Name: intraoperative ultrasound in spinal surgery
Uploaded: 2022-08-17T12:30:00
Description: Watch this Scientific Journal Video about Intraoperative Ultrasound in Spinal Surgery at JoVE.com

作者没有致谢。

这里说明的协议遵循布莱根妇女医院人类研究伦理委员会的指导方针。
1. 术前方案
<ol><li>在临床上评估脊柱病理学患者并确定脊柱手术的资格。进行神经系统评估并获得CT或MRI扫描以识别脊柱病变。</li>
	<li>包括有硬膜内病变的患者，如神经鞘瘤、室管膜瘤、脑膜瘤、星形细胞瘤 等;或有腹侧压迫性硬膜外病变的患者，例如腹侧胸椎间盘突出、腹侧骨折碎片或脊髓肿瘤...

<ol>
	<li>Reid, M. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonic+visualization+of+a+cervical+cord+cystic+astrocytoma.">Ultrasonic visualization of a cervical cord cystic astrocytoma.</a> AJR. American Journal of Roentgenology. 131 (5), 907-908 (1978).</li><li>Dohrmann, G. J., Rubin, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+ultrasound+imaging+of+the+spinal+cord:+syringomyelia,+cysts,+and+tumors--a+preliminary+report.">Intraoperative ultrasound imaging of the spinal cord: syringomyelia, cysts, and tumors--a preliminary report.</a> Surgical Neurology. 18 (6), 395-399 (1982).</li><li>Rubin, J. M., Dohrmann, G. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+ultrasonically+guided+probes+and+catheters+in+neurosurgery.">Use of ultrasonically guided probes and catheters in neurosurgery.</a> Surgical Neurology. 18 (2), 143-148 (1982).</li><li>Braun, I. F., Raghavendra, B. N., Kricheff, I. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spinal+cord+imaging+using+real-time+high-resolution+ultrasound.">Spinal cord imaging using real-time high-resolution ultrasound.</a> Radiology. 147 (2), 459-465 (1983).</li><li>Hutchins, W. W., Vogelzang, R. L., Neiman, H. L., Fuld, I. L., Kowal, L. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differentiation+of+tumor+from+syringohydromyelia:+intraoperative+neurosonography+of+the+spinal+cord.">Differentiation of tumor from syringohydromyelia: intraoperative neurosonography of the spinal cord.</a> Radiology. 151 (1), 171-174 (1984).</li><li>Juthani, R. G., Bilsky, M. H., Vogelbaum, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+Management+and+Treatment+Modalities+for+Intramedullary+Spinal+Cord+Tumors.">Current Management and Treatment Modalities for Intramedullary Spinal Cord Tumors.</a> Current Treatment Options in Oncology. 16 (8), 39 (2015).</li><li>Knake, J. E., Gabrielsen, T. O., Chandler, W. F., Latack, J. T., Gebarski, S. S., Yang, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+sonography+during+spinal+surgery.">Real-time sonography during spinal surgery.</a> Radiology. 151 (2), 461-465 (1984).</li><li>Montalvo, B. M., Quencer, R. M., Green, B. A., Eismont, F. J., Brown, M. J., Brost, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+sonography+in+spinal+trauma.">Intraoperative sonography in spinal trauma.</a> Radiology. 153 (1), 125-134 (1984).</li><li>Montalvo, B. M., Quencer, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+sonography+in+spinal+surgery:+current+state+of+the+art.">Intraoperative sonography in spinal surgery: current state of the art.</a> Neuroradiology. 28 (5-6), 551-590 (1986).</li><li>Pasto, M. E., Rifkin, M. D., Rubenstein, J. B., Northrup, B. E., Cotler, J. M., Goldberg, B. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+ultrasonography+of+the+spinal+cord:+intraoperative+and+postoperative+imaging.">Real-time ultrasonography of the spinal cord: intraoperative and postoperative imaging.</a> Neuroradiology. 26 (3), 183-187 (1984).</li><li>Mari, A. R., Shah, I., Imran, M., Ashraf, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+intraoperative+ultrasound+in+achieving+complete+resection+of+intra-axial+solid+brain+tumours.">Role of intraoperative ultrasound in achieving complete resection of intra-axial solid brain tumours.</a> JPMA. The Journal of the Pakistan Medical Association. 64 (12), 1343-1347 (2014).</li><li>Ivanov, M., Budu, A., Sims-Williams, H., Poeata, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+Intraoperative+Ultrasonography+for+Spinal+Cord+Tumor+Surgery.">Using Intraoperative Ultrasonography for Spinal Cord Tumor Surgery.</a> World Neurosurgery. 97, 104-111 (2017).</li><li>Blumenkopf, B., Daniels, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+ultrasonography+(IOUS)+in+thoracolumbar+fractures.">Intraoperative ultrasonography (IOUS) in thoracolumbar fractures.