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背景:螺旋CT和计算机三维图像技术的出现对评估脊髓型颈椎病术前病理改变,以及选择合适的治疗时机和方法均有重要意义。目的:分析三维CT影像学图像及技术优势在脊髓型颈椎病术前评估及辅助手术计划制定中的作用。设计:回顾性分析,对照观察。单位:南京医科大学附属南京第一医院。对象:南京第一医院2002-01/2005-01收治268例脊髓型颈椎病患者,分为术前评估组146例和对照组122例,两组基线资料有可比性。方法:术前评估组:①CT扫描及三维重建:采用TOSHIBA-HiSpeed/I螺旋机,进行横断位螺旋扫描,扫描后进行标准重建,最后在计算机工作站(Radwork5.1)进行三维重建,相关数据可运用图像分析软件(ADW3.1)进行测量分析。②三维CT辅助手术计划的设计:立体多角度地展现颈椎骨性解剖标志及其相邻结构的解剖关系,提供手术个体化骨性定位标志。对照组:术前常规CT检查,传统的手术方法。主要观察指标:①观察椎体、钩突关节和小关节突骨质增生。②观察椎间盘突出的程度及类型。③观察椎管前后的骨质增生等改变,通过CT仿真椎管镜观察脊髓受压情况。结果:268例进入结果分析。①术前评估组发现椎间盘突出129例、椎体后部缘骨质增生109例、黄韧带肥厚褶起皱61例、后纵韧带钙化27例、小关节突骨质增生31例、椎板增厚29例、椎体滑脱18例;术中所能见到的解剖结构同临床表现与影像发现均相符合;所有患者术中无死亡,无喉返神经损伤、移植骨块移位、感染等并发症。术后6个月复查X射线片示全部病例植骨融合良好,无钛板或螺钉松动或断裂现象。Odom临床疗效评定优良率95.9%。②对照组术后X射线片和CT示24例椎管减压不充分,17例钛板或螺钉位置不满意;Odom临床疗效评定优良率84.4%,低于术前评估组(P<0.05)。结论:术前进行颈椎个性化三维CT检查能对脊髓型颈椎病作出准确、全面的评估,并能辅助制定手术计划,使术中操作更精确安全。
BACKGROUND: The advent of spiral CT and computerized three-dimensional image technology is of great significance for the assessment of preoperative pathological changes of cervical spondylotic myelopathy and the selection of suitable timing and method of treatment. OBJECTIVE: To analyze the effect of three-dimensional CT imaging and its technical advantages on the preoperative evaluation of myelinated cervical spondylosis and the development of ancillary surgery plans. Design: retrospective analysis, control observation. Unit: Nanjing First Affiliated Hospital of Nanjing Medical University. PARTICIPANTS: A total of 268 patients with cervical spondylotic myelopathy were admitted to the First Affiliated Hospital of Nanjing University from January 2002 to January 2005, and divided into preoperative evaluation group (146 cases) and control group (122 cases). The baseline data of the two groups were comparable. Methods: The preoperative evaluation group: ① CT scan and three-dimensional reconstruction: TOSHIBA-HiSpeed / I screw machine for transverse spiral scan, after scan the standard reconstruction, and finally in the computer workstation (Radwork5.1) for three-dimensional reconstruction, the relevant data Using image analysis software (ADW3.1) for measurement and analysis. ② The design of three-dimensional CT-assisted surgery plan: to demonstrate the anatomical relationship between cervical anatomical landmarks and its adjacent structures in a multi-dimensional manner and to provide the individualized bony locating marks for surgery. Control group: conventional preoperative CT examination, the traditional surgical methods. MAIN OUTCOME MEASURES: ① To observe the vertebral body, the uncinate process and the facet joint osteoarthritis. ② observe the degree and type of disc herniation. ③ observed before and after the spinal canal bone hyperplasia and other changes by CT simulation of spinal cord compression spinal cord compression. Results: 268 cases entered the result analysis. ① In the preoperative evaluation group, there were 129 cases of disc herniation, 109 cases of osteophyte hyperplasia on the posterior margin of the vertebral body, 61 cases of hypertrophic folds of the ligamentum flavum, 27 cases of posterior longitudinal ligament calcification, 31 cases of osteoarthritis of the facet joint, 29 cases of thick, spondylolisthesis in 18 cases; intraoperative can see the anatomical structure with clinical findings and imaging findings are consistent; all patients without death, no recurrent laryngeal nerve injury, bone graft displacement, infection, etc. complication. 6 months after the review of X-ray films showed good fusion of all cases, no titanium plate or screw loose or broken phenomenon. Odom clinical efficacy rating rate was 95.9%. ② In the control group, the results of X-ray and CT showed that the decompression of the vertebral canal was inadequate in 24 cases and the position of titanium plate or screw in 17 cases was unsatisfactory. The excellent and good rate of Odom clinical evaluation was 84.4%, lower than the preoperative evaluation group (P <0.05) . Conclusion: The preoperative 3D cervical spine CT examination can make an accurate and comprehensive assessment of cervical spondylotic myelopathy, and can assist in the development of surgical plans to make surgery more precise and safe operation.