腰骶部硬膜背部膜椎韧带的观测及其临床意义

Anatomic study and clinical significance of the dorsal meningovertebral ligaments in lumbosacral region

目的:探讨腰骶部硬膜背部膜椎韧带的性状及其临床意义。方法:取30具正常成人腰骶部防腐标本(年龄40～70岁,平均52岁),先利用内窥镜探入椎管观察硬膜背部膜椎韧带的形态,随后打开椎管,在肉眼及手术显微镜下观察韧带形态、走行方向、附着点位置及分布特点,用游标卡尺在手术显微镜下测量其长度、宽度或横径及厚度。结果:腰骶部硬膜背部膜椎韧带将硬膜连于黄韧带及椎板,黄韧带上附着点相对较多,其中以L5/S1黄韧带处出现率最高,达97%。在L5及S1、S2水平,韧带的厚度最厚。长度多变,自6.02～40.24mm都有。同一节段韧带以一束者居多,呈前上后下走行,质地较为坚韧。其形态可分为5种类型:条带型,条索型,"Y"字型,网格型,薄片型。结论:腰骶部硬膜背部与黄韧带及椎板间分布有正常连接的膜椎韧带,此韧带的分布及形态具有一定解剖特点,为减少腰椎后路手术中硬膜撕裂及硬膜外出血的发生,术中应先行辨别并予以切断。

Objective：To determine the morphology and morphometry of the dorsal meningovertebral ligaments in lumbosacral region.Method：The dorsal meningovertebral ligaments in lumbosacral region were observed endoscopicly on 30 adult embalmed cadavers（aged 40-70 years,mean 52 years）,and then the spinal canal was opened,the morphology,orientation,attachment sites and distribution of the ligaments were observed by naked eye and surgical microscope.Finally,the length,width or diameter and thickness of the ligaments under the surgical microscope were measured using vernier caliper.Result：The dorsal meningovertebral ligaments in lumbosacral region connected the dura with yellow ligament as well as lamina.The attachment points of yellow ligament were relatively more,with the maximum frequency of 97% at L5/S1.The ligaments reached their greatest thickness at L5/S1-S2.Ligaments′lengths varied from 6.02mm to 40.24mm and the orientations of the ligaments were from superoanterio to inferoposterior（dura to yellow ligament or lamina）.The shapes of ligaments were divided into five types：strip-type,cord-type,Y-shaped type,grid type and thin slice type.Conclusion：The ligaments connecting the dura and yellow ligament as well as lamina exist in dorsal lumbosacral epidural space.Inadvertent management of these ligaments has potential risk for inducing dural lacerations and epidural hemorrahage.Dissecting the meningovertebral ligaments before the discectomy may reduce postoperative cerebrospinal fluid leakage.