· 526·主堡窆E盟苤查呈Q ! ! 生垒旦箜兰! 鲞复垒塑￡! 地』墨! 坚：』! 些! Q ! ! ，! 堂：垒2：盟! ：鱼脊髓线预测颈椎后路开门术后脊髓减压效果的临床研究王向阳徐华梓池永龙林焱黄其衫毛方敏倪文飞王胜徐晖【摘要】目的探讨颈椎后路开门手术后脊髓减压程度的预测及方法。方法收集2008年3月至2009年8月25例行颈椎单开门椎管成形术患者术前、术后的M R／图像。根据脊髓前方的压迫程度可分为0～4分；其中>3分( 3和4分) 表明有脊髓压迫，<3分表明脊髓无压迫。在开门节段上位椎体下终板做一水平线与脊髓前方成一交点，在开门节段下位椎体上终板做一水平线与脊髓前方成交点，两交点的连线为脊髓线( SC线) ，根据sC线与前方致压物关系分为3型：I型为致压物在sc线前方，Ⅱ型为致压物与sc接触，Ⅲ型为致压物超过sc线。在M RI图像上分析术前脊髓受压节段的压迫程度评分和sc线分型，并分析术后脊髓减压程度与sc线分型的关系。结果脊髓受压节段sc线分型为I型者术后减压满意，术前评分为(3．82± O ．39)分，术后为(1．15± 0．50)分；Ⅱ型者术后大部分得到减压，术前评分为(3．90± 0．32)分，术后为(2．70± 0．48)分；III型者术后减压不满意，术前评分为(4．00± 0．00)分，术后为(3．50± 0．55)分。三组间术后评分差异有统计学意义(P<0．01)。结论sc线及其分型能较好地预测术后脊髓减压效果并能指导手术计划。【关键词】颈椎；脊髓；椎管成形术；减压Predi cti on ofspi nal corddecom pressi onafter cervi cal l am i nopl asty：theSC—l i neXUH ua—zi ，CH I Yong- l ong，LINYah，H U AN G Q i —shan，M AO 凡昭一rai n，N I W en-fei ，W AN G Sheng，XUH uiD epartm entof O rthopaedi c Surgery，Second Affi l i ated H ospi tal ，W enzhouM edi calW AN G 艇8昭一yang，Col l ege，W enzhou325027，Chi naCorrespondi ngauthor：W AN GXi ang- yang，Em ai l ：xi angyangw ang@ 126．corn【Abstract】O bj ecti vesToreport a newi ndex( the SC-l i ne) anda new cl assi fi cati on forpredi cti ngof postoperati vespi nalcord decom pressi onaftercervi calAugust 2009，M R／i m ages of 25ofthe cervi calspi ne，poi ntA w asendpl atel evelcndpl atel evel of caudal com pressed veaebra．The SC—l i ne w as defi ned asPosteri orsurface ofcom pressorType II，andexceededl l I．Tw enty—fi ve pati entscl assi fi ed i nto 3groups accordi ngt o the SC．1i ne cl assi fi cati on．The posteri or shi ft of t}l e spi nal cord after theposteri or decom pressi on procedurew as eval uatedby usi nga m odi fi edgradati onofdegreeof anteri orspi nalcord com pressi on by M R／fi ndi ng．The rel ati onshi pbetw een thedegreeaftersurgeryand the SC—l i netypesanal yzed．Resul tsshow edhi gh correl ati onscorddecom pressi on．Therew ere 3．82± 0．39poi nts i nTypeIbefore surgery，3．90± 0．32 poi ntssurgery．therew ere1．15± 0．50poi ntsi nTypeⅢ，respecti vel y．Si gni fi cantdi fferences w ere found betw een eachType( F=42．49，P<0．01；TypeI7) S．Type l I：P<O ．01；Type IVS．TypeⅢ：P<0．01；TypeSC—l i ne can be usedto predi ct the degree ofpostoperati vel am i nopl asty．M ethodsFrom M arch 2008t opati entstreated w i th cervi call am i nopl astyw ereretrospecti vel ythespi nalspi nalthatconnects A andstudi ed．U si ng T2一w ei ghted i m agesanteri orpoi ntofcord ati nferi orofcrani alcom pressed vertebraPoi nt B w as anteri orpoi ntofthecord atsuperi oral i neB．atcom pressi onl evel di d not exceed the l i ne i nType I．connected the l i ne i nw ho underw ent cervi cali ti nTypel am i nopl astyw ereof anteri orspi nalcervi calcordcom pressi onSC—l i ne cl assi fi cati onw erePreoperati veto the degreeofspi nali nTypeⅡ，and4．00± 0．00poi ntsi nType I，2．70± 0．48 poi ntsi nType 11，and3．50± 0．55poi ntsi nTypeⅢ，respecti vel y．After11 VS．Type 11I：P=O ．038) ．Concl usi oncorddecom pressi on fol l ow i ng cervi calspi nall am i nopl asty．【Key w ords】Cervi cal vertebrae；Spi nalcord；Lam i nopl asty；D ecom pressi onDO I：10．3760／em a．j ．i ssn．0529-5815．2011．06．013作者单位：325027温州医学院附属第二医院骨科医院脊柱外科通信作者：王向阳，Em ai l ：xi angyangw ang@ 126．corn．论著万方数据
