目的 探讨CT三维成像（three-dimensional computed tomography，3D-CT）技术在颈椎后路经皮脊柱内镜椎间孔减压髓核摘除术中“V”点确定的应用价值。 方法 回顾分析2016年1月至2019年3月行颈椎后路经皮脊柱内镜椎间孔减压髓核摘除术并成功随访的患者50例，均为单侧症状的神经根型颈椎病，经保守治疗6周以上无效，且颈椎动力位X线片未发现颈椎失稳。其中男性27例，女性23例，平均年龄54.2（40~75）岁，C4/5节段14例，C5/6节段25例，C6/7节段11例。患者分为两组，术中常规C臂X线机下定位“V”点为Ａ组（26例），术前通过3D-CT技术确定“V”点为Ｂ组（24例），比较二组平均住院时间、手术时间、术中透视次数和手术疗效，并进行统计学分析。 结果 50例患者平均随访时间（7.20±2.56）月（3~13月），Ａ组平均手术时间和术中透视次数多于Ｂ组（P<0.05）；平均住院时间、术后随防评分、颈椎曲度、手术节段椎间隙高度及颈椎稳定性，二组无显著差异（P>0.05）。 结论 3D-CT技术在颈椎后路经皮脊柱内镜手术中“V”点定位有重要意义。
Abstract
Objective To evaluate the application value of three-dimensional computed tomography (3D-CT) in determining the "V" point in transforaminal decompression and nucleus pulposus enucleation of posterior cervical approach by using percutaneous spinal endoscopy. Methods A retrospective analysis was made on 50 patients who underwent transforaminal decompression and nucleus pulposus enucleation of posterior cervical spine approach by using percutaneous spinal endoscopy and followed up from January 2016 to June 2018. They all sufferred from cervical spondylotic radiculopathy with unilateral symptoms, conservative treatment for more than 6 weeks were ineffective for them. The dynamic X-ray film of cervical spine showed no instability of cervical spine. There were 27 males and 23 females, with an average age of 54.2 (40~75) years, 14 cases of C4/5 segment, 25 cases of C5/6 segment and 11 cases of C6/7 segment. Fifty patients were divided into groups A (26 cases) and group B (24 cases). The patients were positioned according to the intraoperative conventional "V" point positioning method using C-arm X-ray machine in group A, and the patients determined the "V" point using the 3D-CT technology method before the operation in group B. The average hospital stay, operation time, number of intraoperative fluoroscopy and surgical efficacy between the two groups were compared and statistically analyzed. Results All 50 patients were followed up for an average of (7.20±2.56) months (3-13 months), The average operation time and intraoperative fluoroscopy in group A were more than those in group B (P<0.05). There was no signiant difference in the average hospital stay, postoperative follow-up score, the curvature of the cervical spine, the height of the intervertebral space of the operation segment and the stability of the cervical spine between the two groups (P>0.05). Conclusions 3D-CT technology plays an important role in determining the "V" point in posterior cervical approach percutaneous spinal endoscopic surgery.
关键词
颈椎后路 /
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经皮脊柱内镜 /
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CT三维成像技术 /
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V点
Key words
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Posterior cervical approach /
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Percutaneous spinal endoscopy /
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Three-dimensional CT imaging technology /
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“V” point
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参考文献
[1] 刘东宁, 易伟宏, 王尔天, 等. 颈椎后路内窥镜下椎间盘切除术治疗单节段神经根型颈椎病[J]. 中国脊柱脊髓杂志, 2013, 23(7): 594-598. DOI: 10.3969/j.issn.1004-406X.2013.7.594.4.
[2] 谢林, 顾军, 贾晋辉, 等. 经皮5.9 mm 全内窥镜后路椎间孔切开髓核摘除治疗颈椎间盘突出症临床观察[J]. 现代中西医结合杂志, 2013, 22(10): 1074-1075. DOI: 10.3969/j.issn.1008-8849.2013.10.022.
[3] Borden AG, Rechtman AM, Gershon-cohen J. The normal cervical lordosis[J]. Radiology, 1960, 74: 806-809. DOI: 10.1148/74.5.806.
[4] Katsumi Y, Honma T, Nakamura T. Analysis of cervical instability resulting from laminectomies for removal of spine cord tumor[J]. Spine, 1989, 14(11): 1171-1176. DOI: 10.1097/00007632-198911000-00007. [5] Roh SW, Kim DH, Cardoso AC, et al. Endoscopic foraminotomy using MED system in cadaveric specimens[J]. Spine, 2000, 25(2): 260-264. DOI: 10.1097/00007632-200001150-00019.
[6] Winder MJ, Thomas KC. Minimally invasive versus open approach for cervical laminoforaminotomy[J]. Can J Neurol Sci, 2011, 38(2): 262-267. DOI: 10.1017/s0317167100011446.
[7] Heary RF, Ryken TC, Matz PG, et al. Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy[J]. J Neurosurg Spine, 2009, 11(2): 189-202. DOI: 10.3171/2009.2.SPINE08722.
[8] Won S, Kim CH, Chung CK, et al．Comparison of cervical sagittal alignment and kinematics after posterior full-endoscopic cervical foraminotomy and discectomy according to preoperative cervical alignment[J]. Pain Physician, 2017, 20(2): 77-87. PMID: 28158155.
[9] Ahn Y. Percutaneous endoscopic cervical discectomy using working channel endoscopes[J]. Exp Rev Med Dev, 2016, 13(6): 601-610. DOI: 10.1080/17434440.2016.1180245.
[10] 孙兆忠, 郑振阳, 李瑞, 等. 经皮颈椎后路内窥镜术安全性的应用解剖学[J]. 中国矫形外科杂志, 2017, 25(7): 652-656. DOI: 10.3977/j.issn.1005-8478.2017.07.15.
[11] Kim CH, Shin KH, Chung CK, et al. Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy[J]. Global Spine J, 2015, 5(1): 31-38. DOI: 10.1055/s-0034-1395423.
[12] 曹禹文, 刘由军, 袁佳, 等. 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. DOI: 10.13418/j.issn.1001-165x.2020.03.002.
[13] 刘鑫, 孙兆忠, 程艳, 等. 颈椎后路经皮内镜开窗安全性3D-CT分析[J]. 中国矫形外科杂志,2018, 26(3):247-251. DOI: 10.3977/j.issn. 1005-8478.2018.03.12.
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