后结节为针刀靶点治疗神经根型颈椎病的机制研究

Mechanism of needle-knife therpy targeted at posterior tubercles for cervical spondylotic radiculopathy

摘要:

从解剖学角度解析颈椎横突后结节为针刀靶点治疗神经根型颈椎病（CSR）的作用机制。方法31侧CSR患者，侧卧，针刀靶向横突后结节，松解其周围结构。治疗10 d后，复查患者症状、体征及颈椎X 线变化。解剖观察6 具12 侧成年尸体颈椎横突后结节周围结构与脊神经根的关系。结果治疗10 d 后，上肢麻木、疼痛症状明显减轻或消失者占83.9%；臂丛神经牵拉和椎间孔挤压试验转阴率分别为84.2%和75.0%；X线检查显示，横突间距和椎间外孔纵距分别增宽5.24%和15.87%。尸体解剖发现，横突后结节位于脊神经根后外侧，其 前方和侧方主要为中、后斜角肌及肩胛提肌腱附着。部分起自前结节的中、后斜角肌及肩胛提肌腱，以及前斜角肌腱均跨越脊神经沟后合并到后结节。相邻后结节间有明显韧带连结。结论横突后结节为针刀靶点治疗CSR的作用机制可能是解除后结节周围的肌腱和韧带对神经根的压迫。

Abstract:

To analyze the mechanism of needle-knife therapy targeted at the posterior tubercles of cervical vertebral transverse processes for cervical spondylotic radiculopathy (CSR) from the view of anatomy. Methods Thirty -one CSR patients were laterally positioned. Needle -knife was targeted at the posterior tubercles of cervical vertebral transverse processes, and released the surrounding structures. The patients' symptoms, signs and X-ray changes of cervical vertebrae were reviewed 10 days after needle-knife treatment. The relationships between the surrounding structures of the posterior tubercles and the spinal nerve roots were observed after both sides of cervical vertibrae of the 6 adult cadavers were dissected. Results Ten days after needle-knife treatment, the symptoms of upper limb numbness and pain disappeared or obviously relieved in 83.9% of the patients; the negative rates of brachial plexus traction and intervertebral foramen extrusion test were 84.2% and 75.0% respectively; X-ray film displayed that the space between the transverse processes of cervical vertebrae and longitudinal diameter of external intervertebral foramen were widened by 5.24% and 15.87% respectively. Autopsy revealed that the posterior tubercles were located in the posterior-lateral side of the spinal nerve roots, the anterior and lateral sides of the posterior tubercles were mainly attached by scalenus medius, scalenus posterior and levator scapulae tendon. Part of the scalenus medius, scalenus posterior, levator scapulae tendon and scalenus anterior tendon originated from the anterior tubercles crossed the sulci nervi spinalis and merged into the posterior tubercles. There was an obvious ligament connection between the adjacent posterior tubercles. Conclusions The mechnism of needle-knife therapy for CRS targeted at posterior tubercles of cervical vertebral transverse processes may be due to relief of the compression of the nerve roots by the ligaments and tendons around the posterior tubercles.