</a> Journal of Spinal Disorders. 1 (1), 86-93 (1988).</li><li>McGahan, J. P., Benson, D., Chehrazi, B., Walter, J. P., Wagner, F. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+sonographic+monitoring+of+reduction+of+thoracolumbar+burst+fractures.">Intraoperative sonographic monitoring of reduction of thoracolumbar burst fractures.</a> AJR. American Journal of roentgenology. 145 (6), 1229-1232 (1985).</li><li>Quencer, R. M., Montalvo, B. M., Eismont, F. J., Green, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+spinal+sonography+in+thoracic+and+lumbar+fractures:+evaluation+of+Harrington+rod+instrumentation.">Intraoperative spinal sonography in thoracic and lumbar fractures: evaluation of Harrington rod instrumentation.</a> AJR. American Journal of roentgenology. 145 (2), 343-349 (1985).</li><li>Sosna, J., Barth, M. M., Kruskal, J. B., Kane, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+sonography+for+neurosurgery.">Intraoperative sonography for neurosurgery.</a> Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine. 24 (12), 1671-1682 (2005).</li><li>Raymond, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain,+spine+surgeons+say+yes+to+ultrasound.">Brain, spine surgeons say yes to ultrasound.</a> JAMA. 255 (17), 2258-2262 (1986).</li><li>Toktas, Z. O., Sahin, S., Koban, O., Sorar, M., Konya, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+intraoperative+ultrasound+required+in+cervical+spinal+tumors?+A+prospective+study.">Is intraoperative ultrasound required in cervical spinal tumors? A prospective study.</a> Turkish Neurosurgery. 23 (5), 600-606 (2013).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Surgical Approaches to the Spine. , (2015).</li><li>Friedman, J. A., Wetjen, N. M., Atkinson, J. L. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Utility+of+intraoperative+ultrasound+for+tumors+of+the+cauda+equina.">Utility of intraoperative ultrasound for tumors of the cauda equina.</a> Spine. 28 (3), 288-290 (2003).</li><li>Zhou, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+ultrasound+assistance+in+treatment+of+intradural+spinal+tumours.">Intraoperative ultrasound assistance in treatment of intradural spinal tumours.</a> Clinical Neurology and Neurosurgery. 113 (7), 531-537 (2011).</li><li>Harrop, J. S., Ganju, A., Groff, M., Bilsky, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+intramedullary+tumors+of+the+spinal+cord.">Primary intramedullary tumors of the spinal cord.</a> Spine. 34, 69-77 (2009).</li><li>Quencer, R. M., Montalvo, B. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+intraoperative+spinal+sonography.">Normal intraoperative spinal sonography.</a> AJR. American journal of roentgenology. 143 (6), 1301-1305 (1984).</li><li>Aoyama, T., Hida, K., Akino, M., Yano, S., Iwasaki, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+residual+disc+hernia+material+and+confirmation+of+nerve+root+decompression+at+lumbar+disc+herniation+surgery+by+intraoperative+ultrasound.">Detection of residual disc hernia material and confirmation of nerve root decompression at lumbar disc herniation surgery by intraoperative ultrasound.</a> Ultrasound in Medicine &amp; Biology. 35 (6), 920-927 (2009).</li><li>Bose, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thoracic+extruded+disc+mimicking+spinal+cord+tumor.">Thoracic extruded disc mimicking spinal cord tumor.</a> The Spine Journal: Official Journal of the North American Spine Society. 3 (1), 82-86 (2003).</li><li>Harel, R., Knoller, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+spine+ultrasound:+application+and+benefits.">Intraoperative spine ultrasound: application and benefits.</a> European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 25 (3), 865-869 (2016).</li><li>Lazennec, J. Y., Saillant, G., Hansen, S., Ramare, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+ultrasonography+evaluation+of+posterior+vertebral+wall+displacement+in+thoracolumbar+fractures.">Intraoperative ultrasonography evaluation of posterior vertebral wall displacement in thoracolumbar fractures.