椎板侧方入路治疗极外侧腰椎间盘突出症的解剖及临床应用

Applied anatomical and clinical application of the lateral approach to the vertebral lamina for treating extreme lateral lumber dsic herniation

[目的]通过对后正中经椎板侧方手术入路局部解剖结构的观测，探讨该入路治疗极外侧腰椎间盘突出症的临床疗效及注意事项。[方法]20具经防腐固定的成人尸体标本，观测横突间韧带厚度、前后方血管分布规律、腰神经前支与矢状面夹角、椎弓峡部侧缘及横突基底部副突处距腰神经前支距离。自2004年1月～2006年1月，收治极外侧腰椎间盘突出症12例，其中7例采用后正中经椎板侧方手术入路治疗，5例采用后正中经椎板侧方联合经椎管内手术入路治疗。[结果]L3～S1横突间韧带厚度为0．6～1．3mm；腰节段动脉前支及其伴行静脉90％以上位于横突间韧带腹侧上1／2处，横突间韧带背侧中1／3内侧缘处有一恒定腰节段动脉分支穿出；腰神经前支出椎间孔后与矢状面夹角为18．9°～39．2°；副突及峡部侧缘距腰神经前支距离分别为5．6～8.0mm、1．7～3．6mm。12例病人均取得随访，随访时间3～20个月，平均10个月。根据Nakal分级：优8例，良3例，总优良率91．67％。[结论]横突间韧带为后正中经椎板侧方手术入路中重要的解剖学标志，熟悉其应用解剖对于手术治疗极外侧腰椎间盘突出症具有重要指导意义。应用后正中经椎板侧方手术入路治疗极外侧腰椎间盘突出症创伤小，术后效果好，是一种安全有效的手术方法。

[ Objective] To provide microsurgery anatomical data for the surgical operation in treating of extreme lateral lumbar dsic herniation through the observations of the regional anatomic structure about the post-median approach tolateral vetebral lamina （PMALVL） . [ Method] Thicknesses of intertransverse ligament, the distribution of anterior branches of lumbar nerve and vessel were measured at the adult cadavas specimens. Retrospectively analyzed with 12 cases of extreme lateral lumbar disc herniation from January 2004 to January 2006, including 7 cases were treated by the lateral approach to the vertebral lamina, 5 cases treated by PMALVL. [ Result] The thickness of intertransverse lingament is 0. 6 - 1.3 mm. More than 90 percent of anterior branches of lumbar segmental arteries and the accompanying veins from L3 to S1 were located ventrally in the superior portion of the intertransverse ligament. A branch from Lumbar artery permanently locates in the hfiddle of post-lateral intertrans- verse ligament. The angle between the anterior branch of Lumbar nerve root and midline sagittal plane is 18.9° - 39. 2°. The distance from the root of the tranverse to the anterior branch of lumbar nerve root and from the lateral margin of the pars interarticul aris to the anterior branch of lumbar nerve root （5.6 - 8.0） mm and （ 1.7 - 3. 6） mm respectively. The period of follow up in 12 cases was from 3 months to 24 months, with an average of 10 months. The resultwas excellentin 8 cases, good in 3 cases, total fine rate according the classification of Nakal was 91.67%. [ Conclusion ] Intertransvarse ligament is a reliable landmark for PMALVL and treating extreme lateral lumbar disc herniation through PMALVL may get microtraumatic and excellent effect.