3D-CT指导单孔分体内镜精准切除钩状突对颈神经安全减压

3D-CT guided one-hole split endoscope to accurately resect the uncinate process and safely decompress the cervical nerve

摘要:

摘要 目的：单孔分体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对于颈神经减压尤为重要。本研究通过3D-CT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来分析颈神经的安全减压。方法：选取2016年8月至2021年1月的26例神经根型颈椎病患者资料，并在Mimics21.0上观测C3/4-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：C3/4-C7/T1，同节段不同性别、不同侧别之间差异无统计学意义（P＞0.05）；同节段b、e之间差异无统计学意义（P＞0.05），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C3/4-C7/T1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（0.87±0.47）mm至（2.29±1.28）mm至椎弓根峡部外侧缘，向外磨透钩状突，完成UPT至椎弓根区出口处颈神经腹侧减压；向上（5.52±2.10）mm至（7.98±2.98）mm、向内（1.07±0.54）mm至（1.85±0.85）mm分别磨除部分上位椎体和钩状突后外侧壁增生骨赘，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。

Abstract:

[Abstract]:Objective: The precise removal of the uncinate process in anterior cervical discectomy and fusion by one-hole split endoscope is particularly important for cervical nerve decompression.In this study, the position relationship between uncinate process tip (UPT), pedicle isthmus and cervical nerve was observed by 3D-CT to analyze the safe decompression of cervical nerve. Methods: Data of 26 patients with cervical radiculopathy from August 2016 to January 2021 were selected, and C3/4-C7/T1 related parameters were observed on Mimics21.0:The distance between UPT and anterior 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 C3/4-C7/T1 between different sexes and different sides in the same segment (P > 0.05). There was no statistically significant difference between the same segment b and e (P>0.05), 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 C3/4-C7/T1 segment, a gradually decreased. b, d, e, g, ∠A, ∠B gradually increase; c and f increased first and then decreased (P<0.05). Conclusions: With UPT as an important bone marker, the decompression range of cervical nerve was defined and the uncinate process was accurately removed. The UPT was (0.87±0.47) mm to (2.29±1.28) mm forward to the lateral border of the isthmus of the pedicle, and the uncinate process was ground outward to complete the ventral cervical nerve decompression from the UPT to the exit of the pedicle region. The bone proliferation on the posterior lateral wall of the upper vertebra and the posterior lateral wall of the uncinate process was removed by grinding upward (5.52±2.10) mm to (7.98±2.98) mm and inward (1.07±0.54) mm to (1.85±0.85) mm, respectively. The lateral margin of the dura and the upper margin of the origin of the cervical nerve were exposed, and decompression from UPT to the origin of the cervical nerve was completed. It provides theoretical basis for safe decompression of cervical nerve by precise surgical removal of uncinate process.