颈椎后路经皮内镜椎间孔减压解剖学与3D-CT分析

发布时间：2018-06-27 03:49

本文选题：颈椎椎间孔 + 内窥镜　；参考：《中国矫形外科杂志》2017年21期

【摘要】：[目的]通过应用解剖学与3D-CT方法探讨颈椎后路经皮内镜颈椎间盘切除术(PPECD)行颈椎间孔减压安全有效范围。[方法]5具成人颈部标本,肉眼及显微镜观察C_3-C_7侧块内下端与椎板外下缘交点(O点)及术区毗邻解剖结构。此外,8例颈椎病患者行颈椎CTM,Mimics16.0软件重建颈椎3D-CT图像。经各点建立矢状面:O点、硬脊膜外侧缘、下位椎弓根峡部内侧缘M_((内))及外侧缘M_((外))。横断面测量距离及角度:侧块横径(a),V点与硬脊膜外侧缘(b),O点与M_((内))(c),O点与M_((外))(d),O点与V点(e),O点与硬脊膜外侧缘(f),经O点横断面上、下关节突重叠厚度(i),椎弓根峡部外径(k),椎弓根外倾角(m)。矢状面测量距离:O点与相邻上位M(下)(g)及与下位M(上)(h)。数据行统计学分析。[结果]差异无统计学意义:C_3-C_4~C_7-T_1f[(4.17±1.33)mm~(4.64±1.70)mm]、i[(6.06±2.07)mm~(7.20±1.93)mm](P0.05);差异有统计学意义:b[(-0.17±1.74)mm~(2.42±1.41)mm]C_3-C_4~C_5-C_6与C_7-T_1(P0.001);d[(-0.75±1.27)mm~(2.85±1.69)mm]C_3-C_4~C_5-C_6与C_7-T_1、C_3-C_4与C_6-C_7(P0.001);g[(6.79±1.04)mm~(9.57±1.27)mm]C_3-C_4~C_5-C_6与C_7-T_1(P0.001);h[(6.79±1.04)mm~(9.57±1.27)mm]C_3-C_4~C_6-C_7与C_7-T_1(P0.01)。[结论]O点与颈椎间孔关系密切,多贴近下位椎弓根峡部外上缘,与硬脊膜外侧缘距离恒定;C_7-T_1节段形态结构变化大。熟悉该特点,可准确界定减压安全、有效范围,避免或减少重要结构损伤。
[Abstract]:[objective] to investigate the safe and effective range of intervertebral foramen decompression by posterior cervical endoscopic discectomy (PPECD) by using anatomy and 3D-CT. [methods] 5 adult cervical specimens were observed with naked eye and microscope. The junction point (O point) between the lower end of C _ (3-C) C _ (7) side and the lower margin of the vertebral lamina and the adjacent anatomical structure of the operation area were observed. In addition, 8 patients with cervical spondylosis underwent CT CT reconstruction with Mimics16.0 software. The sagittal O point, the lateral dural margin, the medial margin of the pedicle isthmus and the outer). Of the lateral border of the pedicle isthmus were established at each point. Cross sectional measurement of distance and angle: lateral mass transverse diameter, (a) V point and (b) O point and M _ () (c) O point and M _ (external) (d) O point and V point (e) O point) and (f), point O point in the lateral margin of dura dural through the O point cross section, Inferior articular process overlap thickness (i), pedicle isthmus external diameter (k), pedicle external obliquity (m). Sagittal plane measure distance: O and adjacent epigyny M (lower) (g) and lower M (upper) (h).) The data were analyzed statistically. [缁撴灉]宸紓鏃犵粺璁″鎰忎箟:C_3-C_4~C_7-T_1f[(4.17卤1.33)mm~(4.64卤1.70)mm],i[(6.06卤2.07)mm~(7.20卤1.93)mm](P0.05);宸紓鏈夌粺璁″鎰忎箟:b[(-0.17卤1.74)mm~(2.42卤1.41)mm]C_3-C_4~C_5-C_6涓嶤_7-T_1(P0.001);d[(-0.75卤1.27)mm~(2.85卤1.69)mm]C_3-C_4~C_5-C_6涓嶤_7-T_1,C_3-C_4涓嶤_6-C_7(P0.001);g[(6.79卤1.04)mm~(9.57卤1.27)mm]C_3-C_4~C_5-C_6涓嶤_7-T_1(P0.001);h[(6.79卤1.04)mm~(9.57卤1.27)mm]C_3-C_4~C_6-C_7涓嶤_7-T_1(P0.01). [conclusion] the O point is closely related to the intervertebral foramen of cervical vertebrae, most of them are close to the outer upper edge of the isthmus of pedicle, and the distance from the lateral margin of the dural to the lateral margin of the dural is constant. The morphological structure of C7-T 1 segment changes greatly. Familiar with this characteristic, can accurately define decompression safety, effective range, to avoid or reduce important structural damage.
【作者单位】：滨州医学院附属医院脊柱外科;滨州医学院附属医院疼痛科;
【基金】：山东省自然科学基金资助项目(编号:ZR2017LH021) 山东省医药卫生科技发展计划资助项目(编号:2014WS0188)
【分类号】：R322.7;R687

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