针刀疗法治疗腰神经后外侧支卡压症的入路研究

发布时间：2018-03-13 07:36

本文选题：腰痛　切入点：针刀入路　出处：《山西中医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的通过对10具经过防腐处理的成年男性尸体进行解剖研究,对成年男性腰神经后外侧支及其有关结构进行了解剖观测,探讨导致腰神经后外侧支神经卡压症的解剖学机制及小针刀治疗此症的手术入路特点,尤其是针刀在体表定位及针刀进刀方向选择,注意避免损伤的结构,为临床治疗腰椎神经后外侧支神经卡压症提供解剖学数据。方法本课题通过对10具经过防腐处理的成年男性尸体进行解剖(确保进入本课题的尸体符合相关标准),仔细观察腰椎旁浅层、深层的肌肉以肌肉的分布、循行特点,以及所支配该肌肉的神经、血管等走行,重点观察腰神经后外侧支深部的行程及其分支分布规律,并测量腰神经后外侧支骨纤维管的长度、横径、纵径,并对腰神经后外侧支骨纤维管距离体表的深度和其距后正中线的距离进行了测量,并对测量的数据进行统计学分析。结果(1)同一尸体两侧,腰神经后外侧支骨纤维管的长度、横径、纵径、距离体表深度及距后正中线距离差异无统计学意义。(2)腰神经后外侧支骨纤维管长度为(1.67±0.79)mm,横径为(22.70±6.10)mm,纵径为(3.34±1.32)mm,距离体表深度为(37.59±7.50)mm,距后正中线距离为(30.20±6.21)mm。(3)通过解剖研究发现,从L1~L3横突的外侧,L3横突投影与肾脏脏器相互重迭,尤其是右侧肾脏,并且观察发现腰神经后外支骨纤维管位于椎旁肌肉(竖脊肌)深面,故针刀入路治疗腰椎疾病一定要把握适当的深度(30.87~45.09)mm,应明确针刀贴近骨纤维管后在进行具体的操作,以避免损伤周围重要脏器。结论(1)同一尸体两侧,腰神经后外侧支骨纤维管的长度、横径、纵径、距离体表深度及距后正中线距离差异无统计学意义(P0.05);(2)腰神经后外侧支骨纤维管的体表定位,通过解剖可以得知骨纤维的位置在同序数腰椎棘突中点水平成18°~26°角的外上方,距离后正中线外(26.71~36.41)mm的交点外侧定位,从L1~L5夹角逐步减小,而距后正中线的距离逐渐增大。(3)临床针刀治疗腰神经后外侧支卡压症时,要使针刀入口线沿着腰神经后外侧支骨纤维管长轴,与后中线夹角42°~48°的外下方向,自上而下夹角逐步变小。于上述位点垂直进刀(30.87~45.09)mm深达后外支骨纤维管,使刀口顺骨纤维管长轴方向纵切1~3次,即与深层胸腰筋膜之纤维束垂直方向纵切。
[Abstract]:Objective to observe the posterior lateral branch of lumbar nerve and its related structures in 10 adult male cadavers treated with anticorrosion. To explore the anatomical mechanism of nerve compression of the posterior lateral branch of the lumbar nerve and the characteristics of the surgical approach for the treatment of the disease, especially the location of the needle knife on the body surface and the choice of the direction of the knife feed, and to pay attention to the structure of the injury. Methods 10 adult male cadavers treated with anticorrosion were dissected (to ensure that the cadavers entering the subject met the relevant standards) in order to provide anatomical data for the treatment of lumbar nerve posterolateral nerve entrapment. Look closely at the superficial layers of the lumbar vertebrae, The deep muscles are characterized by the distribution of muscles, along the course, as well as the nerves and blood vessels that dominate the muscles. The distribution of the deep branches of the posterior lateral branch of the lumbar nerve is mainly observed. The length, transverse diameter and longitudinal diameter of the fibrous canal of the posterior lateral branch of the lumbar nerve were measured. The depth of the fibrous canal of the posterior lateral branch of the lumbar nerve from the body surface and the distance from the posterior median line to the bone fiber tube of the posterior lateral branch of the lumbar nerve were measured. The measured data were analyzed statistically. Results 1) the length, transverse diameter and longitudinal diameter of the fibrous canal of the posterior lateral branch of the lumbar nerve on both sides of the same cadaver. There was no significant difference in the distance between the body surface depth and the distance from the posterior median line. The length of the fibrous canal of the posterior lateral branch of the lumbar nerve was 1.67 卤0.79 mm, the transverse diameter was 22.70 卤6.10 mm, the longitudinal diameter was 3.34 卤1.32 mm, the distance from the posterior midline was 37.59 卤7.50 mm, and the distance from the posterior median line was 30.20 卤6.21 mm. The projection of L3 transverse process of L1 and L3 transverse process overlapped with the renal organs, especially the right kidney. It was observed that the osseous fibrous canal of the posterior branch of the lumbar nerve was located on the deep side of the paravertebral muscle (Vertical Spinal muscle). Therefore, it is necessary to grasp the appropriate depth of 30.87 ~ 45.09 mm in the treatment of lumbar disease by needle knife approach, and make sure that the needle knife is close to the osseous fibrous tube and carry out specific operation to avoid the injury of important organs around the body. Conclusion No 1) both sides of the same corpse should be treated. There was no significant difference in length, transverse diameter, longitudinal diameter, distance from body surface depth and distance from posterior median line to the length, transverse diameter, longitudinal diameter of the fibrous canal of the posterolateral branch of the lumbar nerve, and there was no significant difference in the body surface location of the fibrous canal of the posterior lateral branch of the lumbar nerve. Anatomical analysis shows that the position of the bone fiber is located on the outer upper side of 18 掳/ 26 掳angle at the middle point of the spinous process of the lumbar vertebrae at the same ordinal number, and the lateral position of the intersection point at 26.71 ~ 36.41 mm away from the posterior median line decreases gradually from the angle between L _ 1 and L _ 5. The distance from the posterior median line to the posterior median line gradually increased. 3) in the treatment of lumbar nerve posterolateral branch entrances along the long axis of the posterior lateral branch of the lumbar nerve, the angle between the needle and the posterior midline is 42 掳or 48 掳. The angle from top to bottom becomes smaller gradually. At the above site, the vertical feed is 30.87 ~ 45.09 mm deep to the outer branch of bone fiber tube, and the cutting edge is longitudinal cut 1 ~ 3 times along the long axis of the bone fiber tube, that is to say, vertical longitudinal cutting with the fiber bundle of the deep thoracolumbar fascia.
【学位授予单位】：山西中医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9

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