| Background and purpose:Conservative treatment invalid cervical spondylotic radiculopathy(CSR)requires surgical treatment.Based on the development of the key hole technology,the percutaneous posterior endoscopic cervical discectomy is developed(PPECD)is the main operation method at present.In the operation,the first step is to determine the entry V-point and then open a bone window.At present,the main method to find V-point is repeatedly confirm the position on the X-ray of the anterior and posterior position of the cervical spine with C-arm machine.In addition,because the V-point is adjacent to the dura mater,vertebral artery and other important structures,it is very easy to cause serious complications.This study envisage by use the three-dimensional computed tomography(3D-CT)or 3D cervical spine printing technology is easier to determine the position of V-point than anterior and posterior cervical X-ray,and then determine the side opening distance on the skin of patients according to the distance from the center of spinous process to V-point.If this method is feasible,the approach operation technology of PPECD will become relatively simple,which can increase the safety of surgery and reduce the exposure of operators and patients under X-ray,and save medical cost.The study will verify it by measure relevant distances on solid specimen.In addition,by measuring the distance between the V-point of each segment and the nearby important structure on the solid specimen and making statistical analysis,to establish the safe range of operation.Experimental methods and procedures:1.Select 20 cryopreserving fresh adult cervical spine specimens,all of the specimens were examined by X-ray and naked eye to exclude the deformity,fracture,tumor,tuberculosis,operation,osteolytic disease and other deformities or abnormalities,so as to ensure that the specimens were free of structural damage,systemic inflammatory arthritis,severe osteoporosis,spondylolisthesis and other diseases.Done CT scanning after thawing and import the CT reconstruction image into picture archiving and communication system(PACS)to obtain the distance between the V-point and the center of spinous process,then insert the Kirschner wire into the solid specimen according to the distance.Observe the positional relationship of Kirschner wire,V-point,facet joint and lamina under spinal endoscope,and the distance between the Kirschner wire and the V-point was measured.2.Carefully remove the surrounding soft tissue from 20 specimens and expose the whole cervical vertebrae,observe the position relationship between the V-point of the lower cervical vertebrae and its adjacent anatomic structures,carefully separate the vertebrae of C3-C7,and keep the continuity and anatomic position of the vertebral artery,dura mater and spinal cord intact.After the specimen is processed,identify the V-point carefully,and measure the distance between the V-point and vertebral artery,dura mater,the width of facet joint with digital caliper.Research methods and contents:1.The relationship of the distance between the V-point of each segment of cervical spine and the line of spinous process obtained from the 3D reconstruction CT image and the distance actually measured on the solid specimen.In the experiment,20 cervical vertebrae were scanned by CT,and the distance between V-point and spinous process of C3 / 4-c6 / 7 segment both the left and right sides was measured and had done paired sample t-test and Pearson correlation coefficient analysis with actual measured distance.2.Safety range related to V-pointBy using vernier caliper to measure the position relationship between V-point and lateral dura mater,vertebral artery and the width of facet of facet joint,Comprehensive consider the position and range of V-point in posterior cervical surgery Result:1.There was no significant difference between the distance between the V-point of each segment of the cervical spine and the line of spinous process obtained from the 3D reconstruction CT image and the distance actually measured on the solid sample by paired sample t-test(P = 0.5360 on the left,P = 0.8633 on the right).And the Pearson correlation analysis showed that the two groups of data were highly correlated(r = 0.8765 on the left,r = 0.9961 on the right).2.The distance between the V-point and the lateral spine dura mater is: left(1.31±0.32 ~ 2.46±0.60)mm;right(1.29±0.35 ~ 2.75±0.45)mm,There was no significant statistical difference between left and right,but there was significant statistical difference among different segments.The horizontal distance between V-point and vertebral artery is: left(2.17±0.42~5.10±0.93)mm,right(1.99±0.39~5.00±0.71)mm,There was no significant statistical difference between left and right,but there was significant statistical difference among different segments.The vertical distance between point V and vertebral artery is: left(11.05±1.06~13.47±1.12)mm,right(11.33±1.20~13.61±1.01)mm,There was statistical difference between left and right,and statistical difference among different segments.The width of facet is: left(10.79±0.93~12.66±0.88)mm,right(10.86±0.68~12.54±0.70)mm.Conclusion:1.There is no statistical difference in the distance between the V-point and the line of spinous process of each segment of cervical spine obtained from the 3D reconstruction CT image and the actual distance measured on the solid specimen.Therefore,it is an effective method to obtain the surface position of V-point through 3D reconstruction CT image before the operation.2.The safety operation area of posterior percutaneous endoscopic cervical discectomy is: control the distance from the inside of the V-point at C3/C4 to C6/C7 levels: 2mm~1.2mm,if it exceeds this distance,pay attention to protect the dura mater adjacent to it;control the distance from the outside of the V-point at C3/C4 to C6/C7 levels: 2mm ~5mm,if this distance is exceeded,the surgical depth is controlled at a vertical distance between C3/C4~C6/C7 and the V point 11mm~14mm to prevent damage to the vertebral artery. |
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