椎弓根内上缘投影点锚定法在经皮内镜下颈椎后路椎间盘切除术中的应用

Application of anchoring of the projection point on the inner upper edge of the pedicle in posterior percutaneous endoscopic cervical discectomy

中文关键词:  经皮内镜下颈椎后路间盘切除术  椎弓根  垂直锚定方法  神经根型颈椎病

英文关键词:Posterior percutaneous endoscopic cervical discectomy  Pedicle  Vertical anchoring technique  Cervical spondylotic radiculopathy

中文摘要:

  【摘要】 目的：评估采用椎弓根内上缘投影点锚定法在经皮内镜下颈椎后路椎间盘切除术中应用的安全性及可行性。方法：收集32例于我院采用经皮内镜下颈椎后路间盘切除术（posterior percutaneous endoscopic cervical discectomy，PPECD）治疗神经根型颈椎病患者资料，并分为两组。一组接受常规PPECD治疗（常规组其中男7例，女4例，平均年龄49.9±13.2岁，症状持续时间27.9±38.7个月），另一组接受椎弓根内上缘投影点锚定方法联合PPECD治疗（改良组其中男13例，女8例，平均年龄54.0±11.8岁，症状持续时间18.4±27.3个月）。术前及术后颈部和上肢疼痛采用视觉模拟评分（visual analogue scale，VAS）评估，神经功能状态采用日本骨科学会（Japanese Orthopaedic Association，JOA）评分评估；术后疗效采用改良MacNab标准评价。术后减压效果采用CT及MRI评价。术后记录两组患者透视次数及手术时间。32例患者行颈部CT，重建颈椎3D图像。经椎弓根内上缘交点建立横断面，测量C3－7椎弓根内上缘投影点与V点（相邻颈椎椎板上、下缘在关节突关节内侧重叠形成的顶端向外的横行V字形结构）距离（a），测量结果用于快速定位和确认V点。结果：改良组患者手术均顺利完成。改良组透视次数4.0±0.9，手术时间70.1±20.0min；常规组透视次数10.7±2.4，手术时间117±44.5min。两组透视次数及手术时间差异有统计学意义（P<0.05）。两组患者术后VAS、JOA评分及改良MacNab评分较术前均明显改善，但两组间差异无统计学意义（P>0.05）。参照上述方法测得C3－7的a值为1.45±0.06~5.03±0.19mm。结论：利用椎弓根内上缘投影点锚定方法可以减少透视次数，缩短手术时间，为PPECD定位及验证V点提供一种新的方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety and feasibility of the projection point on the inner upper edge of the pedicle anchoring method in the posterior percutaneous endoscopic cervical discectomy(PPECD). Methods: Data of 32 patients with cervical spondylotic radiculopathy who were treated with the PPECD in our hospital were collected, and the patients were divided into two groups. One group underwent conventional PPECD(the conventional group including 7 males and 4 females, with an average age of 49.9±13.2 years and symptom duration of 27.9±38.7 months) and the other group underwent PPECD combined with anchoring technique of the projection point on the inner and upper edge of the pedicle(the modified group including 13 males and 8 females, with an average age of 54.0±11.8 years and symptom duration of 18.4±27.3 months). Patients′ preoperative/postoperative neck and arm pain was evaluated by the visual analogue scale(VAS) scores. Neural function was assessed by Japanese Orthopaedic Association(JOA) scores. The postoperative efficacy was evaluated by modified MacNab criteria. The postoperative decompression effect was evaluated by CT and MRI. Fluoroscopy times and operative time were recorded. Cervical CT was performed to reconstruct cervical spine 3D image of the 32 patients. A cross section through the intersection of the inner and upper edges of the pedicle was used to measure the distance(a) between the projection point on the inner upper edge of the C3-7 pedicle and the V point(the transverse V-shaped structure with the tip outward at the medial junction of inferior margin of cephalic lamina and superior margin of caudal lamina). The measurement results were used to quickly locate and verify the V point. Results: The operations in the modified group were successfully completed. The number of fluoroscopy times and operative time were 4.0±0.9 and 70.1±20.0min in the modified group, and 10.7±2.4 and 117±44.5min in conventional group. There were significant differences in the number of fluoroscopy and operative time between the two groups(P<0.05). VAS, JOA score and modified MacNab score were significantly improved in two groups after operation, but there was no significant difference between the two groups(P>0.05). The values of a of C3-7 were 1.45±0.06-5.03±0.19mm. Conclusions: Anchoring of the projection point on the inner upper edge of the pedicle can reduce the fluroscopy times and operative time, which provides a new method for positioning and verification of the V point in PPECD.