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

doi:10.13418/j.issn.1001-165x.2020.03.002

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (3) : 246-249. DOI: 10.13418/j.issn.1001-165x.2020.03.002

应用解剖

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

曹禹文¹，　刘由军²，　袁佳³，　江凯燕³，　徐聪¹

作者信息 +

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

CAO Yu-wen¹, LIU You-jun², YUAN Jia³, JIANG Kai-yan³, XU Cong¹

Author information +

文章历史 +

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。

Abstract

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.

导出引用

曹禹文, 刘由军, 袁佳, 江凯燕, 徐聪. 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[J]. 中国临床解剖学杂志. 2020, 38(3): 246-249 https://doi.org/10.13418/j.issn.1001-165x.2020.03.002

CAO Yu-wen, LIU You-jun, YUAN Jia, JIANG Kai-yan, XU Cong. Anatomical study of posterior percutaneous endoscopic cervical discectomy and its clinical significance[J]. Chinese Journal of Clinical Anatomy. 2020, 38(3): 246-249 https://doi.org/10.13418/j.issn.1001-165x.2020.03.002

中图分类号： R323.2

参考文献

[1] Ruetten S, Komp M, Merk H, et al. A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients[J]. Minim Invasive Neurosurg, 2007, 50(4): 219-226.
[2] Kim CH, Shin KH, Chung CK, et al. Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical discectomy[J]. Global Spine J, 2015, 5(1): 31-38.
[3] Sheth AA, Honeybul S. Vertebral artery dissection following a posterior cervical foraminotomy[J]. J Surg Case Rep, 2017, 2017(2): rjx014.
[4] Lee CH, Hong JT, Kang DH, et al. Epidemiology of iatrogenic vertebral artery injury in cervical spine surgery: 21 Multicenter Studies[J]. World Neurosurg, 2019, 126: e1050-e1054.
[5] Lunardini DJ, Eskander MS, Even JL, et al. Vertebral artery injuries in cervical spine surgery[J]. Spine J, 2014, 14(8): 1520-1525.
[6] Hsu WK, Kannan A, Mai HT, et al. Epidemiology and outcomes of vertebral artery injury in 16582 cervical spine surgery patients: an AOSpine North America multicenter study[J]. Global Spine J, 2017, 7(1 Suppl): 21S-27S.
[7] Chen BH, Natarajan RN, An HS, et al. Comparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion[J]. J Spinal Disord, 2001, 14(1): 17-20.
[8] Zdeblick TA, Zou D, Warden KE, et al. Cervical stability after foraminotomy: a biomechanical in vitro analysis[J]. J Bone Joint Surg Am, 1992, 74(1): 22-27.
[9] Güvençer M, Men S, Naderi S, et al. The V2 segment of the vertebral artery in anterior and anterolateral cervical spinal surgery: a cadaver angiographic study[J]. Clin Neurol Neurosurg, 2006, 108(5): 440-445.
[10] Eskander MS, Drew JM, Aubin ME, et al. Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans[J]. Spine (Phila Pa 1976), 2010, 35(23): 2035-2040.
[11] Oh SW, Singh R, Adsul NM, et al. Anatomical relationship of the vertebral artery with the lateral recess: clinical importance for posterior cervical foraminotomy[J]. Neurospine, 2019, 16(1): 34-40.