颈前路显微椎间孔减压在颈椎病治疗中的应用

目的探讨微创方法治疗颈椎病，为颈椎病提供一种微创、安全、有效的治疗方法。方法通过对颈椎标本的解剖观察、模拟手术及生物力学测定，寻找经椎间孔微创手术的解剖入路，并应用于2例颈椎病患者的手术操作。结果（1）下颈椎椎间孔前内侧壁为钩椎关节、后外侧壁为关节突关节、上、下壁分别为上位颈椎椎弓根下壁及下位颈椎椎弓根上壁，其间走行神经根，椎动脉走行于神经根的前内方，钩椎关节的增生可以压迫经神经根及椎动脉而产生临床症状、体征。（2）颈椎钩突是维持颈椎稳定性的重要结构，单侧单间隙钩突切除可导致颈椎在前屈一后伸方向上运动范围（rang of motion，ROM）的轻度增加；单侧多间隙钩突切除将使颈椎总的运动范围明显增加；双侧钩突切除将导致颈椎在旋转轴上的严重不稳定。（3）2例患者手术均安全、顺利完成，疗效确切。结论颈前路显微椎间孔减压治疗颈椎病是一种安全、有效的微创疗法，尤其在单节段病变中，更符合生物力学要求，且创伤小、经济、有效。

The use of Anterior microforaminotomy(AMF) for the treatment of cervical spondylosis

Objective To investigate the treatment of cervical spondylosis with microforaminotomy, providing a minimally-invasive, safe and efficient method for cervical spondylosis. Methods We tried to find an anatomical approach through foramen intervertebral by observing specimen, simulant operation and biomechanics measure and 2 cases with cervical spondylosis were performed operation by such technique. Result 1 The adjacent cervical foramen intervertebral , the upper and lower peclicle of verterbral arch, zygapophyseal joint and Loschka joint form an tunnel, by which there pass nerve roots, The hypertrophy of Loschka joint would compress the nerve root or vertebral artery and cause symptom, 2 The hamulus is the important construction to maintain the stability of cervical vertebra, when unilateral excision of hamulus was made, it would enlarge the bend rang of motion of cervical vertebra, and multiple unilateral excision of hamulus would enlarge the ROM significantly, Moreover, it would cause the severe instable on rotation axis of cervical spondylosis when the bilateral excision of hamulus was performed. 3 Two cases acquired excellent result. Conclusion The treatment of cervical spondylosis with anterior microforaminotomy is a safe and effective method on cervical spondylosis. It has many merits especially to single segment disturbance of cervical spondylosis, such as more fit to biomechanics, less damage, more economical and effective.