本文選題：頸椎椎間孔 + 內(nèi)窺鏡�。� 參考：《中國矯形外科雜志》2017年21期

【摘要】：[目的]通過應(yīng)用解剖學(xué)與3D-CT方法探討頸椎后路經(jīng)皮內(nèi)鏡頸椎間盤切除術(shù)(PPECD)行頸椎間孔減壓安全有效范圍。[方法]5具成人頸部標(biāo)本,肉眼及顯微鏡觀察C_3-C_7側(cè)塊內(nèi)下端與椎板外下緣交點(O點)及術(shù)區(qū)毗鄰解剖結(jié)構(gòu)。此外,8例頸椎病患者行頸椎CTM,Mimics16.0軟件重建頸椎3D-CT圖像。經(jīng)各點建立矢狀面:O點、硬脊膜外側(cè)緣、下位椎弓根峽部內(nèi)側(cè)緣M_((內(nèi)))及外側(cè)緣M_((外))。橫斷面測量距離及角度:側(cè)塊橫徑(a),V點與硬脊膜外側(cè)緣(b),O點與M_((內(nèi)))(c),O點與M_((外))(d),O點與V點(e),O點與硬脊膜外側(cè)緣(f),經(jīng)O點橫斷面上、下關(guān)節(jié)突重疊厚度(i),椎弓根峽部外徑(k),椎弓根外傾角(m)。矢狀面測量距離:O點與相鄰上位M(下)(g)及與下位M(上)(h)。數(shù)據(jù)行統(tǒng)計學(xué)分析。[結(jié)果]差異無統(tǒng)計學(xué)意義: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);差異有統(tǒng)計學(xué)意義:b[(-0.17±1.74)mm~(2.42±1.41)mm]C_3-C_4~C_5-C_6與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與C_7-T_1、C_3-C_4與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與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與C_7-T_1(P0.01)。[結(jié)論]O點與頸椎間孔關(guān)系密切,多貼近下位椎弓根峽部外上緣,與硬脊膜外側(cè)緣距離恒定;C_7-T_1節(jié)段形態(tài)結(jié)構(gòu)變化大。熟悉該特點,可準(zhǔn)確界定減壓安全、有效范圍,避免或減少重要結(jié)構(gòu)損傷。
[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. [緇撴灉]宸紓鏃犵粺璁″鎰忎箟:C_3-C_4~C_7-T_1f[(4.17鹵1.33)mm~(4.64鹵1.70)mm],i[(6.06鹵2.07)mm~(7.20鹵1.93)mm](P0.05);宸紓鏈夌粺璁″鎰忎箟:b[(-0.17鹵1.74)mm~(2.42鹵1.41)mm]C_3-C_4~C_5-C_6涓嶤_7-T_1(P0.001);d[(-0.75鹵1.27)mm~(2.85鹵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鹵1.04)mm~(9.57鹵1.27)mm]C_3-C_4~C_5-C_6涓嶤_7-T_1(P0.001);h[(6.79鹵1.04)mm~(9.57鹵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.
【作者單位】： 濱州醫(yī)學(xué)院附屬醫(yī)院脊柱外科;濱州醫(yī)學(xué)院附屬醫(yī)院疼痛科;
【基金】：山東省自然科學(xué)基金資助項目(編號:ZR2017LH021) 山東省醫(yī)藥衛(wèi)生科技發(fā)展計劃資助項目(編號:2014WS0188)
【分類號】：R322.7;R687

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