Lee Sang-Hun, Kim Ki-Tack, Jeong Bi-O, Seo Eun-Min, Suk Kyung-Soo, Lee Jung-Hee, Lee Gyung-Kyu
Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
Spine (Phila Pa 1976). 2007 Sep 15;32(20):E569-74. doi: 10.1097/BRS.0b013e31814ce535.
A prospective study using computed tomography (CT) scans.
To identify the structures at risk and the safety zone of a percutaneous cervical approach.
A percutaneous cervical approach may injure the important structures of the anterior neck. However, the dynamic locations of vital structures and the structures at risk by routine trajectory have not been analyzed.
Thirty patients were enrolled for this study. We obtained the CT scans of the cervical spine at each level of the intervertebral disc from C3-C4 to C6-C7, after manually pushing the airway in the same position and manner of discography. The patients ingested contrast materials for imaging of their digestive tracts and were injected intravenous contrast materials for imaging of vascular structures, just before obtaining images. We estimated the distances from the operator's fingertip to the digestive tract on the left side and to the carotid artery on the right side, at each level. The safety zone was determined by the sum of 2 distance calculations. We identified the anatomic structure at risk by simulated needle insertion toward the center of the disc through the safety zone.
At C3-C4, the safety zone was measured 18.9 +/- 6.6 mm. The superior thyroidal artery (STA) was located in the safety zone of C3-C4 in 86.7%. At C4-C5, the safety zone was measured 23.5 +/- 6.5 mm. The STA and the right lobe of the thyroid gland (TG) were located in the safety zone in 26.7% and 30%, respectively. At C5-C6, the safety zone was measured 33.7 +/- 6 mm. The TG was located in the safety zone of C5-C6 in 76.7%. At C6-C7, the safety zone was 29.2 +/- 4.5 mm. The TG was located on the approach plane in 90%.
The safety zone was wider at the distal level (C5-C6, C6-C7) than at the proximal level (C3-C4, C4-C5). The safest needle entry point should be between the pushing point of the airway and the pulsating point of the carotid artery. In addition, the needle should be approached toward the center of the disc. A percutaneous cervical approach allows a low risk of pharyngoesophageal structure injury and is considered a safe diagnostic technique in dynamic imaging studies.
一项使用计算机断层扫描（CT）的前瞻性研究。
确定经皮颈椎入路的危险结构和安全区域。
经皮颈椎入路可能会损伤颈部前方的重要结构。然而，重要结构的动态位置以及常规轨迹所涉及的危险结构尚未得到分析。
本研究纳入30例患者。在以与椎间盘造影相同的位置和方式手动推动气道后，我们获取了从C3 - C4至C6 - C7每个椎间盘水平的颈椎CT扫描图像。在获取图像前，患者口服造影剂以对其消化道进行成像，并静脉注射造影剂以对血管结构进行成像。我们在每个水平估计了从术者指尖到左侧消化道以及到右侧颈动脉的距离。安全区域由这两个距离计算值之和确定。通过模拟经安全区域向椎间盘中心插入针来确定危险的解剖结构。
在C3 - C4水平，安全区域测量值为18.9±6.6毫米。甲状腺上动脉（STA）位于C3 - C4安全区域内的比例为86.7%。在C4 - C5水平，安全区域测量值为23.5±6.5毫米。STA和甲状腺右叶（TG）分别有26.7%和30%位于安全区域内。在C5 - C6水平，安全区域测量值为33.7±6毫米。TG位于C5 - C6安全区域内的比例为76.7%。在C6 - C7水平，安全区域为29.2±4.5毫米。TG位于进针平面内的比例为90%。
安全区域在远端水平（C5 - C6、C6 - C7）比近端水平（C3 - C4、C4 - C5）更宽。最安全的进针点应在气道推压点与颈动脉搏动点之间。此外，针应朝向椎间盘中心进针。经皮颈椎入路导致咽食管结构损伤的风险较低，在动态成像研究中被认为是一种安全的诊断技术。
