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目的应用CT引导下穿刺活检对寰枢椎病变作定性诊断并探讨其在确定治疗方案中的作用。方法对22例寰枢椎病变行CT引导下穿刺活检 ,男7例 ,女15例。侧方及后外侧进针 ,局麻下操作。结果22例中 ,结核7例 ,转移性肿瘤4例 ,骨巨细胞瘤、骨髓瘤、低度恶性组织细胞瘤各2例 ,脊索瘤、嗜酸性肉芽肿、神经纤维瘤、软骨肉瘤各1例 ,纤维及坏死组织1例。活检阳性率95.4 % ,假阴性率4.6 %。手术治疗10例 ,手术后病理证实活检正确率100 %。非手术治疗12例 ,失访1例 ,随访11例均得到证实。4例患者穿刺活检后出现局部轻微疼痛 ,无严重并发症发生。结论寰枢椎局部解剖关系复杂 ,病变的诊断及治疗困难 ,采用CT引导下穿刺活检能获得明确的病理诊断 ,在指导治疗中具有重要作用。
Objective To apply CT-guided biopsy for the diagnosis of atlanto-axial lesions and to explore its role in the determination of treatment regimen. Methods Twenty-two patients with atlanto-axial lesions underwent CT-guided biopsy. There were 7 males and 15 females. Lateral and posterolateral needle, under local anesthesia operation. Results Among the 22 cases, 7 cases were tuberculosis, 4 cases were metastatic tumor, 2 cases were giant cell tumor of bone, 2 cases of myeloma and 2 cases of low grade malignant histiocytoma, 1 case of chordoma, eosinophilic granuloma, neurofibromatosis and chondrosarcoma 1 case of fibrous and necrotic tissue. The biopsy positive rate was 95.4% and the false negative rate was 4.6%. Surgical treatment in 10 cases, pathologically confirmed biopsy correct rate of 100%. Non-surgical treatment in 12 cases, 1 case of loss of follow-up were confirmed in 11 cases. Four patients had local minor pain after biopsy and no serious complications occurred. Conclusions The anatomy of atlantoaxial vertebra is complex and the diagnosis and treatment of the lesions are difficult. CT-guided biopsy can obtain a clear pathological diagnosis and play an important role in guiding the treatment.