经皮穿刺髓核切除术的入路应用解剖学研究

Applied anatomy of percutaneous nucleotomy

目的：对L4～L5，L5～S1椎间盘经皮穿刺髓核切除术有效无伤害进针的角度、深度、距腹腔血管距离、与神经根途径关系及距离进行了解剖学观察和测量。方法：在7具成人尸体进行L4～L5，L5～S1椎间盘进行模拟经皮穿刺髓核穿刺和解剖学观察和测量，同时以测量结果对50例腰椎间盘突出症经皮穿刺髓核切除X光荧光屏临床观察。结果：表明L4～L5椎间盘穿刺点为旁开后正中线8～12cm，与正中矢状面夹角为45度～60度，深度11～13cm；L5～S1椎间盘进针距后正中线6～8cm，进针方向与矢状面呈25～30度，与水平面呈15～20度，深度8～10cm为最佳进针。结论：上述结果在对50例腰椎间盘突出症经皮穿刺髓核切除X光荧光屏临床观察为有效和无伤害的。

The angles, the depths, the distances of the puncturing needle from spinal nerve roots and common iliac blood vessels were investigated and measured in L4～L5, L5～S1 intervestebral disc. Methods: The anatomical percutanous nucleotmp of L4～L5,L5～S1 intervestebral disc were operated in 7 cases. Meanwhile we have observed clinically in 50 cases' herniations of L4～L5、15～S1 nucleus pulpous operated according to the results under TV screen of X rays. Results: L4～L5 disc, the best puncturing skin points are 8-12 cm from poster median line, the angles are 45°- 60°with vertical plane, the depths are 11-13cm. L5～S1 disc puncting skin points are 6-8cm from poster median line, the ang les are 30° with vertical plane and 15°-20°with horizontal plane,the depths are 8-10cm. Conclusion:We treated 50 cases' herniations of L4～L5、L5～S1 nucleus pulpous according to above measures. The results shown no injure and efficacy.