单孔分体内镜颈椎钩状突部分切除三维影像解剖测量△

Three-dimensional anatomical measurement of cervical uncinate process for one-hole split endoscopic partial uncinectomy

摘要:

[目的] 三维重建观测骨骺环和颈神经、钩状突毗邻关系，指导单孔分体内镜切除部分钩状突对颈神经减压。[方法] 建立 33 例神经根型颈椎病三维模型，测量 C_3/4~C₇T₁骨骺环后缘最低点分别至钩状突尖部所在矢状面颈神经前缘前后距离 （anterior and posterior distance of anterior margin of cervical nerve, APDACN） 及下缘垂直距离 （vertical distance of inferior margin of cervical nerve, VDIMCN）、硬脊膜外侧缘左右距离 （left and right distance of lateral border of dure mater, LRDLDM）、颈神经起点上缘垂直距离（vertical distance of superior margin of cervical nerve start point, VDSCNP）、颈神经起点下缘垂直距离（vertical distance of inferior margin of cervical nerve start point, VDICNP）、椎弓根峡部外侧缘前后距离 （anterior and posterior distance of lateral border of isthmus of pedicle, APDLIP）、颈神经外展角 （abductor angle of cervical nerve, AACN） 及前倾角 （anterior inclination angle of cer- vical nerve, AICN）。[结果] 随节段降低，矢状面 APDACN 无显著变化 （P＞0.05）；VDIMCN、VDSCNP、VDICNP、AACN 和 AICN 显著增加 （P＜0.05），LRDLDM 和 APDLIP 显著减少 （P＜0.05）。相应节段 APDACN、VDIMCN、LRDLDM、VDSCNP、 VDICNP、APDLIP、AACN 和 AICN 男女之间的差异均无统计学意义（P＞0.05）；相应节段左右侧之间上述指标的差异亦均无统计学意义（P＞0.05）。主要节段参数（C_5/6 ）APDACN、VDIMCN、LRDLDM、VDSCNP、VDICNP、APDLIP、AACN、AICN 与年龄及 BMI 均无显著相关性（P＞0.05）。[结论] 随颈椎节段下降，骨骺环后缘最低点为标志的 VDIMCN、VDSCNP、VDICNP、AACN 和 AICN 增大，而 LRDLDM 和 APDLIP 减少，相同节段上述指标男性与与女性之间，左与右侧间的差异均不明显。

Abstract:

[Objective] To observe the relationship among epiphysis ring, cervical nerve and uncinate process to guide the decompres- sion of cervical nerve by one-hole split endoscope. [Methods] Three dimensional models were established based on CT data of 33 patients with cervical spondylotic radiculopathy, the anteroposterior distance of anterior margin of cervical nerve (APDACN), vertical distance of in- ferior margin of cervical nerve (VDIMCN), left and right distance of lateral border of dure mater (LRDLDM), vertical distance of superior mar- gin of cervical nerve start point (VDSCNP), vertical distance of inferior margin of cervical nerve start point, (VDICNP), anterior and posterior distance of lateral border of isthmus of pedicle (APDLIP), abductor angle of cervical nerve (AACN) and anterior inclination angle of cervical nerve (AICN） were measured and compared between genders and sides. [Results] As cervical segment declining, the APDACN remained unchanged significanty (P＞0.05), while the VDIMCN, VDSCNP, VDICNP, AACN and AICN significantly increased (P＜0.05), the LRDLDM and APDLIP significantly decreased (P＜0.05). There was no significant difference between male and female in APDACN, VDIMCN, LRDLDM, VDSCNP, VDICNP, APDLIP, AACN and AICN (P＞0.05), additionally, there was no statistical significance in the above indexes between the left and right sides at any corresponding segments (P＞0.05). The APDACN, VDIMCN, LRDLDM, VDSCNP, VDICNP, APDLIP, AACN and AICN in the main segment (C_5/6) were not significantly correlated with age and BMI (P＞0.05). [Conclusion] With the descending of cervical segment, VDIMCN, VDSCNP, VDICNP, AACN and AICN marked by the lowest point of the epiphyseal ring posterior margin in- creased gradually, while LRDLDM and APDLIP decreased. There was no significant difference in the above indexes between male and fe- male at the same segment, and between left and right.