术中超声在胸椎管狭窄减压术中的应用价值

摘要

Objective To investigate the feasibility and clinical value of intraoperative ultrasonogra-phy (IOUS) in thoracic spinal decompression surgery. Methods Ten patients with confirmed thoracic spinal stenosis underwent thoracic spinal decompression in our center from August 2009 to December 2010. The appearance of the compressed section of spinal cord was observed with IOUS. Before and after the decompression operation, the diameters of dural sac and the spinal cord were recorded respectively. The location and nature of the compression-causing mass were confirmed. Results IOUS clearly showed the shape of the normal and the compressed sections of dural sac and spinal cord. In the 14 thoracic spinal cord sections of these 10 patients, the anteroposterior diameter, horizontal diameter, and their ratio were bigger than those before decompression. The values of anteroposterior diameter and anteroposterior/horizontal diameter ratio showed significant differences (the P value of dural sac anteroposterior diameter comparison was 0. 008, which of spinal cord was 0. 007 ; the P values of these two structures ratio comparison were both 0. 002 before and after decompression) , while the horizontal diameter presented no significant differences (the P values of both structures were 0. 270 and 0. 195 respectively before and after decompression). Conclusions IOUS can clearly show the morphological changes of the dural sac and spinal cord before and after the decompression. In addition, it helps surgeons to locate and specify the nature of the compression-causing mass on the ventral side of dural sac. Furthermore, IOUS can suggest whether the decompression is sufficient in a real-time manner.%目的 探讨术中超声监测胸椎管狭窄患者手术减压效果的可行性及临床价值.方法 10例明确诊断为胸椎管狭窄并需行胸椎管减压术患者,进行实时术中超声检查,分别观察并测量硬膜囊、脊髓腹侧减压前后的形态及径值变化,判断硬膜囊腹侧致压物的位置及其性质.结果 术中超声能够清晰显示正常及受压段硬膜囊和脊髓的形态.10例患者14个胸髓节段的硬膜囊以及脊髓的前后径测量值及前后径/横径比值,在减压后显著增大(P=0.008,P=0.007; P=0.002,P=0.002),硬膜囊及脊髓的横径测量值,在减压前后比较有差异但无统计学意义(P= 0.270,P=0.195).结论 术中超声检查能够清晰显示正常及受压段胸椎硬膜囊的形态学变化,帮助术者判断硬膜囊腹侧致压物的位置及性质,提供硬膜囊减压完全与否的即刻影像学依据.