ct三维重建技术辅助治疗下颈椎多节段椎管狭窄并创伤性不稳

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1、CT三维重建技术辅助治疗下颈椎多节段椎管狭窄并创伤性不稳作者：何飞，何波，张春强，王兵，黄河，赵学凌【摘要】［目的］探讨多层螺旋CT三维重建技术辅助治疗下颈椎多节段椎管狭窄合并创伤性颈椎不稳(multileveldegenerativestenosiswithtraumaticinstabilityMDSTl)的方法。［方法］自2006年9月到2007年8月，本科应用颈椎椎弓根钉固定加双开门椎管成形术治疗9例MDSTI患者，结合螺旋CT扫描、VR及MPR重建辅助术前诊断、计划及测量以指导手术，术

2、后MPR重建量化螺钉穿破情况、椎管矢状径及椎管横切面积增加情况。［结果］9例置入颈椎椎弓根钉44枚，按Richter穿破分级法，1级72.7%(32／44)，2级27.3%(12／44)，无3级穿破及医源性损伤发生；双开门椎管成形42个节段，术后椎管矢状径及横切面积较术前显著增加(P<0.05)，增加均值可信区间分别为前者23.43～40.65mm，后者23.18～42.07mm2；术后6个月76.2%的节段(32／42)植骨完全融合，23.8%(10／42)植骨部分吸收，所有节段双侧开槽

3、部均完全融合；随访6个月至1年(平均7.8个月)，比较术前、术后的ASIA评分，2例上升2级，5例上升1级，2例与术前一致，无低于术前水平病例。［结论］CT三维重建技术辅助手术治疗MDSTI可以提高安全性及手术效果。【关键词】多层螺旋CT；三维重建；下颈椎；创伤性不稳；16多节段椎管狭窄；椎管成形术；椎弓根钉固定(PSF)Abstract:［Objective］Tostudythemethodofmulti-spiralCT(MSCT)3Dreconstructiontechniqueassis

4、tingcervicalpediclescrewfixation(PSF)anddouble-doorlaminoplastyinthetreatmentofmultileveldegenerativestenosiswithtraumaticinstability(MDSTI)oflowercervicalspine.［Method］FromSeptember2006toAugust2007,PSFcombinedwithdouble-doorlaminoplastywereperformed

5、in9patientswithMDSTIoflowercervicalspine.MSCT3Dreconstructiontechniques,includingvolumerendering(VR)andmulti-planarreconstruction(MPR),wereusedtoassistpreoperativediagnosis,planandmeasurementtoguideprocedure.PostoperativeMPRwasusedagain:throughcorona

6、lformat,thedegreeofscrewsperforationwasmeasuredpreciselyandthedifferentpositionsofpediclescrewsweredividedintothreegradesaccordingtoRichter'smethod;throughaxialformat,theincreaseinsagittaldiameterandcanalareaofeverylaminoplastylevelweremeasuredprecis

7、ely.Acomparisonbetweenpre-andpostoperativeASIAscoreswasusedtopresentneuralfunctionrecovery.［Result］NinepatientswithMDSTIoflowercervicalspineunderwentPSFandtotal44screws.AccordingtotheclassificationofRichter,grade1were1672.7%(32/44),grade2were27.3%(12

8、/44).Noscrewperforationoccurred(grade3)andnoscrewsrevisionresultedfrommisplacement.Noiatrogenicdamageoccurred.Double-doorlaminoplastywasperformedintotal42volumes.Thepostoperativecervicalspinalcanalsagittaldiameterandtraverseareaweresignificantlyimpro