术中CT在颈椎后纵韧带骨化症前路手术中的应用价值

Clinical Value of Intraoperative CT in Anterior Cervical Operation for Ossification of the Posterior Longitudinal Ligament

目的:研究术中CT在颈椎后纵韧带骨化症(OPLL)前路手术中的价值。方法:选取2015年3月-2016年12月赣州市人民医院脊柱外科因OPLL进行颈椎前路椎管减压椎间植骨融合内固定术(ACDF)患者7例及颈椎前路椎体次全切除椎管减压钛网植骨融合内固定术(ACCF)患者9例,术中应用CT在完成病灶切除后对手术区域进行即时复查,评估骨化病灶切除效果并指导手术。统计术中CT对OPLL前路手术进程及手术结果的影响;术前,术后3 d、3个月、6个月的JOA评分;术后6个月复查颈椎MRI。结果:本组病例中采用单间隙ACDF手术7例,ACCF手术9例;术中CT检查发现,存在骨化病灶残留8例,主要残留区域为椎间隙上缘以及骨化病灶椎体两侧;术中CT扫描次数1~3次,平均(1.7±0.8)次;术前JOA评分(9.6±1.5)分,术后6个月为(12.9±1.2)分,比较差异有统计学意义(P<0.01);术后6个月复查颈椎MRI示椎管减压充分,JOA评分神经功能改善率为(81.5%±6.2%)。结论:在OPLL术中引入CT技术,可对手术区域进行实时监控并及时修正,降低了因骨化病灶切除不完全导致脊髓压迫未能解除而产生残留症状的手术风险,有助于提高手术安全性与有效性。

Objective:To explore the value of intraoperative CT in anterior cervical operation for ossification of the posterior longitudinal ligament(OPLL).Method:Because OPLL,7 cases of cervical anterior decompression and interbody fusion and internal fixation(ACDF)and 9 cases of anterior cervical corpectomy decompression and titanium mesh and bone graft fusion and internal fixation(ACCF)from March 2015 to December 2016 in our hospital were selected.After resection of the lesion,the CT was used to reviewed surgical area,to evaluated the effect of resection of ossifying foci and guided operation.The effect of intraoperative CT of OPLL anterior surgical procedure and surgical results were observed,the JOA score were counted before operation,after operation 3 days,3 months,6 months,and MR of cervical spine was reexamined after operation 6 months.Result:Among the 16 patients,there were 7 cases of single-level ACDF and 9 cases of ACCF,found by CT examination during the operation,8 cases of residual ossification,CT scanning in 1-3 times,the average was(1.7±0.8)times,the preoperative JOA score was(9.6±1.5)points,and after operation 6 months was(12.9±1.2)points,the difference was statistically significant(P<0.01),reexamination of cervical MRI showed adequate decompression of the vertebral canal,the neurological improvement rate of JOA score was(81.5%±6.2%).Conclusion:The introduction of CT technology in OPLL operation,can be real-time monitoring of the operation area and timely correction,reduce the risk of residual symptoms resulting from incomplete compression of the spinal cord resulting from incomplete resection of the lesion,to improve the safety and effectiveness of operation.