单枚融合器行经椎间孔腰椎椎体间融合的解剖学观测

Anatomical observation of transforaminal lumbar interbody fusion using single anatomical threaded cage insertion

背景：有部分学者认为,与经椎间孔腰椎椎体间融合技术相关的手术器械是按照西方人体格设计,和国人体格存在一定的差异,甚至融合物难以置入,所以探讨相关的解剖技术就显得很有必要。目的：测量腰椎椎间孔及与经椎间孔腰椎椎体间融合相关的解剖参数。方法：对14具正常成人尸体脊柱腰段椎间孔宽度、长度、高度进行了观测;对腰椎各结构与后正中矢状面的距离进行了观测。结果与结论：结果表明腰段（L1-L5）椎间孔宽度逐渐变小;L1-L4椎间孔高度逐渐增大,L5略小于L4,L1-L5高度均明显大于其宽度（P〈0.01）;L1-L5椎间孔长度逐渐增大（P〈0.05）。L1至L5椎板峡部宽、下关节突最外侧缘至后正中矢状面距离逐渐增大,其性别间、左右间差异均无显著性意义（P〉0.05）。结果表明国人经椎间孔入路能满足高度9-14mm单枚椎间融合器斜向置入,单枚椎间融合器置入不会因牵拉硬膜囊和神经根而导致脊髓与神经根损伤。

BACKGROUND：The surgical instruments of transforaminal lumbar interbody fusion（TLIF）have been shown to be designed according to the body of the Western.Therefore,it is necessary to explore the related anatomy technique.OBJECTIVE：To measure the lumbar intervertebral foramen and the anatomical data associated with TLIF.METHODS：Intervertebral foramen width,length,and height of 14 normal adult cadavers lumbar spine were observed;the distance from structure of the lumbar spine to the midst sagittal plane from L3 to L5 was measured as well.RESULTS AND CONCLUSION：Lumbar intervertebral foramen width gradually become smaller from L1 to L5;the height was gradually increased from L1 to L4,and L5 was slightly smaller than L4;the height was significantly greater than the width from L1 to L5（P 0.01）;the length of intervertebral foramen was gradually increased from L1 to L5 as well（P 0.05）.The distance from the lateral margin of the pars interarticularis to the midst sagittal plane from L3 to L5 was gradually increased,and the distance from inferior articular process to the midst sagittal plane from L3 to L5 was increased as well.There was no significant difference in gender or two sides（P 0.05）.Results showed that 9-14 mm single posterolateral threaded fusion cage can be inserted by intervertebral foramen approach in Chinese.Single cage implant do not pull dura or nerve roots,thereby preventing spinal cord and nerve root injury.