腰椎小关节穿刺的应用解剖

Applied anatomy of the arthrocentesis of lumbar facet joint

目的:研究腰椎小关节穿刺的解剖入路,供临床参考应用。方法:采用新鲜成人脊柱腰段标本35(男22、女13)例,通过横断断层解剖学方法,从横断面上对L1～2～L5～S1腰椎小关节的类型、关节角、上下关节突间距以及关节面的形态等进行观测。结果:①关节类型L1～2～L5～S1主要为上凹面型(82.6%)和平面型(17.4%),其中L5～S1有51.4%为上凹面型,48.6%为平面型;②关节角从L1～2至L5～S1腰椎关节突关节角逐渐增大,分别为26°、30°、35°、40°、45(°女性平均略大3°～5°);③关节的位置在后正中线外侧,相应的上、下腰椎棘突后缘中点之间,与后正中线的距离由上到下逐渐增加,分别为14.20、15.74、18.90、24.22、27.20mm;④穿刺要经过皮肤、浅筋膜、胸腰筋膜后层、竖脊肌、关节囊后壁。结论:腰椎小关节穿刺应根据关节的类型、关节角大小选择相应腰椎间隙中点的外14.20～27.20mm(平均20.05mm)处进行。

Objective：To investigate anatomic puncture approach of lumbar facet joints and provide references for clinical application. Methods：The joint types, joint angles,the distance between superior and inferior articular processes and the shape of articular surface of L1-2~L5-S1 were observed on 35 adult （22 men and 13 female） lumbar specimens by sectional anatomy method. Results： （1）The joints showed the type of concavity upwardly （82.6%） and the type of plane （17.4%）, in which 51.4% of L5-S1 belonged to the former type, while 48.6% to the plane type. （2） The joint angles increased gradually from L1-2 to L5-S10, formed as 26°, 30°, 35°, 40° and 45° （3°~5° higher in female） respectively. （3）Joints located on lateral side of the posterior median line, between midpoints of the posterior edge of superior and inferior lumbar spines. The distance between joints and the posterior median line were 14.20 mm, 15.74 mm, 18.90 mm, 24.22 mm and 27.20 mm from upper to lower parts. （4）Puncture needle passed through skin, superficial fascia, thoracolumber fascia, erector spinae and articular capsule respectively. Conclusions： According to the type and angle of joints, puncture position of lumbar facet joint should be laterally set on 14.20~ 27.20 mm （average 20.05mm） away from the midpoint of relevant lumbar intervertebral space.