腰椎间盘镜术定位的基础研究与临床应用

Anatomical study and clinical application of the orientation in microendoscopy discectomy.

目的研究国人腰椎间盘镜的最佳穿刺点及其在扩大腰椎间盘镜术适应证的作用。方法CT测量成年男、女各25例L4、L5椎体下缘水平腰椎管横径及棘突中线至侧隐窝的距离，结合临床研究确定最佳穿刺点，应用腰椎间盘镜治疗单纯腰椎间盘突出症218例，腰椎间盘突出合并局限性椎管狭窄86例，中央型腰椎间盘突出症28例，青少年腰椎间盘突出症33例。结果L4、L5腰椎管横径及棘突中线至侧隐窝的距离男、女间差异无显著意义（P〉0．05）。男、女两组合并，50例的测量结果L4、L5腰椎管横径分别为（21．82±1．59）mm、（24．68±1．72）mm；L4、L5棘突中线至侧隐窝的距离分别为（10．91±0．79）mm、（12．31±0．84）mm。治疗单纯型、合并局限性椎管狭窄、中央型及青少年型腰椎间盘突出症的优良率分别达到92．2％、89．5％、92．8％、96．9％。结论国人腰椎椎管测量值有别于其他人种，国人腰椎间盘镜穿刺点应为棘突中线旁10mm。准确的穿刺定位在扩大腰椎间盘镜术适应证、保证疗效有重要作用。

Objective To investigate the appropriate puncture site in microendoscopy discectomy and its clinical significance in expanding the surgical indication. Methods 50 multislice spiral CT scanning images of 25 male and 25 female adult subjects were selected as samples. Transverse diameters of the lumbar spinal canal and the diameters from median spinous process to lateral recess on the inferior border of IA and L5 were measured .The appropriate puncture site was established according to the clinical research and microendoscopy discectomy was used in 218 cases of lumbar disc herniation, 86 cases of lumbar disc herniation with limited spinal stenosis, 28 cases of central lumbar disc herniation and 55 cases of adolescent lumbar disc herniation respectively. Results There was no significant difference between the male group and female group （p〉0.05）. The transverse diameters of the lumbar spinal canal on IA and L5 were （21.82±1.59） mm, （24.68± 1.72）mm respectively. The diameters from median spinous process to lateral recess on IA and L5 were （10.91± 0.79）mm,（12.31± 0.84）mm respectively. The excellent and good rates of clinical treatment in 4 groups were 92.2% ,89.5% .92.8% ,96.9% respectively. Conclusion The lumbar spinal canal data of Chinese differ from those of other populations. The appropriate puncture site in microendoscopy discectomy for Chinese should be 10ram apart from median spinous process ,and has important significance in expanding the surgical indication and successful therapic result.