颈椎前路减压手术解剖标志定位测量及其临床意义

Measurement and clinical significance on anatomic landmark of anterior cervical decompression

目的为颈椎前路减压手术在有限显露术野中达到安全、有效减压提供更科学的减压标志。方法在15具成人尸体标本上,解剖观测C3~7节段相关解剖数据,以所测量的数据为基础,计算：（1）椎体钩前脚至颈长肌内侧缘的距离/颈长肌内侧缘至正中矢状面的距离（AULD/MLPD）;（2）椎体钩前脚至横突孔内侧缘的距离/椎体钩前脚至颈长肌内侧缘的距离（AUTD/AULD）;（3）椎体钩前脚至硬膜囊外侧缘的垂直距离/椎体钩后脚至硬膜囊外侧缘的距离（AUDD/PUDD）和（4）椎体钩与神经根最近点和椎体钩前脚的垂直距离/椎体钩前后脚的垂直距离（UNAD/APUD）。结果 AULD/MLPD在C3的平均值为0.83,在C4的平均值为0.55,在C5的平均值为0.20,在C6的平均值为0.34,在C7的平均值为0.27;AUTD/AULD的平均值为2.71;AUDD/PUDD的平均值为0.28;UNAD/APUD的平均值为0.34。结论椎体钩前脚是颈椎体前部恒定的解剖标志,可作为颈椎前路手术的稳定、可靠的骨性减压标志,依据AUDD/PUDD、UNAD/APUD和AUTD/AULD的比值,有助于术中判断硬膜囊、颈神经根和椎动脉的位置。

Objective The primary purpose of the current study is to provide more scientific landmarks for safe and efficient decompression within limited operating field in cervical anterior decompression. Methods Relative data were observed and measured at C3~7 of 15 adult cadaveric specimens and some data were calculated basing on above data： the ratio of anterior crus of uncinate processmedial border of longus colli muscle distance and medial border of longus colli muscle-median sagittal plane distance（AULD/MLPD）, the ratio of anterior crus of uncinate process- medial border of foramen transversarium distance and anterior crus of uncinate process-medial border of longus colli muscle distance（AUTD/AULD）, the ratio of anterior crus of uncinate process- lateral border of dural sac perpendicular distance and posterior crus of uncinate process- lateral border of dural sac distance（AUDD/PUDD）, and the ratio of the nearest point of uncinate process and nerve root-anterior crus of uncinate process perpendicular distance and anteroposterior crus of uncinate process perpendicular distance（UNAD/APUD）. Results AULD/MLPD averaged 0.83 at C3, 0.55 at C4, 0.20 at C5, 0.34 at C6, and 0.27 at C7. AUTD/AULD averaged 2.71, AUDD/PUDD averaged 0.28, and UNAD/APUD averaged 0.34. Conclusion Anterior crus of uncinate process is a consistent anatomic landmark at anterior border of cervical vertebrae, which could serve as a stationary and reliable landmark in cervical anterior decompression, and facilitate the location of dural sac, cervical nerve root and vertebral artery during operation according to the ratios of AUDD/PUDD, UNAD/APUD and AUTD/AULD.