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[目的]通过应用解剖学与3D-CT方法探讨颈椎后路经皮内镜颈椎间盘切除术(PPECD)行颈椎间孔减压安全有效范围。[方法]5具成人颈部标本,肉眼及显微镜观察C_3-C_7侧块内下端与椎板外下缘交点(O点)及术区毗邻解剖结构。此外,8例颈椎病患者行颈椎CTM,Mimics16.0软件重建颈椎3D-CT图像。经各点建立矢状面:O点、硬脊膜外侧缘、下位椎弓根峡部内侧缘M_((内))及外侧缘M_((外))。横断面测量距离及角度:侧块横径(a),V点与硬脊膜外侧缘(b),O点与M_((内))(c),O点与M_((外))(d),O点与V点(e),O点与硬脊膜外侧缘(f),经O点横断面上、下关节突重叠厚度(i),椎弓根峡部外径(k),椎弓根外倾角(m)。矢状面测量距离:O点与相邻上位M(下)(g)及与下位M(上)(h)。数据行统计学分析。[结果]差异无统计学意义:C_3-C_4~C_7-T_1f[(4.17±1.33)mm~(4.64±1.70)mm]、i[(6.06±2.07)mm~(7.20±1.93)mm](P>0.05);差异有统计学意义:b[(-0.17±1.74)mm~(2.42±1.41)mm]C_3-C_4~C_5-C_6与C_7-T_1(P<0.001);d[(-0.75±1.27)mm~(2.85±1.69)mm]C_3-C_4~C_5-C_6与C_7-T_1、C_3-C_4与C_6-C_7(P<0.001);g[(6.79±1.04)mm~(9.57±1.27)mm]C_3-C_4~C_5-C_6与C_7-T_1(P<0.001);h[(6.79±1.04)mm~(9.57±1.27)mm]C_3-C_4~C_6-C_7与C_7-T_1(P<0.01)。[结论]O点与颈椎间孔关系密切,多贴近下位椎弓根峡部外上缘,与硬脊膜外侧缘距离恒定;C_7-T_1节段形态结构变化大。熟悉该特点,可准确界定减压安全、有效范围,避免或减少重要结构损伤。
[Objective] To explore the safe and effective range of cervical intervertebral decompression through percutaneous endoscopic cervical discectomy (PPECD) by means of anatomy and 3D-CT. [Method] With 5 adult neck specimens, the intersection point (O point) between the lower end of the C_3-C_7 lateral mass and the outer edge of the lamina and the adjacent anatomical structure were observed with naked eye and microscope. In addition, 8 cases of cervical spondylosis underwent cervical spine CTM, Mimics16.0 software to reconstruct cervical 3D-CT images. The sagittal plane was established at each point: point O, epicardial lateral border, inferior medial pedicle isthmus M_ (inner) and outer lateral M_ (outer). Cross section measurements of distance and angle: lateral mass of lateral mass (a), point V and lateral epineurium (b), point O and M_ ((in)) (c), point O and M_ ((outer)) (i), O (subscript o), V (e), O and epiphora (f), thickness of overlap of upper and lower facets (O), outer diameter of pedicle isthmus Pedicle camber (m). Sagittal measurement distance: O point and adjacent to the upper M (down) (g) and the lower M (up) (h). Data line statistical analysis. [Results] There was no significant difference between the two groups (P> 0.05). There was no significant difference between the two groups (P> 0.05) > 0.05). The difference was statistically significant: b [(- 0.17 ± 1.74) mm ~ (2.42 ± 1.41) mm] C_3-C_4 ~ C_5-C_6 and C_7-T_1 (6.79 ± 1.04) mm ~ (9.57 ± 1.27) mm ~ (2.85 ± 1.69) mm] for C_3-C_4 ~ C_5-C_6 and C_7-T_1, C_3-C_4 and C_6- mm] C_3-C_4 ~ C_6-C_6 and C_7-T_1 (P <0.001); h [(6.79 ± 1.04) mm ~ (9.57 ± 1.27) mm] ). [Conclusion] The O point is closely related to the cervical intervertebral foramina, more close to the outer edge of the inferior pedicle isthmus, and the outer edge of the epidural space is constant. The morphology of the C7-T_1 segment changes greatly. Familiar with this feature, can accurately define the decompression safety, effective range, to avoid or reduce the important structural damage.