显微内镜治疗神经根型颈椎病后侧入路的解剖学研究

Anatomical research on the posterior entrance in the treatment of radix type of cervical spondylopathy with microendoscopic discectomy system

目的 探讨后侧手术入路的显微内镜治疗神经根型颈椎病的可行性和安全性。方法 取 10具尸体的第 3～ 7颈椎。以其棘突中点连线为后正中线 ,上、下小关节突外缘为外边线 ,两侧上、下位椎板重叠内缘交点相连为横线 ,分别测量横线及外边线间距。距后正中线旁开 10mm处垂直插入定位针达相应间隙椎板后缘 ,测量进针深度 ,沿定位针逐层解剖 ,观测入路行径。结果 横线间距为 11 3 8～ 19 0 2mm ,平均每侧为后正中线旁开 5 69～ 9 5 1mm ,而边线间距为 4 6 3 2～ 5 7 2 8mm ,平均每侧为后正中线旁开 2 3 16～ 2 8 64mm。进针深度为 2 0 0 5～ 3 1 98mm。取距后正中线旁开 10mm处为进针点 ,进针角度以矢状面 0° ,横断面向下倾斜 0°～ 2 0°插入定位针 ,不会引起意外损伤。

Objective To approach the feasibility and security of posterior entrance in the treatment of radix type of cervical spondylopathy with microendoscopic discectomy system(MED).Methods The 3rd to 7th cervical vertebrae of total 10 cadavers were used.The line connecting the midpoint of every spinous process was posterior median line;The line connecting the outer margin of every articular process is lateral line;The line between the intersecting point of the overlaying innermargin of the two adjective vertebral lamina was called transversal line.The spacing between the two transversal lines and the two lateral lines was measured.Guide pin was inserted vertically at the point 10 cm to posterior median line untill it reached the posterior margin of corresponding vertebral lamina.The depth of needle insertion was measured.Dissection was done layer of layer along the guide pin to observe the structure passing through.Results The spacing between the two transversal lines was 11 38～19 02 mm.The mean distance to posterior median line was 5 69～9 51 mm.The spacing between the two lateral line was 46 32～57 28 mm.The mean distance to posterior median line was 23 16～28 64 mm.The depth of needle insertion was 20 05～31 98 mm.If the needle was inserted at the point 10 mm to posterior median line,took a direction 0 degree with sagittal plane and (0～20)degree with transvers plane,no unexpective injure would occur.Conclusion Posterior entrance is feasible and secure in the treatment of radix type of cervical spondylopathy with microendoscopic discectomy system(MED).