经皮颈椎间盘切吸术前入路的应用解剖研究

Study of the applied anatomy of anterior enter route of percutaneous cervical diskectomy

目的 明确经皮颈椎间盘切吸术 (PCD)前入路的解剖层次及相应重要结构 ,探讨避免损伤重要结构的方法 ,提高PCD安全性及成功率。方法 8具成人尸体 ,按PCD前入路逐层解剖 ,观察通过的解剖层次及相应结构 ,并以数字相机照像记录。结果 PCD前入路通过颈动脉鞘与气管及食管之间的间隙 ,该间隙内主要为颈部筋膜及筋膜间隙 ,深面为椎前组织。在该间隙内穿行的主要解剖结构 :C3～ 4 水平有甲状腺上动、静脉及喉上神经 ,C3～ 7范围内有 0～ 3支甲状腺中静脉 ,C6～ 7水平有甲状腺下动脉及喉返神经 ,C5以下食管略偏向左侧 ,C6水平有交感神经颈中神经节 ,C5～ 7高度有甲状腺侧叶外缘。结论 PCD前路穿刺有安全的解剖基础。熟悉解剖结构及其功能意义 ,严格按规程操作 ,可有效预防并发症 。

Objective To acertain the anatomy levels and corresponding structures of the front enter route (FER) for percutaneous cervical diskectomy (PCD), together with the method of avoiding damage increase safety and success of PCD.Methods 8 cases of adult cavaders were anatomic cut into levels in turn of the FER for PCD. Paied attention to the passing levels and configurations and then recorded by digital camera. Results FER of PCD began with crossing the space of carotid sheath and trachea or esophagus, having cervical fascia, space and prevertebral layers there. Many important anatomic structures, such as at C 3～4 level, there are superior thyroid artery, vein and superior laryngeal nerve; C 3～7 level, there are 0～3 branches of middle thyroid vein; C 6～7 level, there are inferior thyroid artery and laryngeal recurrent nerve. Below C 5, esophagus goes somewhat left ward. At C 6 level, there is middle cervical ganglion; C 5～7 level, there is the outer edge of thyroid lateral lobe.Conclusions The FER of PCD is safety, familiar with the anatomic structures and their function, keep the rules of operation for preventing complications.