超声在脊柱脊髓手术中实时监测的应用研究

Application of the real-time monitoring with ultrasonography in the vertebral and spinal cord operation

目的探讨超声在脊柱脊髓手术过程中实时监测脊髓形态图像特征及其临床应用价值。方法对19例脊柱脊髓手术患者手术过程中行脊髓形态超声监测,采用JOA评分,对术前、术后出院时、术后6个月、12个月随访JOA评分,进行疗效评定。结果 19例术中超声监测均无脊髓损伤症状等并发症发生,无内植物松动、断裂发生,均获骨性融合。术前、出院时、术后6个月及术后1年JOA评分分别为(8.80±1.60)分、(14.00±1.57)分、(14.60±1.61)分及(14.80±1.58)分;出院时、术后6个月及术后1年JOA改善率分别为51.6%、61.3%及64.5%;与术前评分比较,术后不同时间随访,JOA评分分值均明显高于术前评分,差异有统计学意义(P<0.05)。术后颈椎管矢状径明显扩大(平均矢状径扩大6.6mm),与术前比较差异有统计学意义(P<0.05)。结论在急救创伤脊柱脊髓抢救手术中超声实时脊髓形态监测可及时了解脊髓形态改变及脊髓压迫解除情况,为临床医师提高手术效率,避免医源性脊髓损伤,提供影像学依据。

Objective To explore the value of monitoring in vertebral and spinal cord operation by the real-time monitoring of the spinal cord in the process of operation. Methods Nineteen cases were included by the real-time monitoring of spinal cord in the process of operation. Japanese Orthopaedic Association（JOA） score was used to evaluate the clinical efficacy during following-up before and discharge after operation,6 months and 12 months after operation. Results Intraoperative ultrasound monitoring in the 19 patients had no symptom of spinal cord injury and other complications within the plant without loosening fracture occurred were bony fusion; the average JOA scores in the patients before operation,discharge after operation,6 months and 12 months after operation were 8.80±1.60,14.00±1.57,14.60±1.61 and 14.80±1.58,respectively. The improvement rate of JOA score for discharge after operation,6 months and 12 months after operation were individually 51.6%,61.3%,and 64.5%. The JOA score after operation was obviously higher than that before operation. The significant difference between the two groups was observed in the experiment （P0.05）. The cervical spinal canal sagittal diameter significantly increased after operation （mean sagittal diameter of the expansion of 6.6 mm）,compared with that before the trial （P0.05）. Conclusion The real-time monitoring with ultrasonography during operation can identify the change of spinal cord and provide the image evidence of operative efficiency to avoid the injury in vertebral and spinal cord operation.