腰椎间孔镜的应用解剖

发布时间：2018-03-29 13:19

本文选题：腰椎　切入点：安全三角　出处：《南方医科大学》2017年硕士论文

【摘要】：背景和目的腰椎间盘突出症(LDH,lumbar intervertebral disc herniation)是骨科常见病、多发病,LDH的治疗越来越微创化,经皮腰椎间孔镜手术治疗LDH已经成为最具发展潜力和最微创的脊柱手术,临床应用广泛,然而相关解剖学研究相对滞后,尤其国内相关研究较少。本研究旨在完善国人L1/2～L5/S1腰椎安全三角的解剖学资料,为不同节段腰椎间孔镜手术选择适宜尺寸的工作套管提供解剖学依据。方法解剖10套无明显退变、无腰椎畸形、无椎体破坏的福尔马林防腐的健康成人脊柱腰骶段(L1～S1)标本(年龄32～65岁,平均55岁),观测L1/2～L5/S1椎间孔的高、神经根孔高、椎间孔矢状径、神经根/神经节矢状径、椎间隙水平中线与椎间孔后界的交点到出行神经根的垂直距离、椎管内安全三角形态、不同穿刺点到出行神经根和硬膜囊/走行神经根的距离。结果①L1/2～L5/S1 椎间孔高为(16.06±3.18)、(19.30±2.20)、(19.02±2.37)、(16.45±1.82)、(10.77±1.77)mm;②L1/2～L5/S1椎间隙水平中线与椎间孔后界的交点到出行神经根的垂直距离为(4.75±0.80)、(6.42±0.44)、(7.30±0.82)、(7.74±0.52)、(4.68±1.27)mm;③L1/2～L5/S1管内安全三角的底边长为(9.33±1.67)、(10.73±1.51)、(12.60±2.43)、(16.20±2.64)、(14.91±2.88)mm;④L1/2～L5/S1椎管内安全三角的高为(14.32±1.65)、(16.94±3.12)、(19.96±2.46)、(20.87±2.08)、(20.75±2.47)mm;⑤L1/2～L5/S1椎间盘后缘水平中线与椎弓根中心纵垂线交点到出口神经根距离为(3.65±0.73)、(4.14±0.71)、(4.56±0.88)、(5.40±0.67)、(4.49±0.59)mm;⑥L1/2～L5/S1椎间盘后缘水平中线与椎弓根中心纵垂线交点到硬膜囊/走行神经根的距离为(4.49±0.63)、(5.23±0.70)、(6.18±0.93)、(7.73±0.60)、(7.67±1.00)mm;⑦L1/2～L5/S1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到出行神经根的距离为(4.02±0.78)、(4.67±0.65)、(5.17±0.91)、(6.16±0.74)、(5.48±0.61)mm;⑧L1/2～L5/S1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到硬膜囊/走行神经根的距离为(3.89±0.61)、(4.39±0.71)、(5.17±0.97)、(6.58±0.70)、(6.22±1.20)mm。结论椎间孔呈上大下小的倒梨形;椎间孔区韧带的存在使神经根孔高远小于椎间孔高;腰椎安全三角可拆分为“椎间孔安全三角”和“椎管内安全三角”两个平面三角形;椎间孔安全三角自L1/2～L5/S1可分别容许直径为4.0、5.0、6.0、7.5、4.5mm的工作套管;椎管内安全三角自L1/2～L5/S1可分别容许直径为5.0、6.0、7.0、7.5、7.5mm直径工作套管;椎间孔安全三角内有较大风险损伤节段动脉的背侧支或背侧支的分支;椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点可以作为椎间盘穿刺的最优穿刺点。
[Abstract]:Background and objective Lumbar intervertebral disc herniation is a common disease in orthopedic department. The treatment of LDH is becoming more and more minimally invasive. Percutaneous transurethral foramen surgery has become the most promising and minimally invasive spinal surgery, and its clinical application is extensive. However, the related anatomical studies are relatively backward, especially in China. The purpose of this study is to improve the anatomical data of the L1/2~L5/S1 lumbar spine safety triangle in Chinese. The anatomical basis was provided for the selection of suitable size of working cannula for different segmental intervertebral foramen surgery. Methods Ten sets of lumbar vertebrae were dissected without obvious degeneration and deformity of lumbar vertebrae. The L1S1 specimens of healthy adult spine without vertebral damage (32 ~ 65 years old, mean 55 years old) were collected. The height of intervertebral foramen, the height of nerve root foramen, the sagittal diameter of intervertebral foramen, and the sagittal diameter of nerve root / ganglion were observed. The vertical distance between the intersection of the horizontal midline of the intervertebral space and the posterior boundary of the interforaminal foramen and the perpendicular distance between the intervertebral nerve root and the intervertebral canal, and the safety triangle in the spinal canal. Results the height of intervertebral foramina in 1L1/2~L5/S1 was 19.30 卤2.20, 19.02 卤1.82, 10.