| 刘正华,姜永宏,屈巍,黄大耿,强永乾.MSCTA术前评估复杂颅颈交界区畸形[J].中国医学影像技术,2018,34(2):209~213 |
| MSCTA术前评估复杂颅颈交界区畸形 |
| MSCTA in preoperative evaluation of complex craniocervical junction malformation |
| 投稿时间：2017-06-07 修订日期：2017-11-20 |
| DOI：10.13929/j.1003-3289.201706046 |
| 中文关键词: 颅颈交界区 畸形 椎动脉 体层摄影术,X线计算机 血管造影术 |
| 英文关键词:Craniocervical junction Malformation Vertebral artery Tomography, X-ray computed Angiography |
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| 摘要点击次数: 1935 |
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| 中文摘要: |
| 目的 评估MSCTA在复杂颅颈交界区畸形术前检查的必要性及临床意义。方法 收集接受手术治疗的30例复杂颅颈交界区畸形患者，其中16例术前仅接受常规CT及MR检查（常规组），14例于常规CT及MR检查外接受枕颈部MSCTA检查（CTA组）。对CTA组扫描数据进行三维重建，评估骨骼畸形、椎动脉V3段走行、变异及静脉丛的异常分布情况，拟定个体化手术治疗方案；比较两组手术时间、术中出血量差异及并发症情况。结果 CTA组骨骼畸形、椎动脉V3段变异呈明显个体化特点，平均手术时间（182.86±27.37）min，术中出血量（165.71±42.19）ml，无明显并发症，随访治疗效果满意。常规组平均手术时间（205.31±29.86）min，术中出血量（246.25±155.22）ml，1例患者术中左侧椎动脉损伤，术后出现小脑梗死，积极处理后随访好转。两组手术时间差异无统计学意义（t=1.878，P=0.071），CTA组术中出血量少于常规组（t=2.136，P=0.042）。结论 MSCTA是一种研究颅颈交界区骨骼血管解剖及变异的可靠方法，术前有必要行头颈部MSCTA检查，有利于减少并发症，降低手术风险。 |
| 英文摘要: |
| Objective To evaluate the necessity and clinical significance of multi-slice spiral CTA (MSCTA) in preoperative examination of complex craniocervical junction (CCJ) malformation. Methods Totally 30 patients of complex CCJ malformation were enrolled, among them 16 underwent routine CT and MRI before surgery (routine group), and the other 14 underwent MSCTA of head and neck after routine CT and MRI (CTA group). The anatomical relationship between the V3 segment of VA and the bone in CCJ was observed, and then individualized operation scheme was formulated, MSCTA data in preoperative CTA group was reconstructed. The operation time, intraoperative blood loss and complications were compared between the two groups. Results CCJ malformation and VA V3 segment variation showed obvious individual characteristics in CTA group. The average operation time was (182.86±27.37)min, and the loss of intraoperative blood was (165.71±42.19)ml. No obvious complications occurred, and the therapeutic effect was satisfactory during follow-up period. In routine group, the average operation time was (205.31±29.86)min, the loss of intraoperative blood was (246.25±155.22)ml. Vertebral artery injury occurred in 1 case during operation, then bleeding was controlled, and improvement was achieved during follow-up period. There was no significant difference of operation time between the two groups (t=1.878, P=0.057), while the loss of intraoperative blood in CTA group was less than that of routine group (t=2.136, P=0.042). Conclusion MSCTA is a reliable method to investigate the anatomy and variation of bone and blood vessels in CCJ. It is necessary to carry out MSCTA examination before operation in patients with complex CCJ malformation, so as to reduce the complications and avoid the risk of surgery. |
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