实时超声引导联合CT监视在颈椎间盘穿刺中的应用价值

Value of applying real-time ultrasound guidance combined with CT monitoring in cervical intervertebral disc puncture

中文关键词:  实时超声引导  颈椎间盘源性眩晕  CT监视  颈椎间盘穿刺术

英文关键词:Real-time ultrasound-guided  Cervical discogenic dizziness  CT monitoring  Cervical intervertebral disc puncture

中文摘要:

  【摘要】 目的：探讨实时超声引导联合CT监视在颈椎间盘穿刺中的应用价值。方法：选取2023年1月~2024年2月来我院就诊的主诉慢性颈痛和顽固性头晕且对各种形式的保守治疗至少1年效果不佳的疑似颈椎间盘源性眩晕的60例患者，男28例，女32例，年龄26~67岁（47.0±10.5岁）。按照随机数字分配原则将其分成两组，每组各30例。一组由1名具有5年以上肌骨介入经验的超声医师行实时超声引导联合CT监视下颈椎间盘穿刺术，另一组由脊柱科医师行单纯CT引导颈椎间盘穿刺术。收集两组患者的基线资料，包括年龄、性别、体质量指数（body mass index，BMI）、心率、收缩压、舒张压，比较两组穿刺引导参数，包括术前定位时间、穿刺总时间、辐射暴露次数以及并发症情况。采用SPSS 26.0统计学分析软件对两组的上述资料进行比较。结果：两组患者的年龄、性别比、BMI、心率、收缩压、舒张压均无显著性差异（P＞0.05）。60例患者均成功进行颈椎间盘穿刺术，穿刺节段：C4/5 10例，C5/6 44例，C6/7 6例。超声引导联合CT监视组术前定位时间短于单纯CT引导组[3.5（3.0，4.3）min vs 5.0（4.8，6.0）min]，两组间差异有统计学意义（P＜0.001）。超声引导联合CT监视组穿刺总时间[9.0（8.8，11.0）min vs 15.0（14.0，17.0）min]、CT暴露次数均小于单纯CT引导组[2.0（2.0，3.0）次 vs 5.0（5.0，6.0）次]，两组间比较差异有统计学意义（P<0.001）。单纯CT引导组2例出现血肿，超声引导联合CT监视组无血肿出现。结论：实时超声引导联合CT监视下穿刺颈椎间盘是一种快速、安全、有效的新方法，具有临床应用价值。

英文摘要:

  【Abstract】 Objectives: To explore the application value of real-time ultrasound guidance combined with CT monitoring in cervical disc puncture. Methods: From January 2023 to February 2024, a total of 60 patients presenting with chronic cervical pain and refractory dizziness, who had not experienced any improvement despite at least one year of various conservative treatments and were suspected of having cervical discogenic vertigo, were enrolled, including 28 males and 32 females, aged 26-67 years(47.0±10.5 years). Utilizing a random number allocation principle, the patients were divided into two groups of 30 cases each. One group underwent cervical disc puncture performed by an ultrasonographer with over 5 years of musculoskeletal interventional experience using real-time ultrasound guidance combined with CT monitoring, while the other group received simple CT-guided cervical disc puncture performed by spine surgeons. Baseline data were collected of the two groups of patients, including age, gender, body mass index(BMI), heart rate, systolic and diastolic blood pressure. Puncture guidance parameters were compared such as preoperative positioning time, total puncture time, and CT exposures. Complications were also compared between groups. SPSS 26.0 statistical software was used to analyze and compare the above mentioned data. Results: There were no significant differences in age, gender ratio, BMI, heart rate, systolic and diastolic blood pressure between the two groups (P>0.05). All 60 patients successfully underwent cervical intervertebral disc punctures targeting the C4/5(10 cases), C5/6(44 cases), and C6/7(6 cases) segments. Ultrasound-guided CT monitoring group exhibited shorter preoperative positioning time than CT guidance alone group[3.5(3.0, 4.3)min vs 5.0(4.8, 6.0)min], the difference was statistically significant(P＜0.001). However, ultrasound-guided CT monitoring group demonstrated significantly shorter total puncture time[9.0(8.8, 11.0)min vs 15.0(14.0, 17.0)min] and fewer CT exposures[9.0(8.8, 11.0) vs 15.0(14.0, 17.0)] compared to CT guidance alone group(P<0.001). 2 cases in the CT guidance alone group occurred hematoma, while none such complication occurred in the ultrasound guided CT monitoring group. Conclusions: Real-time ultrasound-guided cervical intervertebral disc puncture combined with CT monitoring is a novel, rapid, safe, and effective approach that has certain clinical values.