腰椎乳突和副突间沟穿刺入路的研究及应用

Study and application of lumbar vertebrae needle approach between the mamillary and accessory process

目的 寻求新的腰椎穿刺入路注药以便更有效地治疗腰腿痛患者。方法由腰椎X线正位片、CT片，测量椎体上缘线与同椎体上关节突外缘线相交点a，与脊突垂线的交点b，脊突下缘为C点。a—b连线的长度经等比例换算后得出旁开脊突的实际距离，同理可算出b—c离开脊突下缘的实际距离。穿刺：在C点用10cm 17号针垂直皮肤进针遇骨质韧带即到a点，穿过此韧带再进针即到腰椎间外孔。120例病人随机分为A，B两组。A组行新入路穿刺，B组行腰硬膜外穿刺，注入相同疼痛复合液。观察穿刺点旁开脊突的距离，皮到腰椎乳突和副突间沟的距离和到腰椎间外孔的距离。并比较A、B两组的治疗效果、副作用。结果穿刺点旁开脊突的距离（cm）男女分别为第3腰椎（L3）：2．2±1．2、2.0±1.1，第4腰椎（L4）：2.5±1．3、2.4±1.2；皮至4间沟的显巨离（cm）为L3：3．5±1.1、3．2±1．2，L4：3．5±2．3、3．2±2.1；皮到腰椎间外孔的距离（cm）为L3：4.5±2．3、4.2±1.2，L4：5．5±2、2、5.2±2．5。A、B两组的治疗效果比较，差异无统计学意义（P〉0．05）。A、B两组副作用发生率差异有统计学意义（P〈0．05）。结论腰椎乳突和副突间沟穿刺准确、设计合理、可到达腰椎间外孔和腰神经后支经过的部位，使药物有效地集中在受损神经部位。

Objective To treat lumbo -leg pain effectively by searching for new lumbar puncture approach. Methods By the entopic X - Ray films of lumbar vertebrae, we surveyed the intersection of the upper limb line and the outer line of the superior articular processes of the vertebrae body ＂a＂, and the intersection of the upper limb line with the vertical line of spinous process ＂b＂, then the bottom point of spinous is called ＂c＂. The length from ＂a＂ to ＂b＂ , both actual distance of depart by processus spiuous, can be derived by equal proportion conversion,by the same way we can derived the length of b- c. Puncture take ＂a＂ as the transpedicular entry point,when the 7th acupuncture needle, 10 cm long, reached the bone ligament,that was the case of ＂a＂ point, pass through and the needle reached foraminal. One hundred twenty cases of the patients were randomly divided into group A and B,group A punctured by new approach,group B punctured by lumbar epidural puncture, and two groups were injected the same pain compound liquid. And then we observed the distance from the puncture points to the processus spinous and the distance from skin to lumbar vertebrae fossa of between mamillary process and accessory process, and to lumbar extra foraminal. We also compared the therapeutic effect and the side effect of the two groups. Results The distance from the point of puncture to the processus spinous of the male and the female were ： lumbar 3 （ L3 ） 2.2 ±1.2,2.0 ± 1.1 ; L4 2.5 ± 1.3,2.4 ± 1.2 ,from skin to fossa L3 3.5 ± 1. 1,3.2 ± 1.2 ;L4 3.5±2.3,3.2 ±2. 1, from skin to lumbar extra foraminal： L3 4.5 ± 2.3,4. 2 ± 1. 2, L4 5. 5 ± 2. 2,5. 2±2. 5. The therapeutic effects had no significantly different in group A and B （ P 〉 0.05）. The incidence rates of side effects in the above two groups were significantly different （ P 〈 0.05 ）. Conclusion Lumbar vertebrae needle approach between the mamillary and accessory process is accurate, reasonable designed, can reach lumbar extra foraminal and the part passed by lumbar dorsal rami nerve, and let the drug effectively concentrated in the part of the damaged nerve.