三维CT指导经皮内镜后外侧入路治疗胸椎间盘突出症建立良好的骨性通道  

Three-dimensional CT analysis of the treatment of thoracic disc herniation by percutaneous endoscopic posterolateral approach: establishment of a good osseous channel

作　　者：李岳飞 李瑞[1] 任佳彬[1] 刘鑫[1] 孙宁[1] 刘维克 毕经纬 孙兆忠[1] Li Yuefei;Li Rui;Ren Jiabin;Liu Xin;Sun Ning;Liu Weike;Bi Jingwei;Sun Zhaozhong(Department of Spinal Surgery,Binzhou Medical University Hospital,Binzhou 256603,Shandong Province,China;Department of Orthopedics,Binzhou Hospital of Traditional Chinese Medicine,Binzhou 256600,Shandong Province,China)

机构地区：[1]滨州医学院附属医院脊柱外科,山东省滨州市256603 [2]滨州市中医医院骨科,山东省滨州市256600

出　　处：《中国组织工程研究》2021年第21期3354-3359,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:经皮脊柱内镜技术治疗胸椎间盘突出症的国内外文献报道甚少,尚未对该技术的手术适应证、技术要点、技术局限性等进行深入阐述。目的:通过三维CT成像指导经皮脊柱内镜后外侧入路治疗胸椎间盘突出症。方法:纳入2017年8月至2020年3月滨州医学院附属医院收治的13例胸椎间盘突出症患者,行胸椎电子计算机断层扫描脊髓造影检查,重建胸椎三维CT图像。①测量下关节突外下缘与上关节突外侧缘交点(Y点)至硬脊膜外侧缘(a)、关节突关节内侧缘(b)、上位椎体下终板(c)、下位椎体上终板的距离(d),测量硬脊膜外侧缘至椎弓根根部内侧缘与椎体中线夹角(g),硬脊膜外侧缘至椎体后正中与椎体中线夹角(h)。于肩胛骨位置(T_(1/2)-T6/7)水平,横断面测量相应节段椎弓根根部内侧缘至肩胛骨内侧缘与椎体中线夹角(i)。在软件三维视图中,根据工作通道创建直径7.5 mm 3D圆柱体导板,观察导板到达椎弓根根部内侧缘通道经过的骨性结构,测量关节突关节缺损范围(j)。②13例患者均行经皮脊柱内镜后外侧入路胸椎间盘切除术治疗,采用目测类比评分、日本骨科协会(JOA)胸脊髓功能评分、Oswestry功能障碍指数及改良Mac Nab评估临床疗效。研究获得滨州医学院附属医院伦理委员会批准。结果与结论:①T_(2/3)-T10/11椎体间Y点至硬脊膜外侧缘的距离比较差异无显著性意义(P> 0.05),T_(1/2)-T10/11椎体间Y点至关节突关节内侧缘的距离比较差异无显著性意义(P> 0.05);②T_(1/2)椎体矢状面上Y点投影在椎间隙上方,其余节段矢状面上Y点投影在椎间隙水平;③T_(1/2)椎体hi,导板外展时被肩胛骨阻挡;④13例患者末次随访的目测类比评分、JOA胸脊髓功能评分与Oswestry功能障碍指数评分均较术前明显改善(P<0.05),改良Mac Nab术后优良率为92%;⑤由于T_(1/2)-T_(4/5)节段位置深在且被肩胛骨等阻挡,工作通道外展受�BACKGROUND:There are few domestic and foreign literature reports on the treatment of thoracic disc herniation by percutaneous endoscopy,and the operative indications,technical points and technical limitations of this technique have not been thoroughly expounded.OBJECTIVE:To guide the treatment of thoracic disc herniation by the percutaneous endoscopic posterolateral approach through three-dimensional CT imaging.METHODS:Thirteen patients with thoracic disc herniation admitted to the Affiliated Hospital of Binzhou Medical College from August 2017 to March 2020 were included.Thoracic computed tomography myelograhy examination was performed and three-dimensional CT images of thora cic vertebra were reconstructed.(1)Measu ring articular process under the lower edge and articular process on the lateral margin of inte rsection point(Y)to the late ral edge of dura mater(a),medial margin of articular process(b),lower endplate of upper vertebra(c),and distance of upper endplate of lower vertebra(d),angle between lateral margin of dura mater to medial margin of vertebral arch root and vertebral body centerline(g),angle between the late ral edge of dura mater to poste rior midline of the ve rtebral bodies and vertebral body centerline(h).At the level of the scapula(T1/2-T6/7),the angle between the medial edge of the vertebral arch root to the medial edge of the scapula and the midline of the vertebral body was measured in cross section(i).In the 3D view of the software,a 7.5-mm 3D cylindrical guide plate was created according to the working channel,and the osseous structure of the guide plate to the inner edge channel of the vertebral arch root was observed,and the range of facet joint defect(j)was measured.(2)All the 13 patients underwent thoracic discectomy via percutaneous endoscopic posterolateral approach.Visual analogue scale score,Japanese Orthopedic Association thoracic spinal function score,Oswestry disability index and modified MacNab were used to evaluate the clinical efficacy.The study was approved by the Ethics

关 键 词：骨 椎间盘突出症 三维CT 经皮脊柱内镜 后外侧入路 胸椎间盘切除 骨性通道 临床疗效 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]