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 卤1.77 mm / L ~ (1) L ~ (1 / 2) / L ~ (5S1) intervertebral space, and the vertical distance between the horizontal midline of intervertebral space and the posterior boundary of intervertebral foramen was 4.75 卤0.80, 6.42 卤0.447.30 卤0.827.74 卤0.527.74 卤0.521, 4.68 卤1.27mm ~ (-1) L / L ~ (-1) / L ~ 5S1. The vertical distance between the horizontal midline of intervertebral space and the posterior boundary of interforaminal foramen was 4.75 卤0.80 卤0.447.30 卤0.827.74 卤0.521 卤4.68 卤1.27mm ~ (-1) L-1 / 2L ~ (5S1). The height of the safety triangle in the spinal canal is 14.32 卤1.65 卤1.65 卤16.33 卤1.67 卤10.73 卤1.51, 12.60 卤2.43 and 16.20 卤2.64mm, 14.91 卤2.88mm, 4L1 / 2L5S 1 and 14.32 卤1.65, 16.94 卤3.126.96 卤2.46, 20.87 卤2.08mm, 20.75 卤2.47mm5L1L / 2L / 2L / S _ 5S _ 5S _ 5S _ 5S _ 1 and the perpendicular line between the midline and the center of the pedicle from 3.65 卤0.73m, 4.14 卤0.714 卤0.714 卤4.56 卤0.88 卤0.40 卤0.40 卤0.49 卤0.49 卤0.69 卤0.49 卤0.69 卤0.49 卤0.59mm, respectively. / the distance between the perpendicular to the posterior edge of the intervertebral disc is 4.49 卤0.63 and 5.23 卤0.70, 6.18 卤0.93, 7.73 卤0.60mm, 7.67 卤1.00 卤1.00 mm, 7L 1 / 2 L 5S 1 and 1 / 3 vertical perpendicular point to the transposition nerve root is 4.02 卤0.78, 4.67 卤0.65, 5.17 卤0.746.16 卤0.746.16 卤0.746.16 卤0.746.16 卤0.746.16 卤0.746.16 卤0.74 卤0.61 卤5.48 卤0.61 mm / L ~ (8) L ~ (12) L ~ (-1) / L ~ (1) S ~ (-1) and 1 / 13 vertical line of intervertebral arch to the dural capsule / dural capsule / path, respectively, from the horizontal midline of the posterior edge of the intervertebral disc to the intersecting point of the vertical vertical line of the medial 1 / 3 of the pedicle of the pedicle to the transposition nerve root. The distance between the nerve roots was 4.39 卤0.71, 5.17 卤0.97, 6.58 卤0.70, 6.22 卤1.20 mm. conclusion the intervertebral foramen is inverted pear shape. The nerve root foramina is much higher than the intervertebral foramina due to the existence of ligamentum intervertebral foramen, and the safety triangle of lumbar vertebrae can be divided into two planar triangles: "intervertebral foramina safety triangle" and "intraspinal safe triangle". The safety triangle of intervertebral foramina can be allowed to work with a diameter of 4.0 ~ 5.0 ~ 6.0 ~ 7.5 ~ 4.5 mm from L1/2~L5/S1, and a diameter of 7.0 ~ 7.5 ~ 7.5 mm from L1/2~L5/S1 on intraspinal safety triangulation, and a working casing with a diameter of 7.0 ~ 7.5 ~ 7.5 mm from an intervertebral foraminal safety triangle, and a safety triangle with a diameter of 7.0 ~ 7.5 ~ 7.5 mm from an intervertebral canal. In the intervertebral foramina safety triangle there is a greater risk of injury of the dorsal or dorsal branches of the segmental artery and the intersection of the horizontal midline of the posterior edge of the intervertebral disc and the 1 / 3 vertical line in the pedicle of the intervertebral disc can be used as the optimal puncture point for the puncture of the intervertebral disc.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R322

【参考文献】