螺旋CT三维重建技术评估下颈椎多节段椎管狭窄合并创伤性颈椎不稳的手术效果

目的应用螺旋CT（multi-spiral computerized tomography,MSCT）三维重建技术评估下颈椎多节段椎管狭窄合并创伤性颈椎不稳（multilevel degenerative stenosis with traumatic instability,MDSTI）的手术效果。方法2006年9月-2007年8月,本院应用颈椎椎弓根钉固定及同种异体骨植骨双开门椎管戚形术治疗9例MDSTI患者,结合MSCT三维重建技术量化评估螺钉穿破情况、术后椎管矢状径及横切面积增加情况。结果9例置入椎弓根钉44枚,1级穿破72．7％（32／44）,2级穿破27．3％（12／44）,无3级穿破及置钉不当需重新置钉病例。42个节段行双开门椎管成形术,术后椎管矢状径及横切面积较术前显著增加（P〈0．05）。术后6个月,76．2％（32／42）的患者植骨块完全融合,23．8％（10／42）的患者植骨块部分吸收,所有节段双侧开槽区域均达到坚强融合。结论应用MSCT三维重建技术可量化评估颈椎椎弓根钉固定的准确性和双开门椎管成形术的扩大比例。

Estimating treatment of multilevel degenerative stenosis with traumatic instability of lower cervical spine by multi-spiral CT three-dimensional reconstruction technique

Objective To estimate results of cervical pedicle screw fixation (PSF) and double-door laminoplasty by multi-spiral CT (MSCT) three-dimensional(3D) reconstruction technique in the treatment of multilevel degenerative stenosis with traumatic instability (MDSTI) of lower cervical spine. Methods From September 2006 to August 2007, PSF combined with double-door laminoplasty was performed in 9 patients with MDSTI of lower cervical spine. MSCT 3D multi-planar reconstruction (MPR) technique was used to estimate the degree of screws perforation and the increase in sagittal diameter and canal area of every level after laminoplasty.Results Nine patients with MDSTI of lower cervical spine underwent PSF and total 44 screws. According to the classification of Richter, grade 1 was 72.7% (32/44), grade 2 was 27.3% (12/44). No screws perforation occurred (grade 3) and no screws revision which resulted from misplacement was needed. Double-door laminoplasty was performed in total 42 segments. The postoperative cervical spinal canal sagittal diameter and traverse area were significantly improved (P<0.05). At the sixth month after laminoplasty, based on MSCT axial format, complete union between "open door" and allograft bone was obtained in 76.2% segments (32/42), and allograft bone was absorbed partly in 23.8% (10/42). A solid union in bilateral gutters was obtained in all the patients.Conclusion Assisted by MSCT 3D reconstruction technique, the accuracy of PSF and increased ratio of double-door laminoplasty can be quantitative estimated.