CTA、CTV在极重度脊柱畸形矫正手术中的应用价值

The Clinical Application Value of CTA and CTV in extremely Severe Spinal Deformity Correction

目的探讨64层螺旋CT的CTA、CTV在极重度脊柱畸形矫正手术中的临床应用价值。方法回顾性分析2010年8月至2011年12月间至我院脊柱侧弯中心治疗的重度脊柱畸形7例,男4例,女3例,平均年龄31.8岁。术前术后均行CTA、CTV检查,检查时均行MSCT0.5×64模式薄层扫描,采用容积再现(VR)、多平面重建(MPR)、和最大密度投影(MIP)等方法进行容积数据的重建处理分析。结果 7例重度脊柱畸形患者均成功完成脊柱畸形矫正手术,术前主弯平均160°,术后矫正至平均92°,平均矫正率为42.4%,术前平均后凸125°,术后矫正至平均62.4°,矫正率为47.1%,术后均未出现神经并发症。所有患者的术前术后CTA、CTV经MSCT的各种后处理技术处理后,均能清楚地观察到术前胸、腹主动静脉及肋间血管的形态走向及其与畸形脊柱的位置关系,术后顶椎区域肋间血管的损伤情况及紧张程度。结论术前CTA、CTV检查可清楚的观察脊柱和胸、腹主动静脉及肋间血管的位置关系及紧张程度,为临床医师制定术中截骨和畸形矫正方案提供影像学参考;术后CTA、CTV可观察到术后血管损伤情况及紧张程度,为判断截骨矫形是否存在脊髓缺血损伤提供影像学依据。

Objective Evaluate the clinical value of CTA and CTV in extremely Severe Spinal Deformity Correction.Methods A total 7 patients with extremely severe spinal deformity subjected to osteotomy and deformity correction from Aug 2010 to Jan 2011,who were male 4,female 3,average years（range 31.8 years）.7 patients all toke CTA and CTV before and after operation,All cases were scaned by 64-slice computed tomography.Volume render（VR）,Multi-planar reconstruction（MPR）,maximum intensity projection（MIP） were performed in all patients.Results Spinal deformity correction of 7 patients were successfully taken,The mean preoperative scoliosis of 160° was corrected to 92°（42.4%） after surgery,The mean preoperative kyphosis of 125° was corrected to 62.4°（47.1% correction） after operation.The CTA and CTV data of 4 patients were post-managed by VR,MPR and MIP methods in MSCT.The conformation of thoracoabdominal aorta and vein,intercostal vessels can be observed clearly,the relationship between these vessels and spine can be evaluated in the CTA and CTV films.Conclusion Taking CTA and CTV before and after operation in severe spinal deformity are good for making the decision of osteotomy and correction plan before and during operation,which can decreased the risk of vessels injury and evaluate the potential ischemia of spinal cord.