经皮颈椎后路内窥镜术安全性的应用解剖学

Anatomic study for the safety of percutaneous posterior endoscopic cervical discectomy

[目的]通过应用解剖学方法探讨经皮颈椎后路内窥镜下颈椎间盘切除术的安全性因素,为临床手术提供理论依据。[方法]选取5具成人尸体标本,观测侧块高度(a)、宽度(b);以关节突关节间隙后内侧缘交点(O点)为中心,建立平面直角坐标系,观测O点与对应节段神经根下缘和硬脊膜外侧缘交点(A点)、下一节段神经根上缘与硬脊膜外侧缘交点(B点)的位置关系及各象限重要结构的毗邻关系;O点与硬脊膜外侧缘的水平距离(e)、与椎动脉前壁的垂直距离(g)以及内侧壁的水平距离(j);椎动脉内侧壁与硬脊膜外侧缘的水平距离(d);神经根与下关节突交点和硬脊膜外侧缘的水平距离(c);上位椎弓根内下缘(G点)与下位椎弓根内上缘(H点)连线与O点的水平距离(f);AB间的距离(k)。所得数据行统计学分析。[结果]a为(10.17±0.66)mm^(11.69±0.97)mm;b为(10.30±0.89)mm^(12.29±0.47)mm;e为(5.66±0.51)mm^(7.57±0.44)mm;g为(3.79±0.44)mm^(4.29±0.47)mm;d为(5.73±0.47)mm^(8.29±0.70)mm;c为(6.90±0.60)mm^(8.27±0.44)mm;f为(1.69±0.87)mm^(4.83±0.96)mm;j为(4.81±0.90)mm^(7.40±0.79)mm;k为(18.12±1.11)mm^(20.87±1.19)mm。[结论]PPECD中O点是更具临床意义的定位点,可作为手术入点标示开骨窗安全范围、准确定位病变部位并避免损伤椎管内外重要结构。

[Objective] To study the safety factors of percutaneous posterior endoscopic cervical discectomy. [Methods] Five adult cadaver specimens were selected, the height （a） and width （b） of the lateral mass was measured. Then, the plane rectangular coordinate system was established based on the intersection point of the medial edge of the articular process （ point O ） , and the relationship between point O and intersection point of the lower edge of nerve root and the lateral border of epidural （point A ） was observed, and the relationship between point O and intersection point of the upper edge of the lower segment of nerve root and the lateral border of epidural （point B） was observed, as well as the relationship to adjacent important structures in each quadrant. Thereafter. various anatomic distances were measured for statistical analysis, including horizontal distance （e） between point O and lateral border ofepidural, the vertical distance （g） between point O and front wall of the vertebral artery , the horizontal distance （J） between point O and the medial wall. the horizontal distance （d） between medial wall of the vertebral artery and lateral border of epidural, the horizontal distance （c） between the intersection point of the nerve root and the inferior articular process and lateral border of epidural, the horizontal distance （f） between point O and the connecting line of inferior margin of upper pedicle of vertebral arch （point G） and inferior pedicle of vertebral arch （point H）, and the distance between AB （k）, respectively. [Resultsl The results revealed that, awas （10.17±0.66） mm- （11.69±0.97） mm, bwas （10.30±0.89） mm- （12.29±0.47） mm, ewas （5.66±0.51） mm- （7.57±0.44） mm, g was （3.79±0.44） mm- （4.29±0.47） mm, d was （5,73±0.47） mm- （8.29±0.70） mm, c was （6.9±0.60） mm- （8.27±0.44） mm, fwas （1.69±0.87） mm- （4.83±0.96） mm, j was （4.81±0.90） -（7.40±0.79） ram, k was （18.12±1.11） mm- （20.87± 1.19） mm. [Conclusion] In PPECD surgery, point O is a more clinically meaningful point, which can be used as an anchor point to ＂determine the safety window of bone openning and accurate location of the lesion, at the same time, avoiding injuries of the important structure of spinal canal.