后路经皮内窥镜下颈椎椎间盘切除术的解剖学研究及临床意义  

Anatomical study of posterior percutaneous endoscopic cervical discectomy and its clinical significance

作　　者：曹禹文 刘由军[2] 袁佳 江凯燕 徐聪[1] CAO Yu-wen;LIU You-jun;YUAN Jia;JIANG Kai-yan;XU Cong(Department of Orthopedics,the Fourth Affiliated Hospital of Nanchang University,Nanchang 330003,Jiangxi Province,China;Department of Radiology,the Fourth Affiliated Hospital of Nanchang University,Nanchang 330003,Jiangxi Province,China;Fourth Clinical Medical College of Nanchang University,Nanchang 330027,Jiangxi Province,China)

机构地区：[1]南昌大学第四附属医院骨科,南昌330003 [2]南昌大学第四附属医院放射科,南昌330003 [3]南昌大学第四临床医学院,南昌330027

出　　处：《中国临床解剖学杂志》2020年第3期246-249,共4页Chinese Journal of Clinical Anatomy

基　　金：江西省自然科学基金项目(20151BAB205052)。

摘　　要：目的探讨后路经皮内窥镜下颈椎椎间盘切除术的安全范围。方法选取20具成人颈椎标本,分别测量C3/C4至C6/C7各节段左右两侧V点与硬脊膜外侧距离、V点与椎动脉水平及垂直距离、小关节面宽度,并进行统计学比较。结果 V点与硬脊膜外侧距离为:左(1.31±0.32)^(2.46±0.60)mm,右(1.29±0.35)^(2.75±0.45)mm,各节段间差别有统计学意义,同一水平左右差别无统计学意义;V点与椎动脉水平距离为:左(2.17±0.42)^(5.10±0.93)mm,右(1.99±0.39)^(5.00±0.71)mm,各节段间差别有统计学意义,同一水平左右差别无统计学意义;V点与椎动脉垂直距离为:左(11.05±1.06)^(13.47±1.12)mm,右(11.33±1.20)^(13.61±1.01)mm,同一水平左右侧差别有统计学意义,节段间比较C3/C4与C4/C5无明显差异,其余节段间差别均有统计学意义;小关节面宽度为:左(10.79±0.93)^(12.66±0.88)mm,右(10.86±0.68)^(12.54±0.70)mm。结论后路经皮内窥镜下颈椎椎间盘切除术的安全范围宜控制在距V点内侧C3/C4至C6/C7各水平1.20~2.00 mm;磨除范围距V点外侧C3/C4至C6/C7各水平超过2.00~5.00 mm时可能到达椎动脉体表投影处,因此需注意此时的手术进入深度宜控制在:C3/C4~C6/C7各节段距V点11.00~14.00 mm。Objective To explore the safety operation area of posterior percutaneous endoscopic cervical discectomy. Methods 20 adult cervical spine specimens were taken to measure the distances between the V-point and the lateral spine dura mater, the horizontal and vertical distances between the V-point and the vertebral artery, and the width of the facet joints on the left and right sides of C3/C4 to C6/C7 respectively. Statistical comparison of the data was made. Results The distance between the V point and the lateral spine dura mater was: left(1.31±0.32~2.46±0.60) mm;right(1.29±0.35~2.75±0.45) mm. There was no statistical difference between left and right of the same level, but there was statistical difference among different segments. The horizontal distance between point V and vertebral artery was: left(2.17±0.42~5.10±0.93) mm, right(1.99±0.39~5.00±0.71) mm. There was no statistical difference between left and right of the same level, but there was statistical difference among different segments. The vertical distance between point V and vertebral artery was: left(11.05±1.06~13.47±1.12) mm, right(11.33±1.20~13.61±1.01) mm. There was statistical difference between left and right of the same level,but no statistical difference among the segment of C3/C4 and C4/C5. The width of facet joints was: left(10.79±0.93~12.66±0.88)mm,right(10.86±0.68~12.54±0.70) mm. Conclusions The safety operation area of posterior percutaneous endoscopic cervical discectomy should be controlled within the range of 1.20~2.00 mm from C3/C4 to C6/C7 on the medial side of the V-point. When the grinding range is more than 2.00~5.00 mm from the C3/C4 to C6/C7 on the lateral side of the V-point, it may reach the body surface projection of vertebral artery. Therefore the depth of surgical entry should be controlled at 11.00~14.00 mm from segments of C3/C4~C6/C7 to the V-point.

关 键 词：颈椎 后路 应用解剖 内窥镜 V点 

分 类 号：R323.2[医药卫生—人体解剖和组织胚胎学]