颈神经根管切开减压术的应用解剖研究

为确定颈后路神经根管切开减压术中神经根的减压范围，并进一步探讨神经根型颈椎病的发病机理，在１７具成人颈椎标本上测量了神经根管、神经根及钩突，并模拟手术，从内侧向外逐渐切除关节突关节，根据神经根的减压程度确定切除范围。结果显示：神经根管长度平均为５．７４ｍｍ，上下径平均为９．０１ｍｍ，前后径平均为６．１３ｍｍ。钩突高度平均为５．４７ｍｍ。神经根型颈椎病多由关节突关节及钩椎关节骨质增生压迫神经根所致。由于钩突的阻挡，颈椎间盘向后外侧突出压迫神经根的机会较少。颈后路神经根管切开减压术中关节突关节的最佳切除范围是由关节内侧向外切除约６ｍｍ。小于该范围，易造成减压不充分；大于该范围，因神经根已穿出神经根管，对减压无太大改善，且过多地切除关节突关节，将破坏颈椎的稳定性。

Applied Anatomic Study on Resection and Decompression of Cervical Nerve Root Canal

To determine the decompression range of the nerve root in the posterior resection and decompression of cervical nerve root canal,and study the pathogenesis of cervical spondylotic radiculopathy,the nerve root canal,nerve root and uncinate process were measured,the partial facetectomy from the inside to the outside was simulated in 17 adult cervical specimens,and the best range of facetectomy was determined according to the decompression extent of the nerve root.The results showed that the cervical nerve root canal was 5.74 mm in length,9.01 mm in superoinferior diameter,and 6.13 mm in anteroposterior diameter.The uncinate process was 5.47 mm in height.The common reason of cervical spondylotic radiculopathy was that the nerve root could be compressed by osteophyte of the intervertebral facet joint and the Luschka joint.The uncinate process tended to prevent posterolateral prolapse of the intervertebral disc,rarely causing the compression to the cervical nerve root.Facetectomy of 6 mm from the inside to the outside was the best range.With less resection,the nerve root might still be compressed,while,more resection would destroy the stability of the cervical vertebrae,because the nerve root had already exited from the nerve root canal.