</a> Neurologia Medico-Chirurgica. 39 (1), 8-15 (1999).</li><li>Matsuyama, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cervical+myelopathy+due+to+OPLL:+clinical+evaluation+by+MRI+and+intraoperative+spinal+sonography.">Cervical myelopathy due to OPLL: clinical evaluation by MRI and intraoperative spinal sonography.</a> Journal of Spinal Disorders &amp; Techniques. 17 (5), 401-404 (2004).</li><li>Mueller, L. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound-guided+spinal+fracture+repositioning,+ligamentotaxis,+and+remodeling+after+thoracolumbar+burst+fractures.">Ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures.</a> Spine. 31 (20), 739-747 (2006).</li><li>Nishimura, Y., Thani, N. B., Tochigi, S., Ahn, H., Ginsberg, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thoracic+discectomy+by+posterior+pedicle-sparing,+transfacet+approach+with+real-time+intraoperative+ultrasonography:+Clinical+article.">Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article.</a> Journal of Neurosurgery. Spine. 21 (4), 568-576 (2014).</li><li>Randel, S., Gooding, G. A., Dillon, W. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonography+of+intraoperative+spinal+arteriovenous+malformations.">Sonography of intraoperative spinal arteriovenous malformations.</a> Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine. 6 (9), 539-544 (1987).</li><li>Seichi, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+ultrasonographic+evaluation+of+posterior+decompression+via.+laminoplasty+in+patients+with+cervical+ossification+of+the+posterior+longitudinal+ligament:+correlation+with+2-year+follow-up+results.">Intraoperative ultrasonographic evaluation of posterior decompression via. laminoplasty in patients with cervical ossification of the posterior longitudinal ligament: correlation with 2-year follow-up results.</a> Journal of Neurosurgery. Spine. 13 (1), 47-51 (2010).</li><li>Tian, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+3-dimensional+navigation+and+ultrasonography+during+posterior+decompression+with+instrumented+fusion+for+ossification+of+the+posterior+longitudinal+ligament+in+the+thoracic+spine.">Intraoperative 3-dimensional navigation and ultrasonography during posterior decompression with instrumented fusion for ossification of the posterior longitudinal ligament in the thoracic spine.</a> Journal of Spinal Disorders &amp; Techniques. 26 (6), 227-234 (2013).</li><li>Tokuhashi, Y., Matsuzaki, H., Oda, H., Uei, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+posterior+decompression+for+patients+with+ossification+of+the+posterior+longitudinal+ligament+in+the+thoracic+spine:+usefulness+of+the+ossification-kyphosis+angle+on+MRI.">Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI.</a> Spine. 31 (1), 26-30 (2006).</li><li>Vasudeva, V. S., Abd-El-Barr, M., Pompeu, Y. A., Karhade, A., Groff, M. W., Lu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+Intraoperative+Ultrasound+During+Spinal+Surgery.">Use of Intraoperative Ultrasound During Spinal Surgery.</a> Global Spine Journal. 7 (7), 648-656 (2017).</li><li>Alaqeel, A., Abou Al-Shaar, H., Alaqeel, A., Al-Habib, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+utility+of+ultrasound+for+surgical+spinal+decompression.">The utility of ultrasound for surgical spinal decompression.</a> Medical Ultrasonography. 17 (2), 211-218 (2015).</li><li>Della Pepa, G. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+intraoperative+contrast-enhanced+ultrasound+(CEUS)+in+vascularized+spinal+tumors:+a+technical+note.">Real-time intraoperative contrast-enhanced ultrasound (CEUS) in vascularized spinal tumors: a technical note.</a> Acta Neurochirurgica. 160 (6), 1259-1263 (2018).</li><li>Della Pepa, G. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Integration+of+Real-Time+Intraoperative+Contrast-Enhanced+Ultrasound+and+Color+Doppler+Ultrasound+in+the+Surgical+Treatment+of+Spinal+Cord+Dural+Arteriovenous+Fistulas.">Integration of Real-Time Intraoperative Contrast-Enhanced Ultrasound and Color Doppler Ultrasound in the Surgical Treatment of Spinal Cord Dural Arteriovenous Fistulas.</a> World Neurosurgery. 112, 138-142 (2018).</li></ol>

