经椎体入路经皮内镜下颈椎间盘髓核摘除术的可行性研究

Transcorporeal percutaneous endoscopic cervical discectomy in cadaveric specimens

目的：探讨经椎体入路在经皮内镜下进行颈椎间盘髓核摘除神经减压的可行性。方法2014年3—9月,选取4具新鲜冰冻尸体标本进行前瞻性研究,男女各2具,年龄50~70岁。术前CT检查确定手术靶点和设计骨性通道,经C4、C5、C6、C7椎体入路手术各1具。于血管鞘和气管食管鞘之间进行椎体穿刺,置入工作外鞘于椎体内,镜下磨钻磨除骨质建立骨性通道,经皮内镜直视下去除突出的髓核及骨赘。记录手术时间、透视曝光次数,术后CT检查解剖术区相应组织结构。结果4具尸体均完成经椎体入路的经皮内镜下颈椎间盘髓核摘除术操作,C4和C5骨性通道方向为前上至后下,C6和C7为前下至后上。手术时间分别为92、73、65和60 min,平均72．5 min；术中透视次数24、21、19和18次,平均20．5次。术后CT检查证实骨性通道完整,椎体无骨折塌陷。结论经椎体入路在经皮内镜下进行颈椎间盘髓核摘除脊髓与神经根减压是可行的,该手术方式值得临床进一步研究应用。

Objective To evaluate the feasibility of transcorporeal percutaneous endoscopic cervical discectomy（ TcPECD） in a cadaver study. Methods Four selected fresh adult cadaver specimens, 50-70 years old, high-resolution computerized tomography （ CT ） data were collected before operating for transcorporeal tunnel design. Decompression of levels （ from C3/4 to C6/7 ） was used by transcorporeal approach in each specimen. A puncture needle was advanced into the target vertebra between vascular sheath and tracheoesophagus sheath under fluoroscopic guidance. A working channel with beveled end was inserted into the target vertebra. The rest of trajectory was constructed with high-speed drill under endoscopic monitoring. Decompression of dural and never root could be well obtained by visualized removing of the herniated disc fragment or osteophyte. Operating time and fluoroscopy frequency during the surgery were recorded. CT examination was performed after surgery. Results Surgeries were accomplished. The orientation of transcorporeal trajectory was from anterior superior to posterior inferior in C4 and C5 vertebral body, the orientation of transcorporeal trajectory was from anterior inferior to posterior superior in C6 and C7 vertebral body. The operation time was 92, 73, 65 and 60 min, mean 72. 5 min; the frequency of fluoroscopic checking was 24, 21, 19 and 18 times during the operating, mean 20. 5 times. Postoperative CT scanning was performed to confirm that the whole transcorporeal tunnel was retained and the target vertebra wasn′t collapsed. The important anatomical structures near surgical area were not damaged. Conclusions Transcorporeal percutaneous endoscopic cervical discectomy is technically feasible for cervical decompression, which needs to be proven in future clinical studies.