刘鑫;孙宁;孙兆忠;黄镇;任佳彬;李瑞;

• 1:滨州医学院附属医院脊柱外科

摘要(Abstract)：

[目的]通过断层解剖学与3D-CT方法探讨经皮颈椎后路内镜(PPECD)开窗对关节突关节完整性影响。[方法] 3具成人颈部标本,行矢状面、冠状面及横断面断层解剖,肉眼及显微镜观察C_3～T_1神经走形、关节突关节形态及其毗邻结构。此外,15例颈椎病患者行头颈行CTM和3D-CT检查。确定关节突关节间隙最内侧端垂线与下关节突内下端交点(O点)、下位椎弓根峡部内侧缘M_((内))及外侧缘M_((外)),横突孔外缘。横断面测量距离:侧块横径(a),O点与M_((内))(b),O点与M_((外))(c),M_((内))与M_((外))(d),O点与横突孔外缘(e)。计算d/a、e/a。数据行统计学分析。[结果]颈神经按压迫部位分:椎管内段、椎间孔段、椎动脉段。:bC_3/C_4～C_7/T_1 [(1.55±1.53) mm～(2.52±1.15) mm]差异无统计学意义(P>0.05)。而a C_6/C_7 (11.55±1.19) mm与C3/C4～C5/C6 [(10.54±1.06) mm～(10.85±1.20) mm](P<0.05);c C_3/C_4 (-0.42±1.16) mm与C_4/C_5 (0.38±1.48) mm (P<0.05)、C_5/C_6～C_7/T_1 [(0.89±1.32) mm～(3.15±1.55) mm](P<0.001); d C_3/C_4～C_5/C_6 [(2.11±0.80) mm～(2.65±0.86) mm]与C_6/C_7～C_7/T_1[(3.95±1.03) mm～(5.05±1.67) mm](P<0.001);e C_6/C_7 (7.76±2.02) mm与C_3/C_4～C_5/C_6 [(5.31±1.19) mm～(5.92±1.72) mm](P<0.001)差异有统计学意义。d/a C_3/C_4～C_7/T_1 [(20.43±8.35)%～(46.75±16.81)%];e/a C_3/C_4(50.40±10.55)%,C_4/C_5 (46.39±12.27)%,C_5/C_6 (54.83±15.71)%,C_6/C_7 (66.96±15.17)%。[结论] PPECD开窗减压致关节突关节缺损有一定规律性:椎管内段C_3/C_4～C_7/T_1无缺损;椎间孔段C_3/C_4～C_7/T_1缺损<50%;椎动脉段,除C_(4/5)缺损<50%,其余节段均>50%。

关键词(KeyWords)： 颈椎病;内窥镜;断层解剖学;关节突关节;三维CT(3D-CT)

Abstract:

Keywords:

基金项目(Foundation): 山东省自然科学基金资助项目(编号:ZR2017LH021);; 国家重点研发计划项目(编号:2017YFC0114002)

作者(Author): 刘鑫;孙宁;孙兆忠;黄镇;任佳彬;李瑞;

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DOI:

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