随着新技术的出现，脊柱手术中的术中超声在很大程度上已经失宠，然而，与其他可用的成像方式（如MRI和CT 6，9，16，17，18）相比，它仍然具有一些优势。除了价格便宜之外，在该协议中，我们还表明它易于使用，并且可以提供具有足够分辨率的结构可视化，否则外科医?...

超声是医学上最常见的诊断工具之一，特别是用于观察腹部，四肢和颈部的病理。然而，其用于研究颅骨和脊柱病变目前尚未得到广泛使用。1978年，里德是第一个报告使用超声波可视化宫颈带囊性星形细胞瘤1的人。在这里，在患者颈部弯曲的情况下进行扫描，以允许打开层内窗口。四年后，在1982年，Dohrmann和Rubin报告了在术中超声在10名患者中可视化硬膜内空间2。在10例患者中，术中超声发现的病理包括脊髓空洞症，脊髓囊肿以及髓内和髓外肿瘤。他们进一步证明了使用术中超声引导导管和探针进行肿瘤活检，囊肿引流和心室分流导管放置3。这允许对探头/导管进行实时监控和精确定位，从而减少放置中的不准确和错误。在这些初步报告之后，其他几个人已经发表了使用术中超声引导脊髓囊肿引流，髓内和髓外肿瘤切除以及注射器 - 蛛网膜下腔分流导管放置4，5，6，7，8，9，10.此外，还显示轴内实体脑肿瘤和脊髓硬膜内肿瘤的完全切除率11，12。术中超声也被证明可用于组织操作前的术中手术计划以及随后在脊柱骨折患者中充分神经元件减压的可视化7，9，13，14，15。
随着较新的术中技术的出现，可以更清晰地可视化软组织，例如磁共振成像（MRI）和计算机断层扫描（CT），术中超声已经变得不那么常见，并且在今天的神经外科医生中不太受欢迎16。然而，在某些手术病例中，术中超声可能比这些新技术具有优势（表 1）。术中超声显示，与术中 CT （iCT） 或锥形束 CT （cbCT） 相比，硬膜内结构的软组织可视化效果更好 9，17。虽然术中MRI（iMRI）在可用的情况下是有用的，因为它提供了更高的软组织分辨率，但它是昂贵的，耗时的，并且不能提供实时图像6， 16，18。一个例子是硬膜内肿块腹侧到膜囊的情况，外科医生无法直接可视化。此外，尽管依赖于操作人员，但根据我们的经验，术中超声使用起来相当简单，无需放射科医生即可轻松读取。

<table border="0" cellpadding="0" cellspacing="0" style="width:848px;" width="847">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:215px;">Aloka Prosound 5 mobile ultrasound machine</td>
			<td style="width:123px;">Hitachi</td>
			<td style="width:344px;">N/A</td>
			<td style="width:167px;">any comparable devices on the market should suffice</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">UST-9120 transducer probe.</td>
			<td>Hitachi</td>
			<td>UST-9120</td>
			<td>Has a 20mm diameter with 10 to 4.4 MHz frequency range (any comparable compatible transducer should suffice).</td>
		</tr>
	</tbody>
</table>

intraoperative ultrasound in spinal surgery

自20世纪80年代以来，有几份报告称术中超声作为脊柱手术的有用辅助手段。然而，随着更新的尖端成像方式的出现，术中超声在脊柱手术中的应用在很大程度上已经失宠。尽管如此，与其他术中技术（如磁共振成像和计算机断层扫描）相比，术中超声继续提供一些优势，包括更具成本效益，高效且易于操作和解释。此外，它仍然是实时可视化软组织和病理的唯一方法。本文重点介绍术中超声的优点，特别是在硬膜内病变和向后接近时腹侧至鞘囊的病变病例。

在正常的脊柱超声成像中，硬脑膜是围绕电波脊髓液的回声层。脊髓的特点是其均匀的外观和低回声原性，其周围是回声致密的边缘。这种回声边缘是由于密度从脊髓液到脊髓的转移。中央神经管表现为明亮的中央回声，而退出的神经根似乎具有高度的回声性，特别是在马尾16处。术中超声可在硬膜内占位性病变切除术中起到有利作用。在标准病例中，?...

Watch this Scientific Journal Video about Intraoperative Ultrasound in Spinal Surgery at JoVE.com

Intraoperative Ultrasound in Spinal Surgery

在这里，我们提出了在脊柱手术中使用术中超声的方案，特别是在使用后路时硬膜内病变和腹侧椎管病变的情况下。

脊柱外科术中超声

Since the 1980s, there have been several reports for the use of intraoperative ultrasound as a useful adjunct in spinal surgery. However, with the advent ...

