CT三维成像在颈后路经皮脊柱内镜术中“V”点定位的作用

Application of three-dimensional CT imaging technology in the determination of the"V"point in posterior cervical approach percutaneous spinal endoscopic surgery

目的探讨CT三维成像(three-dimensional computed tomography,3D-CT)技术在颈椎后路经皮脊柱内镜椎间孔减压髓核摘除术中“V”点确定的应用价值。方法回顾分析2016年1月至2019年3月行颈椎后路经皮脊柱内镜椎间孔减压髓核摘除术并成功随访的患者50例,均为单侧症状的神经根型颈椎病,经保守治疗6周以上无效,且颈椎动力位X线片未发现颈椎失稳。其中男性27例,女性23例,平均年龄54.2(40~75)岁,C_(4/5)节段14例,C_(5/6)节段25例,C_(6/7)节段11例。患者分为两组,术中常规C臂X线机下定位“V”点为A组(26例),术前通过3D-CT技术确定“V”点为B组(24例),比较二组平均住院时间、手术时间、术中透视次数和手术疗效,并进行统计学分析。结果50例患者平均随访时间(7.20±2.56)月(3~13月),A组平均手术时间和术中透视次数多于B组(P<0.05);平均住院时间、术后随防评分、颈椎曲度、手术节段椎间隙高度及颈椎稳定性,二组无显著差异(P>0.05)。结论3D-CT技术在颈椎后路经皮脊柱内镜手术中“V”点定位有重要意义。

Objective To evaluate the application value of three-dimensional computed tomography(3D-CT)in determining the"V"point in transforaminal decompression and nucleus pulposus enucleation of posterior cervical approach by using percutaneous spinal endoscopy.Methods A retrospective analysis was made on 50 patients who underwent transforaminal decompression and nucleus pulposus enucleation of posterior cervical spine approach by using percutaneous spinal endoscopy and followed up from January 2016 to June 2018.They all sufferred from cervical spondylotic radiculopathy with unilateral symptoms,conservative treatment for more than 6 weeks were ineffective for them.The dynamic X-ray film of cervical spine showed no instability of cervical spine.There were 27 males and 23 females,with an average age of 54.2(40~75)years,14 cases of C_(4/5) segment,25 cases of C_(5/6) segment and 11 cases of C_(6/7) segment.Fifty patients were divided into groups A(26 cases)and group B(24 cases).The patients were positioned according to the intraoperative conventional"V"point positioning method using C-arm X-ray machine in group A,and the patients determined the"V"point using the 3D-CT technology method before the operation in group B.The average hospital stay,operation time,number of intraoperative fluoroscopy and surgical efficacy between the two groups were compared and statistically analyzed.Results All 50 patients were followed up for an average of(7.20±2.56)months(3-13 months),The average operation time and intraoperative fluoroscopy in group A were more than those in group B(P<0.05).There was no signiant difference in the average hospital stay,postoperative follow-up score,the curvature of the cervical spine,the height of the intervertebral space of the operation segment and the stability of the cervical spine between the two groups(P>0.05).Conclusions 3D-CT technology plays an important role in determining the"V"point in posterior cervical approach percutaneous spinal endoscopic surgery.