超音波於脊椎及周邊神經微創手術的的應用

Abstract

背景: 傳統上，在進行脊椎及周邊神經微創手術時並不會使用超音波作為導引工具，而是用Ｘ光。然而X光並無法清楚顯像軟組織，重要的軟組織結構存在受損的風險。此外，周邊神經手術減壓是否徹底傳統上也沒有一個好的影像評估工具。透過術中超音波的應用，軟組織結構可以清楚辨識，進而提高微創手術的精準度與安全度。透過動態超音波的應用，更可用以確認周邊神經減壓是否充足。因此，本研究闡明進行微創手術時的超音波應用技術，以期增進病患福祉。

方法: 對於應用超音波於脊椎微創手術，可用解剖結構的特異性來定位脊椎節段。運用超音波來顯示脊椎周圍的重要軟組織結構，包括食道、神經根、椎動脈、頸動脈、肺臟表面及肋膜、腸道、腎臟等，藉此避免這些重要結構的穿刺損傷。進行微創周邊神經減壓手術時，可運用動態超音波顯示周邊神經活動的狀態，藉此確保神經的減壓足夠。高解析超音波可清楚顯示頸椎神經根及周邊神經，甚至連神經裡的數個神經束都可清楚呈現，有助於神經病兆的評估，透過超音波導引更可以精確地將營養送到神經周圍以促進神經修復。

結果: 在脊椎及周邊神經微創手術使用超音波有助減少輻射暴露, 提高成功穿刺率 , 預防X光無法顯像的軟組織器官受到傷害。透過動態超音波，更可用以確保周邊神經減壓足夠。 結論: 超音波可以輔助微創手術的進行，有助於提升微創手術的精準度與安全性，希望透過此研究協助醫師熟稔超音波於微創手術的應用技術，進而增進病患福祉。

Background: Traditionally, ultrasound is not used as a guidance tool for minimally invasive spine and peripheral nerve surgeries, instead, X-ray is used. However, X-rays cannot clearly image soft tissue structures, which increases the risk of damage to important soft tissue structures. In addition, there is no good imaging assessment tool for evaluating the completeness of peripheral nerve decompression surgery. The application of intraoperative ultrasound can clearly identify soft tissue structures, thereby improving the accuracy and safety of minimally invasive surgery. Using dynamic ultrasound, it can also be used to confirm whether peripheral nerve decompression is sufficient. Therefore, this study elucidates the application of ultrasound in minimally invasive surgery to improve patient welfare. Methods: In applying ultrasound to minimally invasive spine surgery, the specific anatomical structures of spine can be used to locate the spinal level. Ultrasound is used to display important soft tissue structures surrounding the spine, including the esophagus, nerve roots, vertebral arteries, carotid arteries, lung surfaces and pleura, intestines, kidneys, etc., to avoid puncture damage to these important structures. During minimally invasive peripheral nerve decompression surgery, dynamic ultrasound can be used to display the status of peripheral nerve movement, thereby ensuring that nerve decompression is sufficient. High-resolution ultrasound can clearly display cervical nerve roots and peripheral nerves, even the fascicles within the nerve, which can help assess nerve pathology. Through ultrasound guidance, nutrients can be accurately delivered to the nerve periphery to promote nerve regeneration. Results: The use of ultrasound in minimally invasive spine and peripheral nerve surgery can reduce radiation exposure, improve successful puncture rate, and prevent soft tissue organ damage that cannot be imaged by X-rays. Through dynamic ultrasound, it can also be used to confirm whether peripheral nerve decompression is sufficient. Conclusion: Ultrasound can assist in the conduct of minimally invasive surgery, improving accuracy and safety. We hope that through this study, physicians will become more proficient in the application of ultrasound in minimally invasive surgery, thereby improving patient welfare.