3D-CT指导单孔分体脊柱内镜精准切除钩状突减压颈神经的安全性研究  

Safety study of 3D-CT-guided one-hole split endoscope for precise resection of uncinate process for decompression of cervical nerve

作　　者：刘昌震 王红艳 孙兆忠[1] 孙宁[1] 冯志萌 李洒 李岳飞 LIU Chang-zhen;WANG Hong-yan;SUN Zhao-zhong;SUN Ning;FENG Zhi-meng;LI Sa;LI Yue-fei(Department of Spinal Surgery,Binzhou Medical University Affiliated Hospital,Binzhou 256600,China;Department of Pain,Binzhou Medical University Affiliated Hospital,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院脊柱外科,滨州256600 [2]滨州医学院附属医院疼痛科,滨州256600

出　　处：《中国疼痛医学杂志》2024年第7期515-521,共7页Chinese Journal of Pain Medicine

基　　金：国家重点研发计划资助项目(2017YFC0114002);山东省自然科学基金资助项目(2R2017LH021);滨州市社会发展科技创新计划(2023SHFZ034)。

摘　　要：目的:观测钩状突尖端(uncinate process tip,UPT)、椎弓根峡部和颈神经之间的位置关系,为单孔分体脊柱内镜辅助颈椎前路椎间盘切除减压融合术中钩状突精准切除实现颈神经彻底减压提供临床数据参考。方法:选取2016年8月至2021年1月滨州医学院附属医院的26例神经根型颈椎病病人资料,并在Mimics21.0上观测C3~4至C7~T1相关参数:UPT分别至UPT所在矢状面的颈神经前缘前后距离(a)、UPT所在矢状面的颈神经下缘垂直距离(b)、颈神经起点上缘左右距离(c)、颈神经起点上缘垂直距离(d)、颈神经起点下缘垂直距离(e)、椎弓根峡部外侧缘前后距离(f)、椎弓根峡部外侧缘左右距离(g)、颈神经外展角(∠A)、前倾角(∠B)。结果:C_(3~4)至C_(7)~T_(1),同节段不同性别、不同侧别之间差异无统计学意义;同节段b、e之间差异无统计学意义,表明减压UPT所在矢状面的颈神经下缘即可实现颈神经起点下缘减压;随着C_(3~4)至C_(7)~T_(1)节段降低,a逐渐减小;b、d、e、g、∠A、∠B逐渐增加;c、f先增加后减小(P<0.05)。结论:以UPT作为重要骨性标志点,明确颈神经减压范围并精准切除钩状突。UPT向前(0.9±0.5)mm至(2.3±1.3)mm至椎弓根峡部外侧缘,向外磨透钩状突,可完成UPT至椎弓根区出口处颈神经腹侧减压;向上(5.5±2.1)mm至(8.0±3.0)mm、向内(1.1±0.5)mm至(1.9±0.9)mm分别磨除部分上位椎体和钩状突后外侧壁增生骨赘,可显露硬脊膜外侧缘和颈神经起点上缘,完成UPT至颈神经起点减压,为手术精准切除钩状突安全减压颈神经提供理论依据。Objective:To observe the position relationship between the uncinate process tip(UPT),the isthmic part of the pedicle and the cervical nerve,and provide clinical data reference for the precise removal of the uncinate process to achieve complete decompression of the cervical nerve during the anterior cervical discectomy and decompression fusion assisted by the one-hole split endoscope.Methods:Data of 26 patients with cervical radiculopathy in Binzhou Medical University Affliated Hospital from August 2016 to January 2021 were selected,and C_(3~4) to C_(7)~T_(1) related parameters were observed on Mimics21.0:The distance between UPT and anterior cervical nerve in sagittal plane(a),the vertical distance between inferior cervical nerve in sagittal plane(b),the left and right distance between upper margin of cervical nerve origin(c),the vertical distance between upper margin of cervical nerve origin(d),the vertical distance between lower margin of cervical nerve origin(e),the distance between anterior and posterior margin of pedicle isthmus(f),and the left lateral margin of pedicle isthmus Right distance(g),cervical nerve abduction Angle(∠A),forward Angle(∠B).Results:There was no significant difference in C_(3~4) to C_(7)~T_(1) between different sexes and different sides in the same segment.There was no statistically significant difference between the same segment b and e,indicating that the lower margin of cervical nerve at sagittal surface where decompression UPT was located could achieve decompression at the lower margin of cervical nerve origin.With the decrease of C_(3~4) to C_(7)~T_(1) segment,a gradually decreased;b,d,e,g,∠A,∠B gradually increase;c and f increasedfirst and then decreased(P<0.05).Conclusion:Using UPT as an important bone marker,the decompression range of cervical nerve was defined and the uncinate process was accurately removed.The UPT was(0.9±0.5)mm to(2.3±1.3)mm forward to the lateral border of the isthmus of the pedicle,and the uncinate process was ground outward to complete the ven

关 键 词：3D-CT 单孔分体脊柱内镜 颈椎前路椎间盘切除减压融合术 钩状突尖端 

分 类 号：R687.3[医药卫生—骨科学]