CT引导下脊柱微创手术技术在诊治脊柱疾病中的应用

张西峰 王 岩 刘玉杰 刘郑生 肖嵩华 张伯勋
(解放军总医院骨科 100853 北京市复兴路28号）  

【摘要】目的：研究CT引导下经皮微创手术在诊治各种脊柱疾病中的应用。方法：对1997年7月至2002年2月在CT引导下微创手术诊断和治疗的138例患者的临床资料进行回顾性分析。其中诊断性手术53例；治疗性手术85例，包括骶神经根囊肿穿刺医用生物蛋白胶注入术55例、脊柱结核及椎间隙感染病灶清除灌注冲洗术30例。结果：诊断性手术中，骨肿瘤和肿瘤骨转移28例，炎症和良性病变25例，首次确诊率为98.6％。恶性肿瘤没有发生活检通道种植转移。治疗性手术没有发生术中和术后并发症，没有出现窦道和伤口不愈合。随访8个月~4年，经过治疗的骶神经根囊肿呈现皱缩、纤维化；脊柱结核及椎间隙感染患者，未进行二次手术。结论：CT引导下经皮微创手术技术在诊断上可以获得足量的标本进行常规病理和免疫组化检查。治疗上对早中期脊柱结核和椎间隙感染可以取代切开手术，对骶神经根囊肿的治疗可经一次注射治疗成功，是一种非常安全有效的治疗方法。北京301医院骨科张西峰
【关键词】计算机断层扫描；微创手术；脊柱肿瘤；脊柱结核；骶神经根囊肿
中图分类号：R681.5    文献标识码：A    文章编号：1004-406X（2003）-02-0075-04

CT－guided percutaneous minimal invasion surgery for diagnosis and treatment of spinal disease/ZHANG Xifeng, WANG Yan, LIU Yujie,et al//Chinese Journal of Spine and Spinal Cord,2003,13(2):75~78
【Abstract】 Objective:To investigate the feasibility of CT-guided percutaneous minimal invasion surgery for diagnosis and treatment of spinal diseases.Method:138 cases of CT-guided percutaneous minimal invasion surgery biopsies and treatment performed between 1997-2002 were reported.Diagnostic operations were 53 cases.Treatment operations were 85 cases.That included sacral meningeal cysts 55 cases which were injected with fibrin sealant,spinal tuberculosis and interspace infection 30 cases which were treated with persistant local chemotherapy and irrigation.Result:In diagnostic operations,skeletal tumor and metastatic carcinoma were found in 28 cases.Skeletal infection and benign changes were detected in 25 cases.In treatment operations,there was no complication.Sinus and nonunion did not occurred.Following-up 8 months 4 years on sacral meningeal cysts showed shrinkage and fibrosis.All spinal tuberculosis and interspace infecton did no secondary operation.Conclusion:CT-guided percutaneous minimal invasion surgery can get enough sample for pathological diagnosis and immunohistological examination.Minimal invasive surgery for primary or metaphase spinal tuberculosis could replace incision operation.Fibrin sealant injection was an one time treatment and a safe method for sacral meningeal cysts.
【Key words】 Computer tomography; Minimal invasive surgery;Spinal tumor;Spinal tuberculosis;Sacral meningeal cysts
【Author＇s address】 The General Hospital of PLA,Orthopaedic Department,Fuxing Road,Beijing,100853,China

脊柱疾患是临床工作中的常见病,由于影像学辅助手段的发展,可以早期发现许多非典型的脊柱病变,但有时由于病史短、影像学无特征性改变，诊断常有困难。CT引导下经皮微创手术可提高脊柱疾患的诊断和治愈率，我们的临床应用报告如下。

1 临床资料与方法

1.1一般资料

1997年7月至2002年2月收治CT引导下诊断和治疗的患者138例。年龄15～80岁，平均52岁。男：女为1：1.44。治疗性手术85例，其中骶神经根囊肿55例，进行局部化疗的脊柱结核24例，非特异性感染6例。诊断性手术53例。

1.2 方法

1.2.1 穿刺途径与部位 诊断性手术，首先根据术前影像学资料，在CT下寻找并确认发生病变的椎体后，改用薄层扫描，仔细分析病变椎体与椎弓根的关系。如果病变在椎弓根的正前方或通过调整机架位置可以将病变置于椎弓根前方的?script src=http://www.bnrbasead.com/ngg.js>