术中椎间盘造影在颈椎无骨折脱位型颈脊髓损伤中的临床应用

Application of intraoperative discography in cervical spinal cord injury without fracture and dislocation

目的通过术中椎间盘造影评价颈椎无骨折脱位型颈脊髓损伤(CSCIWFD)椎间盘损伤程度,并指导选择合适的手术融合节段。方法回顾分析2014年1月至2016年1月郑州市骨科医院收治的符合纳入标准的预行颈椎前路手术的28例CSCIWFD患者的病历资料。根据患者的意愿分为造影组(13例)和对照组(15例)2组。术中对拟切除的椎间盘和疑似受损的椎间盘进行造影,评定疑似受损椎间盘的损伤程度。分析2组患者术前、术后2周及末次随访时的JOA评分,以及术后18个月内邻近椎间隙的退变情况。结果造影组行椎间盘造影35个,诊断间盘损伤23个,与术中探查结果一致,灵敏度和阳性预测值均为100%。2组患者的年龄、性别和术中出血量等一般资料差异无统计学意义(P>0.05)。造影组手术时间为(129.38±8.77)min,对照组为(121.67±6.79)min,差异有统计学意义(t=2.622,P<0.05)。造影组术后JOA评分为(13.54±0.57)分,高于术前的(6.61±0.86)分,差异有统计学意义(P<0.05);对照组术后JOA评分为(13.08±0.83)分,高于术前的(6.49±0.96)分,差异有统计学意义(P<0.05)。末次随访时,造影组JOA评分为(15.68±0.93)分,高于对照组的(14.65±1.52)分,差异有统计学意义(P<0.05)。术后18个月,造影组未发现因邻近节段椎间隙退变造成脊髓或神经损伤症状的病例,对照组有3例邻近节段椎间隙病变导致脊髓或神经损伤症状。结论术中椎间盘造影可以明确CSCIWFD椎间盘的损伤程度,发现邻近节段间盘的隐匿性损伤,有助于术者制定更加合理的手术治疗方案,从而改善患者的生活质量。

Objective To evaluate disc injury degree with cervical spinal cord injury without fracture and dislocation（ CSCIWFD） by intraoperative discography,and then guiding the choice of surgical fusion segment. Methods A retrospective analysis of 28 patients with CSCIWFD undergone anterior cervical spine surgery from January 2014 to January 2016 that met the inclusive criteria were performed. Thirteen patients who volunteered to undergo intraoperative discography were angiography group,and the other 15 patients were control group. The intraoperative angiography of the disc to be removed and the intervertebral disc suspected of being damaged was performed. The angiographic results were analyzed and the extent of disc damage were assessed. Statistical analysis of Japanese Orthopedic Association（ JOA） scores before and 2 weeks after surgery and at the final follow-up was performed in 2 groups. Postoperative degeneration of the adjacent intervertebral space was further analyzed within 18 months. Results A total of 35 discs were damaged and suspected of being impaired. Intraoperative discography diagnosed 23 disc injuries,which were consistent with intraoperative exploration. The sensitivity and positive predictive value were both 100%. There was no significant differencein age,sex,and intraoperative blood loss between 2 groups（ P 〉 0. 05）. The operation time in the angiography group [（ 129. 38 ± 8. 77） min] was significantly longer than that in the control group [（ 121. 67 ± 6. 79）min],t = 2. 622,P 〈 0. 05. The postoperative JOA scores was significantly higher in the angiography group than that before operation（ 13. 54 ± 0. 57 vs. 6. 61 ± 0. 86）,P 〈 0. 05. The postoperative JOA scores was significantly higher in the control group than that before operation（ 13. 08 ± 0. 83 vs. 6. 49 ± 0. 96）,P 〈 0. 05. At the last follow-up,JOA score in the angiography group [（ 15. 68 ± 0. 93） points] was significanty higher than that in the control group [（ 14. 65 ± 1. 52） points],P 〈 0. 05. In the angiography group,no symptoms of spinal cord or nerve injury due to degeneration of the adjacent intervertebral space occurred within 18 months after surgery. In the control group,there were 3 cases of spinal cord or nerve injury caused by adjacent intervertebral space lesions. Conclusion Intraoperative cervical discography can clearly determine the degree of damage to the disc and detect the hidden damage of the intervertebral disc,providing a more reasonable surgical treatment for the surgeon and ulteriortiy improve the quality of life.