本文選題：腰椎　切入點(diǎn)：安全三角　出處：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景和目的腰椎間盤突出癥(LDH,lumbar intervertebral disc herniation)是骨科常見病、多發(fā)病,LDH的治療越來越微創(chuàng)化,經(jīng)皮腰椎間孔鏡手術(shù)治療LDH已經(jīng)成為最具發(fā)展?jié)摿妥钗?chuàng)的脊柱手術(shù),臨床應(yīng)用廣泛,然而相關(guān)解剖學(xué)研究相對(duì)滯后,尤其國內(nèi)相關(guān)研究較少。本研究旨在完善國人L1/2～L5/S1腰椎安全三角的解剖學(xué)資料,為不同節(jié)段腰椎間孔鏡手術(shù)選擇適宜尺寸的工作套管提供解剖學(xué)依據(jù)。方法解剖10套無明顯退變、無腰椎畸形、無椎體破壞的福爾馬林防腐的健康成人脊柱腰骶段(L1～S1)標(biāo)本(年齡32～65歲,平均55歲),觀測(cè)L1/2～L5/S1椎間孔的高、神經(jīng)根孔高、椎間孔矢狀徑、神經(jīng)根/神經(jīng)節(jié)矢狀徑、椎間隙水平中線與椎間孔后界的交點(diǎn)到出行神經(jīng)根的垂直距離、椎管內(nèi)安全三角形態(tài)、不同穿刺點(diǎn)到出行神經(jīng)根和硬膜囊/走行神經(jīng)根的距離。結(jié)果①L1/2～L5/S1 椎間孔高為(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椎間隙水平中線與椎間孔后界的交點(diǎn)到出行神經(jīng)根的垂直距離為(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管內(nèi)安全三角的底邊長為(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椎管內(nèi)安全三角的高為(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椎間盤后緣水平中線與椎弓根中心縱垂線交點(diǎn)到出口神經(jīng)根距離為(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椎間盤后緣水平中線與椎弓根中心縱垂線交點(diǎn)到硬膜囊/走行神經(jīng)根的距離為(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椎間盤后緣水平中線與椎弓根中內(nèi)1/3縱垂線交點(diǎn)到出行神經(jīng)根的距離為(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椎間盤后緣水平中線與椎弓根中內(nèi)1/3縱垂線交點(diǎn)到硬膜囊/走行神經(jīng)根的距離為(3.89±0.61)、(4.39±0.71)、(5.17±0.97)、(6.58±0.70)、(6.22±1.20)mm。結(jié)論椎間孔呈上大下小的倒梨形;椎間孔區(qū)韌帶的存在使神經(jīng)根孔高遠(yuǎn)小于椎間孔高;腰椎安全三角可拆分為“椎間孔安全三角”和“椎管內(nèi)安全三角”兩個(gè)平面三角形;椎間孔安全三角自L1/2～L5/S1可分別容許直徑為4.0、5.0、6.0、7.5、4.5mm的工作套管;椎管內(nèi)安全三角自L1/2～L5/S1可分別容許直徑為5.0、6.0、7.0、7.5、7.5mm直徑工作套管;椎間孔安全三角內(nèi)有較大風(fēng)險(xiǎn)損傷節(jié)段動(dòng)脈的背側(cè)支或背側(cè)支的分支;椎間盤后緣水平中線與椎弓根中內(nèi)1/3縱垂線交點(diǎn)可以作為椎間盤穿刺的最優(yōu)穿刺點(diǎn)。
[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 鹵2.20, 19.02 鹵1.82, 10.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵1.77 鹵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 鹵0.80, 6.42 鹵0.447.30 鹵0.827.74 鹵0.527.74 鹵0.521, 4.68 鹵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 鹵0.80 鹵0.447.30 鹵0.827.74 鹵0.521 鹵4.68 鹵1.27mm ~ (-1) L-1 / 2L ~ (5S1). The height of the safety triangle in the spinal canal is 14.32 鹵1.65 鹵1.65 鹵16.33 鹵1.67 鹵10.73 鹵1.51, 12.60 鹵2.43 and 16.20 鹵2.64mm, 14.91 鹵2.88mm, 4L1 / 2L5S 1 and 14.32 鹵1.65, 16.94 鹵3.126.96 鹵2.46, 20.87 鹵2.08mm, 20.75 鹵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 鹵0.73m, 4.14 鹵0.714 鹵0.714 鹵4.56 鹵0.88 鹵0.40 鹵0.40 鹵0.49 鹵0.49 鹵0.69 鹵0.49 鹵0.69 鹵0.49 鹵0.59mm, respectively. / the distance between the perpendicular to the posterior edge of the intervertebral disc is 4.49 鹵0.63 and 5.23 鹵0.70, 6.18 鹵0.93, 7.73 鹵0.60mm, 7.67 鹵1.00 鹵1.00 mm, 7L 1 / 2 L 5S 1 and 1 / 3 vertical perpendicular point to the transposition nerve root is 4.02 鹵0.78, 4.67 鹵0.65, 5.17 鹵0.746.16 鹵0.746.16 鹵0.746.16 鹵0.746.16 鹵0.746.16 鹵0.746.16 鹵0.74 鹵0.61 鹵5.48 鹵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 鹵0.71, 5.17 鹵0.97, 6.58 鹵0.70, 6.22 鹵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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3;R322

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