脊柱手术的术中超声对于硬膜内病理学或腹侧脊髓病理学非常有用，这些病理学允许外科医生在打开硬脑膜之前可视化病变。这也有助于外科医生定位病变的位置，并确认病变切除，肿瘤切除后脊髓的充分减压。它提供了实时信息，这些信息在病例期间对脊柱外科医生非常有用。这种技术的主要优点是允许外科医生在实时打开硬脑膜之前在硬膜内可视化病变。在开始手术之前，进行磁共振成像或MRI扫描，以识别脊柱病变。全身麻醉后，将患者定位为背部暴露，并用聚维酮 - 碘磨砂膏对手术区域进行消毒。接下来，使用手术刀沿着脊柱的长度在适当的椎骨水平上做一个切口。继续切口向下穿过组织，直到到达骨骼。通过电外科烧灼术进行骨膜下解剖，并暴露棘突。将烧灼的切削刃向腹侧转动，然后将其扫过层流，并使用Lexer骨钳和高速钻头的组合去除骨层和棘突，以暴露下面的韧带黄膜。使用倾斜的刮刀和卡里森骨刺去除黄韧带，露出下面的硬脑膜。然后使用双极和止血基质来实现止血。在骨去除和硬脑膜暴露后，用100至500Ml盐水溶液填充手术区域，以便可以浸没直径为20 mm的超声取肉器探针。打开移动超声机，将超声探头放置在生理盐水浴中感兴趣的水平，以开始获取图像。为了可视化脊髓和病变，类似于MRI的矢状面图像，将探针沿椎管方向移动，并在纵平面上获取实时图像。为了可视化脊髓和病变，就像MRI的轴向图像一样，将探针垂直于椎管放置，并在横向平面上获取实时图像。然后获取实时图像以验证任何无法直接可视化的病变的位置，以与术前计算机断层扫描或MRI图像相关联，以指导手术工具的放置，和/或确认病理的分辨率。术前成像近似于硬膜内肿块相对于其已知邻近结构的位置。在这里，术中超声与术前MRI成像相关，显示病变部位上方的积液。轴向术中超声显示肿块包含大部分脊髓，并使用0.5×0.5厘米的无菌压缩海绵来确认肿瘤的卡限。然后进行术中切除后超声检查，以确认肿瘤的完全切除和占位效应的消退。在无症状胸椎间盘突出症中，通过术中超声后路切除有助于评估减压并确保切除所有压缩盘碎片。同样，在腰椎爆裂骨折的情况下，术中超声有助于确认充分减压和去除所有碎片。因此，在进行脊柱手术的超声检查时，重要的是要有耐心，并为该区域提供更广阔的视野，并使用大探头来获得干净的成像。以患者为例，获得脊髓的漂亮干净的轴向和矢状视图，以便用超声图像干净地定义脊髓与肿瘤或病变之间的关系。

Research

JoVE Journal

Medicine

Acute and Chronic Tactile Sensory Testing after Spinal Cord Injury in Rats

在大鼠脊髓损伤后的急性和慢性触觉测试

Spinal cord injury (SCI) impairs sensory systems causing allodynia1-8. To identify cellular and molecular causes of allodynia, sensitive and valid sensory ...

科研

医学

Reproducable Paraplegia by Thoracic Aortic Occlusion in a Murine Model of Spinal Cord Ischemia-reperfusion

可重放截瘫胸主动脉阻断脊髓缺血再灌注的小鼠模型

Background
Lower extremity paralysis continues to complicate aortic interventions. The lack of understanding of the underlying pathology has hindered ...

Controlled Cortical Impact Model for Traumatic Brain Injury

控制皮层影响模型创伤性脑损伤

Every year over a million Americans suffer a traumatic brain injury (TBI).  Combined with the incidence of TBIs worldwide, the physical, emotional, ...

Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research

肱动脉的临床研究超声评价血管内皮依赖性血流介导的血管舒张功能

The vascular endothelium is a monolayer of cells that cover the interior of blood vessels and provide both structural and functional roles. The ...

Contrast Enhanced Ultrasound Imaging for Assessment of Spinal Cord Blood Flow in Experimental Spinal Cord Injury

超声造影成像脊髓血流量的评估实验脊髓损伤

Reduced spinal cord blood flow (SCBF) (i.e., ischemia) plays a key role in traumatic spinal cord injury (SCI) pathophysiology and is accordingly an ...

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

胃镜检查术在腹腔镜手术的肿瘤定位于胃腺癌

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

锥形束术中计算机断层扫描图像指南,用于微创跨体间融合

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way

口腔癌切除边缘的术中评估：这是方法

The goal of head and neck oncological surgery is complete tumor resection with adequate resection margins while preserving acceptable function and ...

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

内镜超声引导下胆道引流：内镜超声引导下肝胃造瘘术治疗恶性胆道梗阻

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde ...

Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture

骨科机器人辅助股骨颈系统治疗股骨颈骨折

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm ...