术中超声在脊柱后路减压手术中的应用

The value of intraoperative B-ultrasound in posterior spinal decompression surgery

目的探讨术中超声在脊柱后路减压手术中的应用价值。方法选择2017年10月至2019年12月在本院行脊柱后路减压手术28例,其中颈后路单开门内固定术13例,椎管内肿瘤切除术5例,脊柱爆裂性骨折、脱位减压复位内固定7例,黄韧带增厚切除减压2例,陈旧性环枢椎脱位复位减压1例。所有患者术前均完善CT、MR及必要的检查制定相应的手术方案。术中完成减压步骤后在切口内注入碘伏溶液+生理盐水形成声窗进行超声检查并根据超声下所示的减压效果决定是否需进一步减压。术后复查MR或CT评估手术减压情况。结果所有手术均顺利完成,未出现神经损伤、感染等并发症。在12例(92.31%)颈后路单开门椎板成形内固定术、4例(80.00%)后路椎管内肿瘤切除术及2例(100.00%)后路黄韧带切除术中超声显示效果较好,1例颈椎后路单开门椎板成形内固定术中超声发现减压欠充分予加大开门角度。但受限于超声探头较大及减压范围较小的原因术中超声在5例(72.50%)骨折脱位减压手术中显示效果较差。术中超声在颈后路单开门椎板成形内固定术显示效果明显优于其在骨折脱位减压内固定手术中的应用(P=0.01),但在后路椎管内肿瘤切除术(4/5)、后路黄韧带切除术(2/2)与骨折脱位减压内固定手术显示效果无明显差异(P=0.27,0.44)。术后复查CT或MR结果显示本组患者均减压良好。结论术中超声在脊柱后路减压手术中具有方便快捷、操作简单的优点,在脊柱后路减压范围较大的手术中可评估减压效果并指导手术操作,值得在临床中推广应用。

Objective To explore the value of intraoperative B-ultrasound in posterior spinal decompression surgery.Methods A total of 28 cases of posterior spinal decompression surgery were selected in our hospital from October 2017 to December 2019,including 13 cases of spinal cervical spondylosis undergoing posterior open-door laminoplasty,5 cases of resection of intravertebral canal tumors,7 cases of vertebral burst fractures or dislocations,2 cases of resection of ossification of ligamentum flavum,and 1 case of chronic atlantoaxial dislocation.All patients underwent CT,MR,and other necessary examinations before surgery.Intraoperative ultrasound was used to evaluate the spinal cord after main decompression procedure,and further surgery was performed according to the ultrasound examination.Postoperative MR or CT was performed to assess the decompression.Results All operations were successfully completed without complications such as nerve injury or injection.The spine ultrasound showed good results in open-door laminoplasty(12/13,92.31%),intravertebral canal tumor resection(4/5,80.00%),and resection of ligamentum flavum ossification(2/2,100.00%).However,the application of spine ultrasound was limited by the volume of ultrasound probe and the small decompression area in burst fracture or dislocation cases(72.50%).Intraoperative spinal ultrasound showed significantly better results in open-door laminoplasty cases than those in fracture or dislocation cases(P=0.01),but there were no significant differences among intravertebral canal tumor resection(4/5),posterior resection of ligamentum flavum ossification(2/2),and burst fracture or dislocation cases(P=0.27,0.44).Postoperative CT or MR showed that all patients had good decompression.Conclusion Intraoperative spine ultrasound has the advantages of convenience,quickness,and simple operation in posterior spinal decompression surgery,which can be used to evaluate the decompression effect and guide the surgical operation in a wide range of posterior spinal decompression surgery.