| Objective:Digital imaging and anatomical methods were used to investigate the safety of Percutaneous Posterior Endoscopic Cervical Discectomy and the effective range of decompression at various lesion sites,which provided the theoretical basis for clinical operation.Methods:5 adult cervical specimens were observed with naked eye and microscope.Observed the point of intersection(point O)which between the lower end of C3-C7 lateral mass and the lower margin of the vertebral lamina,and the anatomic structure adjacent to the operation area.(2)A total of 35 patients with cervical spondylopathy treated with PPECD were selected since July 2016 to May 2017.? The cervical vertebrae remained neutral,CTM was examined,the layer thickness was 0.625mm,Dicom data was input into Mimics16.0 software,and 3D-CT images of cervical spine were reconstructed,and 8 patients' 3D-CT images were selected according to the inclusion criteria.Sagittal plane is established on the 3D-CT image by the following points:the lower end of the lateral mass and the outer lower edge of the vertebral plate(point O),intersections of adjacent upper and lower vertebral plates(point V),dural lateral margin,medial margin of inferior pedicle isthmus M(inner)and the lateral margin of the isthmus of the lower pedicle isthmus M(external),center line of spinous process.Cross section measurement distance:lateral block transverse diameter(a),distance between the point V and the lateral dural margin(b),distance between the point O and the lower pedicle isthmus medial margin M(inner)(c),distance between the point O and the lateral margin of the inferior pedicle isthmus M(external)(d),distance between the point O and the point V(e),distance between the point O and the lateral dural margin(f),distance between the center line of spinous process and the lateral dural margin(g),upper articular process overlap thickness at point O(h),The external diameters of the pedicle isthmus(k)and the angle of inclination outside the pedicle of the vertebral pedicle(q),distance between the lower pedicle isthmus medial margin M(inner)and the lateral margin of the inferior pedicle isthmus M(external)(r).Sagittal measurement:the distance between the point O and the adjacent superior edge of lower margin of pedicle isthmus M(lower)(i),the distance between the point O and the adjacent inferior edge of superior margin of pedicle isthmus(j),distance between the point O and the lateral margin of the inferior pedicle isthmus M(extenal)was calculated as a percentage of lateral block transverse diameter(d/a).distance between the lower pedicle isthmus medial margin M(inner)and the lateral margin of the inferior pedicle isthmus M(external)was calculated as a percentage of lateral block transverse diameter(r/a).Results:There was no significant difference between the point O and the lateral margin of the dura mater,the midline of the spinous process and the lateral margin of the dura mater,and the overlap thickness of the lower articular process from the segment between the C3/C4-C7/T1(P>0.05).The difference was statistically significant:the width of lateral mass was C3/C4-C5/C6 and C6/C7 respectively(P<0.05).V point and lateral margin of dural C3/C4-C5/C6 and C7/T1(P<0.001),C3/C4 and C5/C6(P<0.001),C4/C5,C7/T1 and C6/C7(P<0.05).point O and the lower pedicle isthmus medial margin M(inner)C3/C4 and C6/C7(P<0.05);Point O and lateral margin of pedicle isthmus M(external)C3/C4-C5/C6 and C7/T1(P<0.001),Point O and lateral margin of pedicle isthmus M(external)C4/C5-C5/C6 and C6/C7(P<0.01),the point O and the point V C3/C4-C4/C5 and C7/T1(P<0.01),C3/C4-C4/C5 ? C6/C7(P<0.05);The external diameters of the pedicle isthmusC3/C4-C6/C7and C7/T1(P<0.001),C3/C4-C4/C5 and C6/C7(P<0.001),the angle of inclination outside the pedicle of the vertebral pedicleC3/C4-C5/C6 and C7/T1(P<0.001),C4/C5 and C5/C6-C6/C7(P<0.01),distance between the lower pedicle isthmus medial margin M(inner)and the lateral margin of the inferior pedicle isthmus M(extemal)C3/C4-C5/C6 and C6/C7-C7/T1(P<0.001),C3/C4-C5/C6,C6/C7-C7/T1(P>0.05),the distance between the point O and the adjacent superior edge of lower margin of pedicle isthmus M(lower)(i)C3/C4-C5/C6 and C7/T1(P<0.001),the distance between the point O and the adjacent inferior edge of superior margin of pedicle isthmus(j)C3/C4-C6/C7 and C7/T1(P<0.01).d/a C3/C4-C7/T1(11.04±7.87%-27.58±19.40%),r/a C3/C4-C7/T1(15.12±7.39%-33.51 ± 9.10%).Conclusion:?The point O can be used as a constant bone marker of PPECD.The operation can be divided into central spinal canal area,axillary area,shoulder area and intervertebral foramen area.The decompression range of each area is constant and each has its fenestration point.,decompression safety scope and important structure.?Nerve root decompression channel induced by a certain regularity of facet joint defect degree:spinal segment(the central spinal canal area,underarm area,shoulder area)C3/C4-C7/T1 without defect;intervertebral foramen block defect was calculated as a percentage of lateral block transverse diameter between the segment C3/C4-C7/T1 was 11.04 ± 7.87%?33.51 ±9.10%,will not affect the stability of the cervical spine. |
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