CT/MRI融合成像对腰椎爆裂骨折伴神经损伤手术的意义

Significance of CT/MRI fusion imaging for surgical treatment of lumbar fractures complicated with nerve injury

摘要:

[目的] 评价 CT/MRI 融合成像诊断腰椎爆裂骨折中创伤性马尾神经硬膜疝的价值，以及确定手术方式的意义。 [方法] 回顾性分析 2016 年 6 月—2020 年 6 月郑州市骨科医院脊柱外科收治的腰椎爆裂性骨折合并椎板骨折、马尾神经损伤 28 例患者的临床资料。术前常规行薄层 CT、MRI 检查，并使用 Medraw 软件实现 CT、MRI 三维图像的快速配准融合。术中探查验证影像诊断马尾神经根被嵌夹的准确性，并实施相应个体化手术治疗。[结果] 术前 CT/MRI 图像融合 28 例中，23 例 （82.1%） 发生马尾神经硬膜疝，马尾神经根被嵌夹在椎板骨折裂隙中，术中探查所见与影像所见完全一致，影像诊断准确率 100.0%。所有患者均顺利手术，随访 12~26 个月，平均（18.5±2.3）个月。与术前相比，末次随访时 VAS 评分 [(8.3±0.7), (2.2± 0.3), P＜0.001]、ODI 评分 [(38.5±4.3), (7.2±1.3), P＜0.001]、JOA 评分 [(12.8±0.8), (25.6±1.4), P＜0.001] 以及 ASIA 神经功能评级 [A/ B/C/D/E, (0/18/7/3/0), (0/0/3/5/20), P＜0.001] 均显著改善。[结论] 对腰椎爆裂骨折合并神经症状者术前行 CT/MRI 融合成像，能够直观判断马尾神经硬膜与后方骨折椎板的位置关系，准确诊断创伤性马尾神经硬膜疝，为精准手术提供重要参考，取得了满意的临床结果。

关键词:脊柱骨折;椎板骨折;马尾神经硬膜疝;融合图像

Abstract:

[Objective] To evaluate the value of CT/MRI fusion imaging in the diagnosis of traumatic cauda equina dural herniation in lumbar burst fractures, and its significance in determining the surgical technique. [Methods] A retrospective study was conducted on 28 patients who received surgical treatment for lumbar burst fracture combined with laminar fracture and cauda equina nerve injury in Zhengzhou Orthopaedic Hospital from June 2016 to June 2020. As thin-slice CT and MRI were performed routinely before operation, and Medraw software was used to achieve rapid registration fusion of CT and MRI 3D images. Intraoperative exploration was conducted to verify accuracy of imaging diagnosis of dural cauda equina herniation, and carried out corresponding individualized surgical treatment. [Results] On the preoperative CT/MRI fusion imaging of 28 patients, dural and cauda equina nerve herniation were found in 23 cases, accounting for 82.1%, which presented cauda equina nerve embedded in the lamina fracture gap. The intraoperative findings were completely consistent with the imaging findings, and the diagnostic accuracy of imaging was 100.0%. All patients underwent successful surgery and were followed up for 12 to 26 months (18.5±2.3). Compared with those before surgery, the VAS scores [(8.3±0.7), (2.2±0.3), P＜0.001], ODI score [(38.5± 4.3), (7.2±1.3), P＜0.001], JOA score [(12.8±0.8), (25.6±1.4), P＜0.001], and ASIA nerve function scale [A/B/C/D/E, (0/18/7/3/0), (0/0/3/5/ 20), P＜0.001] significantly improved at the last follow-up. [Conclusion] The CT/MRI fusion imaging taken before surgery for patients with lumbar fracture complicated with neurological symptoms does intuitively determine the position relationship between the dura cauda equina and the posterior lamina fractured, accurately diagnose traumatic dura cauda equina herniation, provide an important reference for accurate surgery, and obtain satisfactory clinical results.

Key words:spinal fracture; laminar fracture; dural cauda equina herniation; fusion imaging