摘要
目的 经皮椎间盘切除已成为治疗腰椎间盘突出症一种成熟的方法,但仍有并发症发生。探讨经皮穿刺至椎间隙的局部解剖学特点,为提高手术质量和临床疗效提供解剖学依据。方法 对11例成人尸体的L_(3.4)、L_(4.5)和L_5S_1间隙经皮椎间盘切除的进针过程可能遇到的组织结构进行局部解剖学研究,结合临床实际提出操作时应采取的措施。结果 人体正中矢状面后侧旁开3～5cm,从皮肤到椎间隙途经皮肤、皮下脂肪、深筋膜骶棘肌外侧部、腰方肌、腰大肌和神经根下方,L_5S_1间隙有10例遇到髂骨翼。外侧途径经皮肤、皮下脂肪、深筋膜、骶棘肌中部、腰方肌、腰大肌和下位椎体的上关节突。旁开8～10cm途径皮肤、皮下脂肪、深筋膜、腹外斜肌、腹内斜肌、腹膜后方和腰大肌,有4例遇到结肠。结论 经皮椎间盘切除以正中矢状面后旁开8～10cm、进针方向与椎间隙平行且与正中矢状面成45°～60°夹角最为安全,L_5S_1间隙遇到髂骨翼时可行髂骨翼钻孔进入。
Objective To study the lateral regional anatomy of the low back from skin to the intervertebral space for improving the curative effect of the percutaneous discectomy. Methods The regional anatomy of L3.4,L4.5 and L5S1 from skin to intervertebra space was studied in 11 adult corpses. Results From the median sagittal plane the wing of ilium was met in 10 corpses in the L5S1 space. From the lateral approach, the colon was met in 4 corpses. Conclusion The optimal approach for discetomy is 8cm-10cm from the median sagittal plane, the puncture needle should be paralleled the intervertebral space and 45°-60° between the puncture needle and the median sagittal plane. If the wing of ilium is met, a hole might be drilled for the puncture needle to pass through.
