减少手术风险、手术创伤和并发症 。

Objective:[The optimal approach with less operative trauma should be selected after the individual features and the MRI measurements are carefully studied prior to surgery.Methods:[76 patients underwent cervicothoracic operations,including 26 cases with spinal injuries,35 with spinal tumors,12 with cervical spondylotic myelopathy,and 3 with post laminectomy kyphosis.The average age was 45 5 years old.Meanwhile,the line horizontally to the suprasternal notch and another line from the suprasternal notch to the anterior midpoint of the C 7T 1 intervertebral disc and the angle composed of the former lines were drawn and determined from 95 consecutive midsagittal cervicothoracic MRI studies.Results:[Cervicothoracic angle(CTA) was 47 66 degree on the average,ranging from 25 to 73 degrees.Low cervical approach could be in consideration when the CTA was more than the mean value and when the lesion was located above the line horizontally to the suprasternal notch(50 cases).Otherwise,the trans manubrial approach,then the trans sternal approach was in consideration.Conclusion:[The operative approach with least operative trauma such as the low cervical approach should be selected in the cervicothoracic spinal operations,then the trans manubrial approach is the second choice.Only in the patients with long level involvements the trans thorcacic or the trans sternal are used.Preoperative MRI finding of the CTA and the understanding of the lesion could be combined to select the most possible approach to reduce the intra operative and post operative risk in the patients. [